Challenges in Teaching Anatomy in Sub-saharan Africa: A National Survey of Educator Experiences in Uganda

Challenges in Teaching Anatomy in Sub-saharan Africa: A National Survey of Educator Experiences in Uganda | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Challenges in Teaching Anatomy in Sub-saharan Africa: A National Survey of Educator Experiences in Uganda Johnson Nyeko Oloya, Fred Gendi, Frida Chebet, Rogers Muhozi, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8235223/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 12 You are reading this latest preprint version Abstract Anatomy education remains a cornerstone of medical training, providing the foundational knowledge required for clinical practice and biomedical sciences. This study reports findings from a national survey conducted among anatomy educators across Ugandan medical schools, encompassing both public and private universities. Responses were analyzed to capture the demographic profile of educators, their teaching modalities, institutional responsibilities, and the barriers they encounter in delivering effective instruction. The survey revealed persistent challenges including under-staffing of anatomy departments, shortages of cadavers for dissection, overcrowded teaching laboratories, and limited access to professional development opportunities. Inadequate remuneration and insufficient institutional support further compound these difficulties, threatening the sustainability of anatomy education. Despite these constraints, educators demonstrated resilience and innovation. Many reported adopting hybrid teaching strategies that combine traditional dissection with digital resources, online platforms, and problem-based learning approaches. Faculty members also expressed strong advocacy for systemic reforms, emphasizing the need for coordinated national policies, strategic investment in teaching resources, and collaborative faculty development programs. These efforts reflect a commitment to maintaining the integrity and quality of anatomy education in Uganda, even under resource-limited conditions. The findings underscore the urgent need for government, universities, and professional bodies to prioritize anatomy education through policy reform, infrastructure development, and faculty support. Strengthening anatomy teaching will not only enhance medical education but also ensure the production of competent health professionals capable of addressing Uganda’s healthcare challenges. Challenges in Anatomy teaching Cadaver shortages Teaching modalities Professional development Policy reform Uganda Figures Figure 1 1.0 Introduction Human anatomy remains a foundational pillar of medical education, underpinning clinical reasoning, diagnostic acumen, and surgical competence across health professions. Its mastery is essential for understanding the structure-function relationships of the human body, and for developing the spatial awareness required in clinical practice ((Drake et al., 2009 ; M. Estai & S. Bunt, 2016 ). Globally, cadaveric dissection has long been considered the gold standard for anatomy instruction, offering tactile, visual, and emotional engagement that fosters professional identity and empathy (Aziz et al., 2002 ; Kwon et al., 2025 ). In Uganda, anatomy education is delivered across a growing number of public and private medical institutions, including Makerere University, amongst others. However, the quality and consistency of instruction vary widely due to disparities in institutional capacity, resource availability, and faculty development (Atupele Mwabaleke et al., 2023 ). Many institutions face infrastructural limitations such as overcrowded dissection rooms, inadequate cadaver supply, and poor preservation techniques, which compromise the fidelity and integrity of experiential learning (Ndyamuhakyi, Michael, et al., 2024). Cultural attitudes toward cadaveric dissection further complicate anatomy education in Uganda. The absence of a formal body donation policy has led to reliance on unclaimed bodies, often of poor tissue and microbial integrity, raising ethical and pedagogical concerns (Ndyamuhakyi, Usman, et al., 2024 ). Students and educators alike report emotional discomfort, spiritual conflict, and societal stigma surrounding dissection practices, which hinder engagement and learning outcomes (Kwon et al., 2025 ) Pedagogically, Ugandan anatomy educators are increasingly adopting hybrid approaches that blend traditional lectures with digital resources, including YouTube videos and virtual simulations. Yet, access to these tools is constrained by poor internet connectivity, limited institutional investment, and lack of training in modern educational technologies (Nabirye et al., 2023 ). The shift toward learner-centered methods is further challenged by high student-to-teacher ratios, limited time for revision, and information overload, factors that contribute to student disengagement and academic stress (Atupele Mwabaleke et al., 2023 ) This study presents findings from a national survey of anatomy educators, aiming to document professional realities, identify common constraints, and inform policy and pedagogical reforms that can enhance the quality, sustainability and effectiveness of anatomy teaching in Uganda. 2.0 Methodology 2.1 Study Design This study employed a cross-sectional descriptive survey design to explore the professional experiences, pedagogical practices, and institutional challenges faced by anatomy educators in Ugandan medical schools. The design was selected for its appropriateness in capturing a snapshot into educator realities across diverse institutional contexts. 2.2 Ethical Considerations This study adhered to the principles of the Declaration of Helsinki, ensuring respect, integrity, and anonymity throughout. It received approval of AAU Research and Ethics Committee. Informed consent was embedded in the survey tool, highlighting voluntary participation, withdrawal rights, and confidentiality. Only participants who clicked “Agree” proceeded; no personal identifiers were collected, and responses were securely encrypted. 2.3 Sampling and Recruitment Participants were recruited using voluntary purposive sampling, targeting anatomy educators affiliated to accredited Ugandan medical schools. Recruitment was facilitated through professional networks, institutional contacts, and academic forums. Eligibility criteria included current involvement in teaching of human anatomy at undergraduate or postgraduate level. The survey was carried out between September 13 and September 25, 2025. The sample included educators from both public and private universities, representing a range of academic ranks from teaching assistants to professors), teaching experience, and institutional contexts. While modest in size, the sample provided rich, multi-institutional insights into the anatomy education landscape in Uganda. 2.4 Data Collection Data was collected using an online survey tool, distributed through emails, WhatsApp groups, and direct reach out to department heads. The instrument was designed to be mobile-friendly and accessible across devices, minimizing barriers to participation. The survey remained open for a two-week period, allowing flexibility for respondents. The survey captured both: Quantitative data: Age, gender, academic qualifications, teaching experience, employment status, disciplines taught, and challenges faced. Qualitative data: Open-ended reflections on teaching practices, institutional support, emotional engagement, and recommendations for reform. 2.5 Data Analysis Quantitative data analysis was conducted using descriptive statistics in R and STATA. Frequency and percentages were calculated to summarize demographic profiles, teaching roles, and reported challenges. These statistics were systematically tabulated to identify patterns across institutions and educator categories. Qualitative data were analyzed using inductive thematic analysis (Byrne, 2022 ). Responses were manually coded, with emergent themes grouped into categories such as infrastructural constraints, pedagogical adaptation, emotional engagement, and policy recommendations. Attention was given to semantic content, emotional tone, and cultural nuance, ensuring that educators’ voices were authentically represented. Triangulation was achieved by cross-referencing quantitative trends with qualitative narratives, enhancing the credibility and depth of findings. Reflexivity was maintained throughout the analysis, with the researcher’s acknowledging positionality and potential interpretive bias. 3.0 Results 3.1 Demographic and Academic Profile The survey captured responses from anatomy educators across 14 medical schools in Uganda. Participants ranged in age from 25 to 60 years, with the majority (61%) falling within the 31–50 age bracket. Gender distribution was predominantly male (78%), and most respondents were Ugandan nationals (94%). 3.2 Practices of Anatomy Educators 3.3 Challenges experienced by Anatomy Educators Survey findings revealed a range of instructional, infrastructural, and professional challenges encountered by anatomy educators. The most frequently reported issues were limited opportunities for staff development and overcrowding in dissection rooms, indicating widespread concern about both faculty growth and physical learning environments as indicated in Table 1 below. Table 1 showing the challenges of teaching anatomy Challenge % of Respondents Limited opportunity for staff development 71.4% Crowding in the dissection room 71.4% Cadaver shortages 57.1% Poor cadaver quality / unfit dissection rooms 50.0% Understaffing 50.0% Inadequate remuneration 42.9% Poor student attitude toward cadaver dissection 28.6% 3.4 Reflections from study participants Open-ended responses revealed a shared desire for institutional and national support to strengthen anatomy education in Uganda. Educators articulated a vision for reform that encompasses policy, professional development, collaboration, and scholarly engagement. Four key themes emerged: 3.4.1 Theme 1. Government Support for Cadaver Acquisition and Regulatory Frameworks Educators consistently emphasized the need for a formalized, ethical, and accessible cadaver acquisition system. The absence of a national body donation policy and reliance on unclaimed bodies were cited as major impediments to effective dissection-based learning. Government should help private universities and institutions to acquire cadavers easily and possibly with no costs. This sentiment reflects a broader call for regulatory clarity and logistical support to ensure equitable access to anatomical resources across institutions. 3.4.2 Theme 2. Structured Career Development Pathways and Occupational Allowances Respondents expressed concern over limited opportunities for promotion, inadequate remuneration, and the absence of clear career trajectories for anatomy educators. These constraints were seen as demotivating and detrimental to faculty retention. I would like to have a clear career development path, standard remuneration for my service, and occupational allowance where possible. Such reflections underscore the need for institutional policies that recognize and reward the specialized contributions of anatomy faculty. 3.4.3 Theme 3. Engagement with Professional Associations Several educators advocated for stronger ties with national and international professional bodies, such as the Association of Anatomists of Uganda (AAU) and the International Federation of Associations of Anatomists (IFAA). These affiliations were viewed as avenues for networking, advocacy, and professional growth. The need to embrace the professional associations is crucial; AAU and IFAA. This theme highlights the importance of collective identity and institutional legitimacy in advancing the discipline of anatomy. 3.4.4 Theme 4. Collaborative Research Opportunities and Scholarly Platforms Respondents called for increased support for research in anatomy education, including joint grant applications, inter-institutional collaborations, and the creation of a national journal to showcase Ugandan scholarship. I think to improve peer collaboration—e.g., joint research ventures with anatomists in different Ugandan institutions, creation of research grant opportunities, and perhaps creation of a journal by Ugandan anatomists. This vision reflects a desire to elevate anatomy education through evidence-based practice and scholarly dissemination. Together, these reflections underscore the educators’ commitment to reform and their aspiration for a more sustainable, equitable, and professionally rewarding anatomy education system. The voices offer a compelling foundation for policy advocacy, institutional investment, and collaborative transformation. 4.0 Discussion Anatomists occupy a foundational position in medical education, serving as the custodians of human structural knowledge and facilitators of professional formation. Their contributions span pedagogy, curriculum development, clinical integration, and ethical stewardship, making them indispensable to the training of competent and compassionate health professionals. 4.1 Cadaveric Dissection and role of Anatomist Traditionally, anatomists are responsible for teaching core subjects such as gross anatomy, histology, embryology, and cell biology. These disciplines form the bedrock of biomedical understanding, enabling students to interpret clinical signs, perform procedures, and appreciate the spatial relationships within the human body (Turney, 2007 ). Cadaveric dissection, often facilitated by anatomists, remains a powerful pedagogical tool that fosters manual dexterity, spatial reasoning, and emotional maturity (Arráez-Aybar et al., 2008 ). Dissection is usual the first encounter medical students have with human mortality, positioning anatomists as guides through both technical and emotional terrain. Beyond the classroom, anatomists increasingly contribute to curriculum reform, educational technology, and interdisciplinary teaching. They play a critical role in integrating anatomy with radiology, surgery, and pathology, ensuring that structural knowledge remains clinically relevant (Mohamed Estai & Stuart Bunt, 2016). In many institutions, anatomists are involved in developing competency-based curricula, designing assessments, and mentoring junior faculty. Their expertise also extends to simulation-based education, virtual anatomy platforms, and ultrasound-guided procedural training (Iwanaga et al., 2021 ) However, this study reveals a complex and evolving anatomy education landscape in Uganda, shaped by infrastructural constraints, critical human resource deficits, pedagogical adaptation, and institutional diversity. Across surveyed institutions, educators highlighted persistent challenges of cadaver shortages, overcrowded dissection rooms, understaffing, and inadequate facilities that reflect systemic underinvestment in foundational sciences. These limitations not only restrict hands-on learning but also erode the emotional and sensory engagement that cadaveric dissection uniquely fosters. The tactile experience of dissection, its textures, spatial depth, and visceral reality offer irreplaceable insights into anatomical relationships that digital or illustrative alternatives struggle to replicate(McLachlan & Patten, 2006 ). Beyond technical comprehension, cadaveric dissection cultivates a profound sense of respect, empathy, and professional identity among students, anchoring their transition from theoretical learners to compassionate practitioners. 4.2 Ethical Cadaver Acquisition for Medical Acquisition This study reveals that medical schools in Uganda are experiencing persistent cadaver shortages, largely stemming from how bodies are obtained. Institutions predominantly rely on unclaimed bodies, typically sourced from hospital mortuaries. This practice, while common in many low-resource settings, raises significant ethical and legal concerns. Habicht et al. ( 2018 ) reported that only 22 of 68 countries rely exclusively on body donation, while the remainder depend on unclaimed bodies, a method increasingly scrutinized for its lack of transparency and ethical safeguards (Habicht et al., 2018 ). The use of unclaimed bodies presents several challenges. First, preservation quality is often poor due to limited infrastructure, inadequate embalming protocols, and prolonged storage without refrigeration. Second, the quantity of cadavers is insufficient to meet the demands of expanding student populations and mushrooming private and public medical schools. In some institutions, up to 20–25 students share a single cadaver, severely limiting hands-on learning. This dependency on unclaimed bodies reflects the absence of a national body donation framework, making public engagement and voluntary donation extremely difficult. Globally, countries with structured body donation programs offer valuable models for ethical anatomical education. These frameworks emphasize transparency, legal safeguards, and sustained public engagement, the principles that remain underdeveloped in Uganda’s current cadaver acquisition practices. Voluntary body donation is widely regarded as the ethical gold standard for body acquisition for medical education, emphasizing informed consent, dignity, and public trust (International Federation of Associations of, 2012). In South Africa, institutions such as the University of Cape Town have implemented transparent consent protocols and public awareness campaigns that normalize voluntary body donation and reduce reliance on unclaimed bodies. (Billings et al., 2024 ) highlight how ethical sourcing of cadavers, grounded in informed consent and community education, has reshaped anatomical practice and enhanced public trust in medical institutions. India offers another instructive example through its Anatomy Act, which mandates documentation, informed consent, and respectful handling of donated bodies. Susai et al ( 2023 ) describes how the Act provides a legal framework that balances educational needs with human dignity, ensuring that cadaveric material is acquired and used under regulated conditions (Susai et al., 2023 ). The Act also empowers institutions to engage with donors and families transparently, fostering a culture of voluntary donation and ethical anatomical education. These international models demonstrate that ethical cadaver acquisition is achievable through coordinated legal frameworks, public education, and institutional accountability. Uganda’s anatomy education system would benefit from adopting similar reforms, including the establishment of a national body donation program and public engagement strategies that promote informed consent and community trust. These limitations have direct pedagogical consequences. Poorly preserved cadaver’s obscure anatomical landmarks, distort tissue color and texture, and hinder students’ ability to appreciate spatial relationships. Overcrowding further reduces hands-on engagement, limiting each student’s opportunity to explore and internalize anatomical structures. Moreover, the emotional toll of working with decomposed or ambiguous specimens can be distressing, leading some students to disengage or withdraw from dissection sessions altogether. A recent qualitative study we conducted at Makerere University revealed that students dropped out of cadaver dissection due to the poor preservation state, inability to identify key structures, and the disturbing condition of decomposing bodies (Oloya et al., 2025 ). 4.3 Digital Transition and Blended Learning in Anatomy Education Cadaver quality and safe laboratory environments are essential for sustaining meaningful anatomical education, particularly in resource-constrained settings where poor preservation and reliance on unclaimed bodies can undermine both learning and safety (Gangata et al., 2010 )In response to these challenges, anatomy educators increasingly supplement cadaveric teaching with digital resources, including online dissection videos, 3D models, and virtual anatomy platforms. This study reveals that educators often refer students to online videos for clarification when they struggle to identify structures on poorly preserved cadavers. However, in low-resource environments, internet connectivity issues and subscription costs frequently limit access to these digital tools (Nabirye et al., 2023 ) While hybrid instruction offers promise, studies such as McLachlan and Patten ( 2006 ) caution that digital alternatives may fall short of replicating the emotional depth, tactile realism, and professional formation fostered by traditional dissection. The absence of physical engagement with human tissue can reduce students’ spatial understanding, emotional resilience, and sense of clinical responsibility, an element that is critical in shaping competent and empathetic practitioners. Concerns about balancing pedagogical effectiveness with occupational health risks particularly those linked to formalin exposure have led some institutions to reduce laboratory time or seek safer alternatives. This study reveals that some anatomy educators actively avoid dissection rooms due to fears of health complications associated with formalin. Formaldehyde, the active ingredient in formalin, is a volatile compound widely used to preserve cadavers. However, prolonged exposure has been linked to serious health risks, including respiratory irritation, allergic reactions, and increased cancer risk. The International Agency for Research on Cancer (IARC) classifies formaldehyde as a Group 1 human carcinogen, associated with nasopharyngeal cancer and possibly leukemia (Protano et al., 2021 ). Adamović et al. ( 2021 ) reported that cancer risk levels for anatomy staff exposed to formaldehyde in Serbian laboratories were several thousand times higher than the threshold recommended by the U.S. Environmental Protection Agency (EPA), underscoring the urgency of improving ventilation, exposure monitoring, and protective measures (Adamović et al., 2021 ). Given these risks, institutions should consider establishing health insurance schemes that specifically cover occupational hazards related to prolonged formaldehyde exposure. Such provisions would not only protect anatomy staff but also encourage sustained engagement in cadaveric teaching, which remains central to medical education. Globally, curricular reform in anatomy education has accelerated due to growing concerns over formalin exposure, cadaver shortages, and the emotional toll associated with dissection. These pressures have led many institutions to adopt virtual modalities. Drake et al. ( 2009 ) documented the rise of virtual microscopy and the reduction of laboratory hours in embryology and gross anatomy, urging educators to balance technological innovation with experiential depth. Such reforms reflect a broader pedagogical shift toward blended learning, which integrates digital tools with traditional methods to enhance educational outcomes (Drake et al., 2009 ). In Uganda, however, this transition remains uneven. Faculty development in educational technology is limited, and digital infrastructure including reliable internet access, hardware availability, and institutional support is often inadequate. Nabirye et al. ( 2023 ) observed that students increasingly rely on online dissection videos and illustrated texts to compensate for poorly preserved cadavers yet face significant barriers such as subscription costs and unstable connectivity (Nabirye et al., 2023 ). These challenges highlight the urgent need for targeted investment in faculty training, infrastructure upgrades, and the development of locally adaptable digital resources to ensure equitable access to high-quality anatomy education. 4.4 Staffing Shortages and Their Impact on Anatomy Education Understaffing within anatomy departments was consistently reported across all surveyed medical schools in this study. This constraint has compelled educators to adopt alternative teaching modalities—including digital resources, peer-led instruction, and self-directed learning to safeguard against burnout and stress. These adaptations, while resourceful, are frequently reactive rather than strategic, and may compromise the depth and consistency of anatomical instruction. The staffing shortage is particularly concerning when viewed against national benchmarks. According to Schedule 4 of Statutory Instrument No. 80 of 2005, as referenced in the 2014 National Council for Higher Education (NCHE) Quality Assurance Framework, the ideal instructor-to-student ratio for basic sciences such as Medicine, Veterinary Medicine, and Pharmacy is 1:8. Ratios exceeding 1:26 are deemed unacceptable (Kasozi, 2017 ) as they compromise instructional quality, supervision, and safety especially in practical settings such as anatomy laboratories, where close guidance and oversight are essential In anatomy education, this standard is especially critical. Cadaveric dissection requires close supervision not only to ensure technical accuracy and pedagogical effectiveness, but also to maintain occupational safety and support students’ emotional adaptation when encountering human remains. When staffing falls below acceptable thresholds, educators are unable to provide the individualized guidance and psychological scaffolding that dissection demands, potentially undermining both learning outcomes and professional identity formation. Compounding this challenge is the growing difficulty in attracting professionals into the anatomy discipline. Globally, the intellectual appeal of gross anatomy has waned in comparison to emerging biomedical fields such as molecular biology and genetics, which often receive greater research funding and institutional prioritization. Gunderman and Wilson ( 2005 ) observed that anatomy departments have been downsized or closed in several institutions, resulting in fewer anatomists available to teach (Gunderman & Wilson, 2005 ). In Uganda, this trend is further exacerbated by the limited employability of anatomists within the broader medical sector. For many, medical schools remain the sole avenue for formal employment, even though anatomists possess valuable expertise that could support a range of clinical and forensic services. With appropriate policy recognition, anatomists could be meaningfully integrated into hospital-based teams alongside pathologists, contributing to dissections, tissue harvesting, and the management of deceased individuals in mortuaries. Their expertise is also highly relevant in the transplant sector, where precision in anatomical knowledge is critical for organ retrieval, preservation, and surgical planning. Furthermore, anatomists possess valuable skills that can be applied in research centers, particularly in areas such as morphometric analysis, comparative anatomy, developmental biology, and forensic science. Their involvement in multidisciplinary research teams would enrich biomedical investigations and strengthen the academic output of institutions. To address these gaps, the establishment of a Department of Clinical Anatomy under the Ministry of Health would be a transformative step. Such a department could formally integrate anatomists into hospital-based clinical and research teams. It would also provide a platform for professional certification, career advancement, and intersectoral collaboration, bridging the divide between academic anatomy and applied medical practice. By institutionalizing the clinical relevance of anatomy, this reform would not only expand employment opportunities but also elevate the discipline’s visibility, utility, and strategic value within Uganda’s health system. However, the absence of structured career pathways and institutional frameworks to support such roles has led to widespread underutilization of this workforce, further discouraging entry into the field. This study found that many anatomists do not see a viable future in anatomical practice. The lack of career growth, promotion structures, and professional development opportunities was consistently cited by respondents as a major concern. In anatomy education, this dynamic is particularly acute. Educators face mounting pressure to deliver high-quality instruction despite limited access to cadaveric materials, digital infrastructure, and continuing education. The absence of institutional recognition and strategic career planning leaves anatomists professionally isolated, undervalued, and vulnerable to burnout. While Ministries of Education (MOEs) emphasize regulation, accreditation, and compliance with national standards, they often overlook the foundational investments required to sustain educational quality such as faculty recruitment, workload redistribution, and long-term career development support. These include structured mentorship, protected time for professional growth, incentives for scholarly engagement, and clear career progression pathways. Without these structural commitments, departments are left to navigate increasing demands with limited personnel, outdated infrastructure, and minimal professional growth opportunities. Globally, the literature affirms the pivotal role of faculty development in maintaining and advancing anatomy education. Drake et al. ( 2009 ) emphasized that curricular reform particularly the shift toward integrated and multimodal delivery must be matched by deliberate investment in educator capacity. This includes training in pedagogical methods, digital literacy, curriculum design, and assessment strategies. As anatomy instruction evolves to include virtual platforms, problem-based learning, and interdisciplinary integration, educators must be equipped not only with content expertise but also with the skills to adapt and innovate. Without such support, faculty may struggle to meet evolving pedagogical demands, widening the gap between institutional expectations and educator preparedness. This disconnect can lead to inconsistent instructional quality, reduced student engagement, and diminished learning outcomes. In anatomy education, where tactile experience, emotional resilience, and spatial reasoning are central to professional formation, underprepared faculty may inadvertently compromise the depth and integrity of the learning process. To address these challenges, a dedicated committee within the National Council for Higher Education (NCHE) should be established to monitor and regulate the quality of anatomy teaching across institutions. Such a team would be tasked with identifying systemic gaps, evaluating instructional standards, and responding to the unique challenges faced by anatomy educators. This oversight mechanism would promote accountability, foster continuous improvement, and ensure that anatomy education remains aligned with national health workforce goals. 4.5 Professional Governance and Strategic Support for Anatomists These findings highlight the urgent need for national frameworks and institutional policies that prioritize faculty development as a strategic investment. For anatomy educators, this support is not only essential for sustaining teaching excellence but also for restoring professional dignity and ensuring long-term retention in the field. The absence of a formal regulatory body for anatomists in Uganda compounds these challenges. The practice of anatomists and professionals involved in the handling of deceased individuals remains unregulated, leaving critical gaps in oversight, accountability, and career development. Respondents in this study emphasized the need to establish a national body such as an Anatomical Society of Uganda to address the current lack of professional governance. Such an organization would be responsible for: Registering and licensing anatomists, ensuring professional standards and ethical compliance. Establishing clear career ranks and promotion pathways, supporting long-term growth and retention. Supervising clinical anatomy services and mortuary operations within hospitals, enhancing safety and quality. Coordinating public education initiatives on ethical body donation, fostering transparency and community trust. Acting as a national mouthpiece for anatomists, advocating for their interests in policy and institutional forums. Regulating the handling of human remains by private organizations, ensuring ethical practices, legal compliance, and public accountability. This regulatory framework would not only elevate the status of anatomists but also strengthen their integration into clinical, forensic, and research teams. It would provide a structured platform for advocacy, professional development, and institutional recognition ensuring that anatomy remains a vital and respected pillar of medical education and healthcare delivery in Uganda. 5.0 Strengths and Limitations 5.1 Strengths This study is among the first to systematically document the perspectives of anatomy educators across Ugandan institutions, offering context-specific insights into staffing, pedagogy, and infrastructure. The mixed-methods questionnaire, developed through literature review and expert consultation, ensured contextual relevance and content validity. Inclusion of diverse educator roles and institutional types enhanced the representativeness and applicability of findings across the national anatomy education landscape. 5.2 Limitations The study relied on self-reported data, which may be subject to recall bias or social desirability effects. The cross-sectional design captures a snapshot in time and may not reflect evolving institutional dynamics or post-pandemic adaptations. Limited sample size and uneven institutional representation may constrain generalizability to all anatomy programs in Uganda. 6.0 Recommendations To strengthen anatomy education in Uganda and address concerns raised by educators, the following priority actions are proposed to MoE, MoH and Medical Institutions: To address the systemic challenges facing anatomy education and professional practice in Uganda, a regulatory body should be established through an Act of Parliament. This body would provide legal recognition and oversight for anatomists and related professionals involved in the handling of human remains The Ministry of Health, in collaboration with the Ministry of Education and the proposed Anatomical Society of Uganda, should develop a comprehensive National Cadaver Donation and Acquisition Policy. This policy must establish clear legal, ethical, and procedural frameworks for sourcing, preserving, and utilizing human remains in medical education and research To address professional stagnation and restore confidence in anatomical careers, the Ministry of Public Service, in collaboration with the proposed Anatomical Society of Uganda and academic institutions, should develop structured career pathways for anatomists. These pathways should include: Clearly defined ranks and promotion criteria, aligned with academic, clinical, and research contributions. Mentorship programs to support early-career anatomists in teaching, research, and leadership development. Occupational health and risk allowances, recognizing the hazards associated with formalin exposure and cadaver handling. Protected time for professional development, enabling anatomists to engage in scholarship, curriculum innovation, and interdisciplinary collaboration. Such measures would enhance retention, attract new entrants to the field, and ensure that anatomy departments are staffed by motivated, well-supported professionals. To modernize anatomy education and enhance instructional resilience, institutions should actively support the integration of digital tools, virtual simulations, and self-directed learning (SDL) strategies. These modalities offer scalable solutions to address cadaver shortages, overcrowded laboratories, and limited faculty availability. Key actions include: Investing in virtual anatomy platforms, 3D models, and online dissection resources tailored to local curricula. Providing faculty training in instructional design and educational technology, equipping educators with the skills to develop, curate, and deliver blended learning content. Embedding SDL into anatomy curricula, with structured guidance, curated resources, and mentorship to ensure pedagogical depth and learner accountability. Improving digital infrastructure, including reliable internet access, hardware provision, and institutional support for e-learning platforms. These measures will foster student autonomy, adaptability, and clinical reasoning while ensuring that educators are empowered to deliver high-quality, multimodal instruction. To elevate scholarly output and foster innovation, the Ministry of Education and academic institutions and Anatomical Association of Uganda should facilitate collaborative research across universities and teaching hospitals, encouraging anatomists to engage in joint studies, multicenter projects, and interdisciplinary inquiry. In parallel, a national journal or publication platform dedicated to anatomical sciences should be established to: Showcase local research in anatomy, medical education, and clinical applications. Provide a credible outlet for early-career anatomists and faculty development fellows. Promote visibility of Ugandan scholarship in regional and global academic networks. Encourage mentorship, peer review, and editorial leadership within the anatomy community. This initiative would strengthen research culture, support evidence-based teaching, and position Ugandan anatomists as contributors to global discourse. 7.0 Conclusion This study highlights the structural, pedagogical, and professional challenges shaping anatomy teaching in Uganda. Educators face cadaver shortages, overcrowded facilities, poor renumerations and limited career development, yet continue to innovate through hybrid teaching. Their resilience underscores the need for coordinated national efforts to improve the teaching and learner’s conditions. Abbreviations AAU Association of Anatomists of Uganda IFAA International Federation of Associations of Anatomists MoE Ministry of Education SDL Self Directed Learning NCHE National Council of Higher Education Declarations 7.1 Ethical approval and consent to participate The study was conducted in compliance with the principles of the Declaration of Helsinki , ensuring respect for participants’ autonomy, confidentiality, and well-being. Ethical clearance was granted by the AAU (Anatomical Association of Uganda) Research and Ethics Committee. Informed consent was obtained electronically, and only individuals who selected the “Agree” option in the consent form were able to access the questionnaire; those who declined were excluded. 7.2 Consent for publication All authors have reviewed the final version of this manuscript and agree to its submission and publication. 7.3 Availability of data and materials Data is available upon request 7.4 Competing interests There is no conflict of interest among the authors. 7.5 Funding No external funding was received to support this study. 7.6 Authors' contributions Johnson Nyeko Oloya¹ – Conceived and designed the study, coordinated data collection, drafted the initial manuscript, and provided critical revisions for intellectual content. Fred Gendi³, – Contributed to study design, supervised data analysis, and provided expert input on methodology and interpretation of findings. Frida Chebet¹ – Assisted in data acquisition, literature review, and contributed to drafting and editing sections of the manuscript. Rogers Muhozi² – Supported data management, statistical analysis, and contributed to the interpretation of results. John Kukiriza⁴ – Provided technical guidance, reviewed the manuscript for accuracy, and contributed to refining the discussion and recommendations. Godfrey Mwarisi Masilili¹ – Oversaw project administration, contributed to conceptual framing, and provided final approval of the version to be published. 7.7 Acknowledgements We sincerely acknowledge all individuals who generously devoted their time to participate in this study. Their contributions were invaluable to the success of this research. References Adamović, D., Čepić, Z., Adamović, S., Stošić, M., Obrovski, B., Morača, S., & Vojinović Miloradov, M. (2021). Occupational exposure to formaldehyde and cancer risk assessment in an anatomy laboratory. 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The reliance on unclaimed cadavers for anatomical teaching by medical schools in Africa. Anat Sci Educ , 3 (4), 174-183. https://doi.org/10.1002/ase.157 Gunderman, R. B., & Wilson, P. K. (2005). Exploring the human interior: The roles of cadaver dissection and radiologic imaging in teaching anatomy. Academic Medicine , 80 (8), 745-749. Habicht, J. L., Kiessling, C., & Winkelmann, A. (2018). Bodies for Anatomy Education in Medical Schools: An Overview of the Sources of Cadavers Worldwide. Acad Med , 93 (9), 1293-1300. https://doi.org/10.1097/acm.0000000000002227 International Federation of Associations of, A. (2012). Recommendations of good practice for the donation and study of human bodies and tissues for anatomical examination. Plexus: Newsletter of the Ifaa , 4-5. Iwanaga, J., Loukas, M., Dumont, A. S., & Tubbs, R. S. (2021). A review of anatomy education during and after the COVID‐19 pandemic: Revisiting traditional and modern methods to achieve future innovation. Clinical Anatomy , 34 (1), 108-114. Kasozi, A. B. K. (2017). The National Council for Higher Education and the growth of the university sub-sector in Uganda, 2002-2012 . CODESRIA. Kwon, Y. G., Namgung, M., Park, S. H., Kim, M. K., Kim, C. W., & Yoo, H. H. (2025). Honoring donors: medical students’ reflections on cadaveric dissection. BMC Medical Education , 25 (1), 116. https://doi.org/10.1186/s12909-025-06674-1 McLachlan, J. C., & Patten, D. (2006). Anatomy teaching: ghosts of the past, present and future. Med Educ , 40 (3), 243-253. https://doi.org/10.1111/j.1365-2929.2006.02401.x Nabirye, P., B Paul, L., & S Mwaka, E. (2023). Attitudes and usage of visual-aids in graduate student learning of gross anatomy at Makerere University. African Health Sciences , 23 (1), 631-637. https://doi.org/10.4314/ahs.v23i1.67 Ndyamuhakyi, E., Michael, U., & Fischer, V. (2024). Support For Whole-Body Donation Among Educational Staff in Southwestern Ugandan Medical Education. Annals of Anatomy - Anatomischer Anzeiger , 257 . https://doi.org/10.1016/j.aanat.2024.152327 Ndyamuhakyi, E., Usman, I. M., Nabona, J., Fischer, V. A., Anyanwu, E., Owembabazi, E., Makena, W., & Etukudo, E. M. (2024). Profiles, tissue and microbial integrity of cadavers used in medical faculties in South-western Uganda: implication in anatomical education. Anatomy & cell biology , 10 . Oloya, J. N., Okello, M., & Munabi, I. G. (2025). Social Norms and Medical Students’ Engagement With Cadaveric Dissection: A Qualitative Study and Integrated Model of Cadaveric Engagement (IMCE Model). Journal of medical education and curricular development , 12 , 23821205251378866. Protano, C., Buomprisco, G., Cammalleri, V., Pocino, R. N., Marotta, D., Simonazzi, S., Cardoni, F., Petyx, M., Iavicoli, S., & Vitali, M. (2021). The Carcinogenic Effects of Formaldehyde Occupational Exposure: A Systematic Review. Cancers (Basel) , 14 (1). https://doi.org/10.3390/cancers14010165 Susai, S., Chandrupatla, M., & Motwani, R. (2023). Anatomy acts concerning body and organ donations across the globe: past, present and future with a special emphasis on the indian scenario. Anat Cell Biol , 56 (1), 1-8. https://doi.org/10.5115/acb.22.166 Turney, B. W. (2007). Anatomy in a modern medical curriculum. The Annals of The Royal College of Surgeons of England , 89 (2), 104-107. Additional Declarations No competing interests reported. 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18:39:05","extension":"html","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":103933,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8235223/v1/cf0256088c6b1c6f306b3d49.html"},{"id":98641582,"identity":"07104787-4cc2-472f-8062-de4ea4958272","added_by":"auto","created_at":"2025-12-19 18:39:04","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":37824,"visible":true,"origin":"","legend":"\u003cp\u003ePractices of Anatomy Educators\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8235223/v1/1df215f473671be0923ec627.png"},{"id":98782626,"identity":"ad0100a6-8a30-4d32-b5ee-25cfcc42d479","added_by":"auto","created_at":"2025-12-22 12:40:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1044108,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8235223/v1/9460ac1e-ea4b-4d66-9c36-5f2b742877e2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Challenges in Teaching Anatomy in Sub-saharan Africa: A National Survey of Educator Experiences in Uganda","fulltext":[{"header":"1.0 Introduction","content":"\u003cp\u003eHuman anatomy remains a foundational pillar of medical education, underpinning clinical reasoning, diagnostic acumen, and surgical competence across health professions. Its mastery is essential for understanding the structure-function relationships of the human body, and for developing the spatial awareness required in clinical practice ((Drake et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; M. Estai \u0026amp; S. Bunt, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Globally, cadaveric dissection has long been considered the gold standard for anatomy instruction, offering tactile, visual, and emotional engagement that fosters professional identity and empathy (Aziz et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2002\u003c/span\u003e; Kwon et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Uganda, anatomy education is delivered across a growing number of public and private medical institutions, including Makerere University, amongst others. However, the quality and consistency of instruction vary widely due to disparities in institutional capacity, resource availability, and faculty development (Atupele Mwabaleke et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Many institutions face infrastructural limitations such as overcrowded dissection rooms, inadequate cadaver supply, and poor preservation techniques, which compromise the fidelity and integrity of experiential learning (Ndyamuhakyi, Michael, et al., 2024).\u003c/p\u003e \u003cp\u003eCultural attitudes toward cadaveric dissection further complicate anatomy education in Uganda. The absence of a formal body donation policy has led to reliance on unclaimed bodies, often of poor tissue and microbial integrity, raising ethical and pedagogical concerns (Ndyamuhakyi, Usman, et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Students and educators alike report emotional discomfort, spiritual conflict, and societal stigma surrounding dissection practices, which hinder engagement and learning outcomes (Kwon et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2025\u003c/span\u003e)\u003c/p\u003e \u003cp\u003ePedagogically, Ugandan anatomy educators are increasingly adopting hybrid approaches that blend traditional lectures with digital resources, including YouTube videos and virtual simulations. Yet, access to these tools is constrained by poor internet connectivity, limited institutional investment, and lack of training in modern educational technologies (Nabirye et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). The shift toward learner-centered methods is further challenged by high student-to-teacher ratios, limited time for revision, and information overload, factors that contribute to student disengagement and academic stress (Atupele Mwabaleke et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2023\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThis study presents findings from a national survey of anatomy educators, aiming to document professional realities, identify common constraints, and inform policy and pedagogical reforms that can enhance the quality, sustainability and effectiveness of anatomy teaching in Uganda.\u003c/p\u003e"},{"header":"2.0 Methodology","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study Design\u003c/h2\u003e \u003cp\u003eThis study employed a cross-sectional descriptive survey design to explore the professional experiences, pedagogical practices, and institutional challenges faced by anatomy educators in Ugandan medical schools. The design was selected for its appropriateness in capturing a snapshot into educator realities across diverse institutional contexts.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Ethical Considerations\u003c/h2\u003e \u003cp\u003e This study adhered to the principles of the Declaration of Helsinki, ensuring respect, integrity, and anonymity throughout. It received approval of AAU Research and Ethics Committee. Informed consent was embedded in the survey tool, highlighting voluntary participation, withdrawal rights, and confidentiality. Only participants who clicked \u0026ldquo;Agree\u0026rdquo; proceeded; no personal identifiers were collected, and responses were securely encrypted.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Sampling and Recruitment\u003c/h2\u003e \u003cp\u003eParticipants were recruited using voluntary purposive sampling, targeting anatomy educators affiliated to accredited Ugandan medical schools. Recruitment was facilitated through professional networks, institutional contacts, and academic forums. Eligibility criteria included current involvement in teaching of human anatomy at undergraduate or postgraduate level.\u003c/p\u003e \u003cp\u003eThe survey was carried out between September 13 and September 25, 2025. The sample included educators from both public and private universities, representing a range of academic ranks from teaching assistants to professors), teaching experience, and institutional contexts. While modest in size, the sample provided rich, multi-institutional insights into the anatomy education landscape in Uganda.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Data Collection\u003c/h2\u003e \u003cp\u003eData was collected using an online survey tool, distributed through emails, WhatsApp groups, and direct reach out to department heads. The instrument was designed to be mobile-friendly and accessible across devices, minimizing barriers to participation. The survey remained open for a two-week period, allowing flexibility for respondents.\u003c/p\u003e \u003cp\u003eThe survey captured both:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eQuantitative data: Age, gender, academic qualifications, teaching experience, employment status, disciplines taught, and challenges faced.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eQualitative data: Open-ended reflections on teaching practices, institutional support, emotional engagement, and recommendations for reform.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Data Analysis\u003c/h2\u003e \u003cp\u003eQuantitative data analysis was conducted using descriptive statistics in R and STATA. Frequency and percentages were calculated to summarize demographic profiles, teaching roles, and reported challenges. These statistics were systematically tabulated to identify patterns across institutions and educator categories.\u003c/p\u003e \u003cp\u003eQualitative data were analyzed using inductive thematic analysis (Byrne, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Responses were manually coded, with emergent themes grouped into categories such as infrastructural constraints, pedagogical adaptation, emotional engagement, and policy recommendations. Attention was given to semantic content, emotional tone, and cultural nuance, ensuring that educators\u0026rsquo; voices were authentically represented.\u003c/p\u003e \u003cp\u003eTriangulation was achieved by cross-referencing quantitative trends with qualitative narratives, enhancing the credibility and depth of findings. Reflexivity was maintained throughout the analysis, with the researcher\u0026rsquo;s acknowledging positionality and potential interpretive bias.\u003c/p\u003e \u003c/div\u003e"},{"header":"3.0 Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Demographic and Academic Profile\u003c/h2\u003e \u003cp\u003eThe survey captured responses from anatomy educators across 14 medical schools in Uganda. Participants ranged in age from 25 to 60 years, with the majority (61%) falling within the 31\u0026ndash;50 age bracket. Gender distribution was predominantly male (78%), and most respondents were Ugandan nationals (94%).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Practices of Anatomy Educators\u003c/h2\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Challenges experienced by Anatomy Educators\u003c/h2\u003e \u003cp\u003eSurvey findings revealed a range of instructional, infrastructural, and professional challenges encountered by anatomy educators. The most frequently reported issues were limited opportunities for staff development and overcrowding in dissection rooms, indicating widespread concern about both faculty growth and physical learning environments as indicated in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e below.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eshowing the challenges of teaching anatomy\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChallenge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e% of Respondents\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLimited opportunity for staff development\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e71.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCrowding in the dissection room\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e71.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCadaver shortages\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e57.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor cadaver quality / unfit dissection rooms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnderstaffing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInadequate remuneration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor student attitude toward cadaver dissection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Reflections from study participants\u003c/h2\u003e \u003cp\u003eOpen-ended responses revealed a shared desire for institutional and national support to strengthen anatomy education in Uganda. Educators articulated a vision for reform that encompasses policy, professional development, collaboration, and scholarly engagement. Four key themes emerged:\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003e3.4.1 Theme 1. Government Support for Cadaver Acquisition and Regulatory Frameworks\u003c/h2\u003e \u003cp\u003eEducators consistently emphasized the need for a formalized, ethical, and accessible cadaver acquisition system. The absence of a national body donation policy and reliance on unclaimed bodies were cited as major impediments to effective dissection-based learning.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eGovernment should help private universities and institutions to acquire cadavers easily and possibly with no costs.\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThis sentiment reflects a broader call for regulatory clarity and logistical support to ensure equitable access to anatomical resources across institutions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003e3.4.2 Theme 2. Structured Career Development Pathways and Occupational Allowances\u003c/h2\u003e \u003cp\u003eRespondents expressed concern over limited opportunities for promotion, inadequate remuneration, and the absence of clear career trajectories for anatomy educators. These constraints were seen as demotivating and detrimental to faculty retention.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI would like to have a clear career development path, standard remuneration for my service, and occupational allowance where possible.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eSuch reflections underscore the need for institutional policies that recognize and reward the specialized contributions of anatomy faculty.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e \u003ch2\u003e3.4.3 Theme 3. Engagement with Professional Associations\u003c/h2\u003e \u003cp\u003eSeveral educators advocated for stronger ties with national and international professional bodies, such as the Association of Anatomists of Uganda (AAU) and the International Federation of Associations of Anatomists (IFAA). These affiliations were viewed as avenues for networking, advocacy, and professional growth.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe need to embrace the professional associations is crucial; AAU and IFAA.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThis theme highlights the importance of collective identity and institutional legitimacy in advancing the discipline of anatomy.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e \u003ch2\u003e3.4.4 Theme 4. Collaborative Research Opportunities and Scholarly Platforms\u003c/h2\u003e \u003cp\u003eRespondents called for increased support for research in anatomy education, including joint grant applications, inter-institutional collaborations, and the creation of a national journal to showcase Ugandan scholarship.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI think to improve peer collaboration\u0026mdash;e.g., joint research ventures with anatomists in different Ugandan institutions, creation of research grant opportunities, and perhaps creation of a journal by Ugandan anatomists.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThis vision reflects a desire to elevate anatomy education through evidence-based practice and scholarly dissemination.\u003c/p\u003e \u003cp\u003eTogether, these reflections underscore the educators\u0026rsquo; commitment to reform and their aspiration for a more sustainable, equitable, and professionally rewarding anatomy education system. The voices offer a compelling foundation for policy advocacy, institutional investment, and collaborative transformation.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"4.0 Discussion","content":"\u003cp\u003eAnatomists occupy a foundational position in medical education, serving as the custodians of human structural knowledge and facilitators of professional formation. Their contributions span pedagogy, curriculum development, clinical integration, and ethical stewardship, making them indispensable to the training of competent and compassionate health professionals.\u003c/p\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Cadaveric Dissection and role of Anatomist\u003c/h2\u003e \u003cp\u003eTraditionally, anatomists are responsible for teaching core subjects such as gross anatomy, histology, embryology, and cell biology. These disciplines form the bedrock of biomedical understanding, enabling students to interpret clinical signs, perform procedures, and appreciate the spatial relationships within the human body (Turney, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). Cadaveric dissection, often facilitated by anatomists, remains a powerful pedagogical tool that fosters manual dexterity, spatial reasoning, and emotional maturity (Arr\u0026aacute;ez-Aybar et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). Dissection is usual the first encounter medical students have with human mortality, positioning anatomists as guides through both technical and emotional terrain.\u003c/p\u003e \u003cp\u003eBeyond the classroom, anatomists increasingly contribute to curriculum reform, educational technology, and interdisciplinary teaching. They play a critical role in integrating anatomy with radiology, surgery, and pathology, ensuring that structural knowledge remains clinically relevant (Mohamed Estai \u0026amp; Stuart Bunt, 2016). In many institutions, anatomists are involved in developing competency-based curricula, designing assessments, and mentoring junior faculty. Their expertise also extends to simulation-based education, virtual anatomy platforms, and ultrasound-guided procedural training (Iwanaga et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2021\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eHowever, this study reveals a complex and evolving anatomy education landscape in Uganda, shaped by infrastructural constraints, critical human resource deficits, pedagogical adaptation, and institutional diversity. Across surveyed institutions, educators highlighted persistent challenges of cadaver shortages, overcrowded dissection rooms, understaffing, and inadequate facilities that reflect systemic underinvestment in foundational sciences. These limitations not only restrict hands-on learning but also erode the emotional and sensory engagement that cadaveric dissection uniquely fosters.\u003c/p\u003e \u003cp\u003eThe tactile experience of dissection, its textures, spatial depth, and visceral reality offer irreplaceable insights into anatomical relationships that digital or illustrative alternatives struggle to replicate(McLachlan \u0026amp; Patten, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). Beyond technical comprehension, cadaveric dissection cultivates a profound sense of respect, empathy, and professional identity among students, anchoring their transition from theoretical learners to compassionate practitioners.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Ethical Cadaver Acquisition for Medical Acquisition\u003c/h2\u003e \u003cp\u003eThis study reveals that medical schools in Uganda are experiencing persistent cadaver shortages, largely stemming from how bodies are obtained. Institutions predominantly rely on unclaimed bodies, typically sourced from hospital mortuaries. This practice, while common in many low-resource settings, raises significant ethical and legal concerns. Habicht et al. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) reported that only 22 of 68 countries rely exclusively on body donation, while the remainder depend on unclaimed bodies, a method increasingly scrutinized for its lack of transparency and ethical safeguards (Habicht et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). The use of unclaimed bodies presents several challenges. First, preservation quality is often poor due to limited infrastructure, inadequate embalming protocols, and prolonged storage without refrigeration. Second, the quantity of cadavers is insufficient to meet the demands of expanding student populations and mushrooming private and public medical schools. In some institutions, up to 20\u0026ndash;25 students share a single cadaver, severely limiting hands-on learning. This dependency on unclaimed bodies reflects the absence of a national body donation framework, making public engagement and voluntary donation extremely difficult.\u003c/p\u003e \u003cp\u003eGlobally, countries with structured body donation programs offer valuable models for ethical anatomical education. These frameworks emphasize transparency, legal safeguards, and sustained public engagement, the principles that remain underdeveloped in Uganda\u0026rsquo;s current cadaver acquisition practices.\u003c/p\u003e \u003cp\u003eVoluntary body donation is widely regarded as the ethical gold standard for body acquisition for medical education, emphasizing informed consent, dignity, and public trust (International Federation of Associations of, 2012). In South Africa, institutions such as the University of Cape Town have implemented transparent consent protocols and public awareness campaigns that normalize voluntary body donation and reduce reliance on unclaimed bodies. (Billings et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) highlight how ethical sourcing of cadavers, grounded in informed consent and community education, has reshaped anatomical practice and enhanced public trust in medical institutions.\u003c/p\u003e \u003cp\u003eIndia offers another instructive example through its Anatomy Act, which mandates documentation, informed consent, and respectful handling of donated bodies. Susai et al (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) describes how the Act provides a legal framework that balances educational needs with human dignity, ensuring that cadaveric material is acquired and used under regulated conditions (Susai et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). The Act also empowers institutions to engage with donors and families transparently, fostering a culture of voluntary donation and ethical anatomical education.\u003c/p\u003e \u003cp\u003eThese international models demonstrate that ethical cadaver acquisition is achievable through coordinated legal frameworks, public education, and institutional accountability. Uganda\u0026rsquo;s anatomy education system would benefit from adopting similar reforms, including the establishment of a national body donation program and public engagement strategies that promote informed consent and community trust.\u003c/p\u003e \u003cp\u003eThese limitations have direct pedagogical consequences. Poorly preserved cadaver\u0026rsquo;s obscure anatomical landmarks, distort tissue color and texture, and hinder students\u0026rsquo; ability to appreciate spatial relationships. Overcrowding further reduces hands-on engagement, limiting each student\u0026rsquo;s opportunity to explore and internalize anatomical structures. Moreover, the emotional toll of working with decomposed or ambiguous specimens can be distressing, leading some students to disengage or withdraw from dissection sessions altogether. A recent qualitative study we conducted at Makerere University revealed that students dropped out of cadaver dissection due to the poor preservation state, inability to identify key structures, and the disturbing condition of decomposing bodies (Oloya et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Digital Transition and Blended Learning in Anatomy Education\u003c/h2\u003e \u003cp\u003eCadaver quality and safe laboratory environments are essential for sustaining meaningful anatomical education, particularly in resource-constrained settings where poor preservation and reliance on unclaimed bodies can undermine both learning and safety (Gangata et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2010\u003c/span\u003e)In response to these challenges, anatomy educators increasingly supplement cadaveric teaching with digital resources, including online dissection videos, 3D models, and virtual anatomy platforms. This study reveals that educators often refer students to online videos for clarification when they struggle to identify structures on poorly preserved cadavers. However, in low-resource environments, internet connectivity issues and subscription costs frequently limit access to these digital tools (Nabirye et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2023\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eWhile hybrid instruction offers promise, studies such as McLachlan and Patten (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2006\u003c/span\u003e) caution that digital alternatives may fall short of replicating the emotional depth, tactile realism, and professional formation fostered by traditional dissection. The absence of physical engagement with human tissue can reduce students\u0026rsquo; spatial understanding, emotional resilience, and sense of clinical responsibility, an element that is critical in shaping competent and empathetic practitioners.\u003c/p\u003e \u003cp\u003eConcerns about balancing pedagogical effectiveness with occupational health risks particularly those linked to formalin exposure have led some institutions to reduce laboratory time or seek safer alternatives. This study reveals that some anatomy educators actively avoid dissection rooms due to fears of health complications associated with formalin. Formaldehyde, the active ingredient in formalin, is a volatile compound widely used to preserve cadavers. However, prolonged exposure has been linked to serious health risks, including respiratory irritation, allergic reactions, and increased cancer risk.\u003c/p\u003e \u003cp\u003eThe International Agency for Research on Cancer (IARC) classifies formaldehyde as a Group 1 human carcinogen, associated with nasopharyngeal cancer and possibly leukemia (Protano et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Adamović et al. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) reported that cancer risk levels for anatomy staff exposed to formaldehyde in Serbian laboratories were several thousand times higher than the threshold recommended by the U.S. Environmental Protection Agency (EPA), underscoring the urgency of improving ventilation, exposure monitoring, and protective measures (Adamović et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGiven these risks, institutions should consider establishing health insurance schemes that specifically cover occupational hazards related to prolonged formaldehyde exposure. Such provisions would not only protect anatomy staff but also encourage sustained engagement in cadaveric teaching, which remains central to medical education.\u003c/p\u003e \u003cp\u003eGlobally, curricular reform in anatomy education has accelerated due to growing concerns over formalin exposure, cadaver shortages, and the emotional toll associated with dissection. These pressures have led many institutions to adopt virtual modalities. Drake et al. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2009\u003c/span\u003e) documented the rise of virtual microscopy and the reduction of laboratory hours in embryology and gross anatomy, urging educators to balance technological innovation with experiential depth. Such reforms reflect a broader pedagogical shift toward blended learning, which integrates digital tools with traditional methods to enhance educational outcomes (Drake et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2009\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Uganda, however, this transition remains uneven. Faculty development in educational technology is limited, and digital infrastructure including reliable internet access, hardware availability, and institutional support is often inadequate. Nabirye et al. (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) observed that students increasingly rely on online dissection videos and illustrated texts to compensate for poorly preserved cadavers yet face significant barriers such as subscription costs and unstable connectivity (Nabirye et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). These challenges highlight the urgent need for targeted investment in faculty training, infrastructure upgrades, and the development of locally adaptable digital resources to ensure equitable access to high-quality anatomy education.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003e4.4 Staffing Shortages and Their Impact on Anatomy Education\u003c/h2\u003e \u003cp\u003eUnderstaffing within anatomy departments was consistently reported across all surveyed medical schools in this study. This constraint has compelled educators to adopt alternative teaching modalities\u0026mdash;including digital resources, peer-led instruction, and self-directed learning to safeguard against burnout and stress. These adaptations, while resourceful, are frequently reactive rather than strategic, and may compromise the depth and consistency of anatomical instruction.\u003c/p\u003e \u003cp\u003eThe staffing shortage is particularly concerning when viewed against national benchmarks. According to Schedule 4 of Statutory Instrument No. 80 of 2005, as referenced in the 2014 National Council for Higher Education (NCHE) Quality Assurance Framework, the ideal instructor-to-student ratio for basic sciences such as Medicine, Veterinary Medicine, and Pharmacy is 1:8. Ratios exceeding 1:26 are deemed unacceptable (Kasozi, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) as they compromise instructional quality, supervision, and safety especially in practical settings such as anatomy laboratories, where close guidance and oversight are essential\u003c/p\u003e \u003cp\u003eIn anatomy education, this standard is especially critical. Cadaveric dissection requires close supervision not only to ensure technical accuracy and pedagogical effectiveness, but also to maintain occupational safety and support students\u0026rsquo; emotional adaptation when encountering human remains. When staffing falls below acceptable thresholds, educators are unable to provide the individualized guidance and psychological scaffolding that dissection demands, potentially undermining both learning outcomes and professional identity formation.\u003c/p\u003e \u003cp\u003eCompounding this challenge is the growing difficulty in attracting professionals into the anatomy discipline. Globally, the intellectual appeal of gross anatomy has waned in comparison to emerging biomedical fields such as molecular biology and genetics, which often receive greater research funding and institutional prioritization. Gunderman and Wilson (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2005\u003c/span\u003e) observed that anatomy departments have been downsized or closed in several institutions, resulting in fewer anatomists available to teach (Gunderman \u0026amp; Wilson, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2005\u003c/span\u003e). In Uganda, this trend is further exacerbated by the limited employability of anatomists within the broader medical sector. For many, medical schools remain the sole avenue for formal employment, even though anatomists possess valuable expertise that could support a range of clinical and forensic services. With appropriate policy recognition, anatomists could be meaningfully integrated into hospital-based teams alongside pathologists, contributing to dissections, tissue harvesting, and the management of deceased individuals in mortuaries. Their expertise is also highly relevant in the transplant sector, where precision in anatomical knowledge is critical for organ retrieval, preservation, and surgical planning. Furthermore, anatomists possess valuable skills that can be applied in research centers, particularly in areas such as morphometric analysis, comparative anatomy, developmental biology, and forensic science. Their involvement in multidisciplinary research teams would enrich biomedical investigations and strengthen the academic output of institutions.\u003c/p\u003e \u003cp\u003eTo address these gaps, the establishment of a Department of Clinical Anatomy under the Ministry of Health would be a transformative step. Such a department could formally integrate anatomists into hospital-based clinical and research teams. It would also provide a platform for professional certification, career advancement, and intersectoral collaboration, bridging the divide between academic anatomy and applied medical practice. By institutionalizing the clinical relevance of anatomy, this reform would not only expand employment opportunities but also elevate the discipline\u0026rsquo;s visibility, utility, and strategic value within Uganda\u0026rsquo;s health system.\u003c/p\u003e \u003cp\u003eHowever, the absence of structured career pathways and institutional frameworks to support such roles has led to widespread underutilization of this workforce, further discouraging entry into the field. This study found that many anatomists do not see a viable future in anatomical practice. The lack of career growth, promotion structures, and professional development opportunities was consistently cited by respondents as a major concern.\u003c/p\u003e \u003cp\u003eIn anatomy education, this dynamic is particularly acute. Educators face mounting pressure to deliver high-quality instruction despite limited access to cadaveric materials, digital infrastructure, and continuing education. The absence of institutional recognition and strategic career planning leaves anatomists professionally isolated, undervalued, and vulnerable to burnout.\u003c/p\u003e \u003cp\u003eWhile Ministries of Education (MOEs) emphasize regulation, accreditation, and compliance with national standards, they often overlook the foundational investments required to sustain educational quality such as faculty recruitment, workload redistribution, and long-term career development support. These include structured mentorship, protected time for professional growth, incentives for scholarly engagement, and clear career progression pathways. Without these structural commitments, departments are left to navigate increasing demands with limited personnel, outdated infrastructure, and minimal professional growth opportunities.\u003c/p\u003e \u003cp\u003eGlobally, the literature affirms the pivotal role of faculty development in maintaining and advancing anatomy education. Drake et al. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2009\u003c/span\u003e) emphasized that curricular reform particularly the shift toward integrated and multimodal delivery must be matched by deliberate investment in educator capacity. This includes training in pedagogical methods, digital literacy, curriculum design, and assessment strategies. As anatomy instruction evolves to include virtual platforms, problem-based learning, and interdisciplinary integration, educators must be equipped not only with content expertise but also with the skills to adapt and innovate.\u003c/p\u003e \u003cp\u003eWithout such support, faculty may struggle to meet evolving pedagogical demands, widening the gap between institutional expectations and educator preparedness. This disconnect can lead to inconsistent instructional quality, reduced student engagement, and diminished learning outcomes. In anatomy education, where tactile experience, emotional resilience, and spatial reasoning are central to professional formation, underprepared faculty may inadvertently compromise the depth and integrity of the learning process.\u003c/p\u003e \u003cp\u003eTo address these challenges, a dedicated committee within the National Council for Higher Education (NCHE) should be established to monitor and regulate the quality of anatomy teaching across institutions. Such a team would be tasked with identifying systemic gaps, evaluating instructional standards, and responding to the unique challenges faced by anatomy educators. This oversight mechanism would promote accountability, foster continuous improvement, and ensure that anatomy education remains aligned with national health workforce goals.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003e4.5 Professional Governance and Strategic Support for Anatomists\u003c/h2\u003e \u003cp\u003eThese findings highlight the urgent need for national frameworks and institutional policies that prioritize faculty development as a strategic investment. For anatomy educators, this support is not only essential for sustaining teaching excellence but also for restoring professional dignity and ensuring long-term retention in the field.\u003c/p\u003e \u003cp\u003eThe absence of a formal regulatory body for anatomists in Uganda compounds these challenges. The practice of anatomists and professionals involved in the handling of deceased individuals remains unregulated, leaving critical gaps in oversight, accountability, and career development. Respondents in this study emphasized the need to establish a national body such as an Anatomical Society of Uganda to address the current lack of professional governance. Such an organization would be responsible for:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eRegistering and licensing anatomists, ensuring professional standards and ethical compliance.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eEstablishing clear career ranks and promotion pathways, supporting long-term growth and retention.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eSupervising clinical anatomy services and mortuary operations within hospitals, enhancing safety and quality.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eCoordinating public education initiatives on ethical body donation, fostering transparency and community trust.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eActing as a national mouthpiece for anatomists, advocating for their interests in policy and institutional forums.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eRegulating the handling of human remains by private organizations, ensuring ethical practices, legal compliance, and public accountability.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eThis regulatory framework would not only elevate the status of anatomists but also strengthen their integration into clinical, forensic, and research teams. It would provide a structured platform for advocacy, professional development, and institutional recognition ensuring that anatomy remains a vital and respected pillar of medical education and healthcare delivery in Uganda.\u003c/p\u003e \u003c/div\u003e"},{"header":"5.0 Strengths and Limitations","content":"\u003cp\u003e \u003cb\u003e5.1 Strengths\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eThis study is among the first to systematically document the perspectives of anatomy educators across Ugandan institutions, offering context-specific insights into staffing, pedagogy, and infrastructure.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eThe mixed-methods questionnaire, developed through literature review and expert consultation, ensured contextual relevance and content validity.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eInclusion of diverse educator roles and institutional types enhanced the representativeness and applicability of findings across the national anatomy education landscape.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e5.2 Limitations\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eThe study relied on self-reported data, which may be subject to recall bias or social desirability effects.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eThe cross-sectional design captures a snapshot in time and may not reflect evolving institutional dynamics or post-pandemic adaptations.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eLimited sample size and uneven institutional representation may constrain generalizability to all anatomy programs in Uganda.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e"},{"header":"6.0 Recommendations","content":"\u003cp\u003eTo strengthen anatomy education in Uganda and address concerns raised by educators, the following priority actions are proposed to MoE, MoH and Medical Institutions:\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eTo address the systemic challenges facing anatomy education and professional practice in Uganda, a regulatory body should be established through an Act of Parliament. This body would provide legal recognition and oversight for anatomists and related professionals involved in the handling of human remains\u003c/li\u003e\n \u003cli\u003eThe Ministry of Health, in collaboration with the Ministry of Education and the proposed Anatomical Society of Uganda, should develop a comprehensive National Cadaver Donation and Acquisition Policy. This policy must establish clear legal, ethical, and procedural frameworks for sourcing, preserving, and utilizing human remains in medical education and research\u003c/li\u003e\n \u003cli\u003eTo address professional stagnation and restore confidence in anatomical careers, the Ministry of Public Service, in collaboration with the proposed Anatomical Society of Uganda and academic institutions, should develop structured career pathways for anatomists. These pathways should include:\u003c/li\u003e\n\u003c/ol\u003e\n\u003cul\u003e\n \u003cli\u003eClearly defined ranks and promotion criteria, aligned with academic, clinical, and research contributions.\u003c/li\u003e\n \u003cli\u003eMentorship programs to support early-career anatomists in teaching, research, and leadership development.\u003c/li\u003e\n \u003cli\u003eOccupational health and risk allowances, recognizing the hazards associated with formalin exposure and cadaver handling.\u003c/li\u003e\n \u003cli\u003eProtected time for professional development, enabling anatomists to engage in scholarship, curriculum innovation, and interdisciplinary collaboration.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eSuch measures would enhance retention, attract new entrants to the field, and ensure that anatomy departments are staffed by motivated, well-supported professionals.\u003c/p\u003e\n\u003col start=\"4\" type=\"1\"\u003e\n \u003cli\u003eTo modernize anatomy education and enhance instructional resilience, institutions should actively support the integration of digital tools, virtual simulations, and self-directed learning (SDL) strategies. These modalities offer scalable solutions to address cadaver shortages, overcrowded laboratories, and limited faculty availability. Key actions include:\u003c/li\u003e\n\u003c/ol\u003e\n\u003cul\u003e\n \u003cli\u003eInvesting in virtual anatomy platforms, 3D models, and online dissection resources tailored to local curricula.\u003c/li\u003e\n \u003cli\u003eProviding faculty training in instructional design and educational technology, equipping educators with the skills to develop, curate, and deliver blended learning content.\u003c/li\u003e\n \u003cli\u003eEmbedding SDL into anatomy curricula, with structured guidance, curated resources, and mentorship to ensure pedagogical depth and learner accountability.\u003c/li\u003e\n \u003cli\u003eImproving digital infrastructure, including reliable internet access, hardware provision, and institutional support for e-learning platforms.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThese measures will foster student autonomy, adaptability, and clinical reasoning while ensuring that educators are empowered to deliver high-quality, multimodal instruction.\u003c/p\u003e\n\u003col start=\"5\" type=\"1\"\u003e\n \u003cli\u003eTo elevate scholarly output and foster innovation, the Ministry of Education and academic institutions and Anatomical Association of Uganda should facilitate collaborative research across universities and teaching hospitals, encouraging anatomists to engage in joint studies, multicenter projects, and interdisciplinary inquiry. In parallel, a national journal or publication platform dedicated to anatomical sciences should be established to:\u003c/li\u003e\n\u003c/ol\u003e\n\u003cul\u003e\n \u003cli\u003eShowcase local research in anatomy, medical education, and clinical applications.\u003c/li\u003e\n \u003cli\u003eProvide a credible outlet for early-career anatomists and faculty development fellows.\u003c/li\u003e\n \u003cli\u003ePromote visibility of Ugandan scholarship in regional and global academic networks.\u003c/li\u003e\n \u003cli\u003eEncourage mentorship, peer review, and editorial leadership within the anatomy community.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThis initiative would strengthen research culture, support evidence-based teaching, and position Ugandan anatomists as contributors to global discourse.\u003c/p\u003e"},{"header":"7.0 Conclusion","content":"\u003cp\u003eThis study highlights the structural, pedagogical, and professional challenges shaping anatomy teaching in Uganda. Educators face cadaver shortages, overcrowded facilities, poor renumerations and limited career development, yet continue to innovate through hybrid teaching. Their resilience underscores the need for coordinated national efforts to improve the teaching and learner’s conditions.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 10.4425%;\"\u003e\n \u003cp\u003eAAU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89.5575%;\"\u003e\n \u003cp\u003eAssociation of Anatomists of Uganda\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 10.4425%;\"\u003e\n \u003cp\u003eIFAA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89.5575%;\"\u003e\n \u003cp\u003eInternational Federation of Associations of Anatomists\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 10.4425%;\"\u003e\n \u003cp\u003eMoE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89.5575%;\"\u003e\n \u003cp\u003eMinistry of Education\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 10.4425%;\"\u003e\n \u003cp\u003eSDL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89.5575%;\"\u003e\n \u003cp\u003eSelf Directed Learning\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 10.4425%;\"\u003e\n \u003cp\u003eNCHE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89.5575%;\"\u003e\n \u003cp\u003eNational Council of Higher Education\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e7.1 Ethical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in compliance with the principles of the \u003cstrong\u003eDeclaration of Helsinki\u003c/strong\u003e, ensuring respect for participants’ autonomy, confidentiality, and well-being. Ethical clearance was granted by the AAU (Anatomical Association of Uganda) Research and Ethics Committee. Informed consent was obtained electronically, and only individuals who selected the “Agree” option in the consent form were able to access the questionnaire; those who declined were excluded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e7.2 Consent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have reviewed the final version of this manuscript and agree to its submission and publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e7.3 Availability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData is available upon request\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e7.4 Competing interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is no conflict of interest among the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e7.5 Funding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo external funding was received to support this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e7.6 Authors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eJohnson Nyeko Oloya¹ – Conceived and designed the study, coordinated data collection, drafted the initial manuscript, and provided critical revisions for intellectual content.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eFred Gendi³, – Contributed to study design, supervised data analysis, and provided expert input on methodology and interpretation of findings.\u003c/li\u003e\n \u003cli\u003eFrida Chebet¹ – Assisted in data acquisition, literature review, and contributed to drafting and editing sections of the manuscript.\u003c/li\u003e\n \u003cli\u003eRogers Muhozi² – Supported data management, statistical analysis, and contributed to the interpretation of results.\u003c/li\u003e\n \u003cli\u003eJohn Kukiriza⁴ – Provided technical guidance, reviewed the manuscript for accuracy, and contributed to refining the discussion and recommendations.\u003c/li\u003e\n \u003cli\u003eGodfrey Mwarisi Masilili¹ – Oversaw project administration, contributed to conceptual framing, and provided final approval of the version to be published.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e7.7 Acknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe sincerely acknowledge all individuals who generously devoted their time to participate in this study. Their contributions were invaluable to the success of this research.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAdamović, D., Čepić, Z., Adamović, S., Sto\u0026scaron;ić, M., Obrovski, B., Morača, S., \u0026amp; Vojinović Miloradov, M. (2021). Occupational exposure to formaldehyde and cancer risk assessment in an anatomy laboratory. \u003cem\u003eInternational journal of environmental research and public health\u003c/em\u003e,\u003cem\u003e 18\u003c/em\u003e(21), 11198. \u003c/li\u003e\n\u003cli\u003eArr\u0026aacute;ez-Aybar, L. A., Casta\u0026ntilde;o-Collado, G., \u0026amp; Casado-Morales, M. I. (2008). 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Support For Whole-Body Donation Among Educational Staff in Southwestern Ugandan Medical Education. \u003cem\u003eAnnals of Anatomy - Anatomischer Anzeiger\u003c/em\u003e,\u003cem\u003e 257\u003c/em\u003e. https://doi.org/10.1016/j.aanat.2024.152327 \u003c/li\u003e\n\u003cli\u003eNdyamuhakyi, E., Usman, I. M., Nabona, J., Fischer, V. A., Anyanwu, E., Owembabazi, E., Makena, W., \u0026amp; Etukudo, E. M. (2024). Profiles, tissue and microbial integrity of cadavers used in medical faculties in South-western Uganda: implication in anatomical education. \u003cem\u003eAnatomy \u0026amp; cell biology\u003c/em\u003e,\u003cem\u003e 10\u003c/em\u003e. \u003c/li\u003e\n\u003cli\u003eOloya, J. N., Okello, M., \u0026amp; Munabi, I. G. (2025). 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Anatomy acts concerning body and organ donations across the globe: past, present and future with a special emphasis on the indian scenario. \u003cem\u003eAnat Cell Biol\u003c/em\u003e,\u003cem\u003e 56\u003c/em\u003e(1), 1-8. https://doi.org/10.5115/acb.22.166 \u003c/li\u003e\n\u003cli\u003eTurney, B. W. (2007). Anatomy in a modern medical curriculum. \u003cem\u003eThe Annals of The Royal College of Surgeons of England\u003c/em\u003e,\u003cem\u003e 89\u003c/em\u003e(2), 104-107. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Challenges in Anatomy teaching, Cadaver shortages, Teaching modalities, Professional development, Policy reform, Uganda","lastPublishedDoi":"10.21203/rs.3.rs-8235223/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8235223/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eAnatomy education remains a cornerstone of medical training, providing the foundational knowledge required for clinical practice and biomedical sciences. This study reports findings from a national survey conducted among anatomy educators across Ugandan medical schools, encompassing both public and private universities. Responses were analyzed to capture the demographic profile of educators, their teaching modalities, institutional responsibilities, and the barriers they encounter in delivering effective instruction. The survey revealed persistent challenges including under-staffing of anatomy departments, shortages of cadavers for dissection, overcrowded teaching laboratories, and limited access to professional development opportunities. Inadequate remuneration and insufficient institutional support further compound these difficulties, threatening the sustainability of anatomy education. Despite these constraints, educators demonstrated resilience and innovation. Many reported adopting hybrid teaching strategies that combine traditional dissection with digital resources, online platforms, and problem-based learning approaches. Faculty members also expressed strong advocacy for systemic reforms, emphasizing the need for coordinated national policies, strategic investment in teaching resources, and collaborative faculty development programs. These efforts reflect a commitment to maintaining the integrity and quality of anatomy education in Uganda, even under resource-limited conditions. The findings underscore the urgent need for government, universities, and professional bodies to prioritize anatomy education through policy reform, infrastructure development, and faculty support. Strengthening anatomy teaching will not only enhance medical education but also ensure the production of competent health professionals capable of addressing Uganda\u0026rsquo;s healthcare challenges.\u003c/p\u003e","manuscriptTitle":"Challenges in Teaching Anatomy in Sub-saharan Africa: A National Survey of Educator Experiences in Uganda","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-19 18:39:00","doi":"10.21203/rs.3.rs-8235223/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-13T06:48:04+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-07T18:59:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"313879598931755609021621285215963955869","date":"2026-01-05T11:37:18+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-04T07:11:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"251148806384147501400136072178134491197","date":"2026-01-04T01:57:45+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-19T11:29:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"33689877584738366624579665645899161095","date":"2025-12-19T09:54:22+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-16T23:17:27+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-09T14:52:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-05T20:18:51+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-04T04:18:26+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-12-04T04:13:38+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c8a7a3a8-af81-46ea-887b-25f8f12c45a7","owner":[],"postedDate":"December 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-01-13T06:54:14+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-19 18:39:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8235223","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8235223","identity":"rs-8235223","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}