Soft-Embalmed Cadavers Win Over Surgeons-in-Training in Malaysian Study

For generations, the smell of formalin has been inseparable from the anatomy laboratory. The pungent fixative preserves tissue for years, but it does so at a cost: it stiffens joints, bleaches natural color, and hardens the delicate planes between structures that surgeons must learn to navigate. A new study from Malaysia suggests that for one of the most anatomy-intensive surgical specialties, the future of training may smell considerably different. Researchers surveying otorhinolaryngology residents across the country found that soft body cadavers—specimens preserved with modern, flexible embalming techniques—were consistently rated as more effective learning tools than their formalin-preserved counterparts, even though the traditional specimens retained clear practical advantages in the laboratory.

The study, published in BMC Medical Education, was led by Jia Ern Leong of the Department of Otorhinolaryngology at Universiti Malaya, together with Liew Yew Toong and Sakina Ghauth of the university’s Silent Mentor Centre. The team set out to answer a deceptively simple question: how do postgraduate surgical trainees actually perceive the different types of cadavers they learn from? The answer matters because otorhinolaryngology—ear, nose, and throat surgery—demands an unusually precise three-dimensional understanding of compact, complex anatomy. The temporal bone alone, with its embedded inner ear structures, houses some of the smallest and most functionally critical anatomy in the human body, and residents must master it before ever lifting a scalpel on a living patient.

To capture those perceptions, the researchers employed a cross-sectional quantitative design, distributing a validated questionnaire to otorhinolaryngology residents at four Malaysian university hospitals and a range of government hospital training facilities. The survey covered three clinical themes related to the application of soft body cadavers in postgraduate anatomical education, and the responses were analyzed using descriptive statistics. Sixty-one residents ultimately participated, a majority of them women, at 62.3 percent of the sample. That gender distribution itself reflects the changing face of surgical training in Malaysia, where specialties once dominated by men are increasingly populated by female trainees.

The numbers tell a striking story. Soft body cadavers were perceived to improve anatomy knowledge by 59.0 percent of respondents, boost motivation by 73.8 percent, aid the differentiation of anatomical structures by 67.2 percent, and enhance three-dimensional orientation by 63.9 percent. Perhaps most tellingly, 73.8 percent of residents said soft specimens offered more realistic coloration, and 55.7 percent reported clearer spatial relations. For a specialty in which surgeons must distinguish a tumor from normal tissue, a nerve from a vessel, and a thin bony plate from an air cell—all often within a few millimeters—realistic color and spatial fidelity are not cosmetic details. They are the difference between a training experience that approximates the operating room and one that does not.

The advantages of soft embalming stem from the chemistry of modern preservation. Traditional formalin fixation cross-links proteins extensively, producing the firm, pale, rigid specimens familiar to generations of medical students. Soft-fix and similar techniques use lower concentrations of formaldehyde, often combined with alcohol, glycerin, and other additives, or rely on vascular perfusion of the preservative through the circulatory system. The result is tissue that retains much of its natural pliability, color, and texture. Joints remain movable, tissue planes remain separable, and structures look closer to what a surgeon encounters in the operating theater. For procedures such as endoscopic sinus surgery or temporal bone drilling, where tactile feedback and visual cues guide every movement, that fidelity can translate directly into surgical readiness.

Yet the study’s findings are not a one-sided endorsement. Formalin-preserved cadavers were still considered more practical for laboratory use by 60.7 percent of respondents and easier to handle by 36.1 percent. This is no surprise to anyone who has worked in a dissection lab: formalin specimens are durable, resistant to decay, can be stored for long periods, and tolerate repeated handling across multiple teaching sessions. Soft-embalmed and fresh-frozen specimens, by contrast, are more expensive to produce, more demanding to store, and have a limited working life before tissue quality degrades. In resource-conscious training systems, those logistical realities weigh heavily, and the residents’ responses suggest they are well aware of the trade-off.

One of the most intriguing results concerned fresh frozen cadavers, which are preserved by freezing without chemical fixation and thawed for use. These specimens most closely replicate living tissue but are the most logistically challenging of all. Nevertheless, 65.6 percent of residents preferred fresh frozen cadavers for revision and self-directed learning. The finding hints at an evolving philosophy in surgical education: as trainees increasingly take responsibility for their own learning outside scheduled laboratory sessions, they value specimens that behave like living tissue, even at the cost of convenience. A resident revisiting temporal bone anatomy at their own pace, drilling repeatedly until the anatomy becomes second nature, benefits more from lifelike tissue than from a specimen that lasts longer but feels artificial.

The statistical analysis added demographic nuance to the picture. The researchers found no significant gender differences in perception across most measures, with a single exception: clinical knowledge improvement, where the difference between men and women reached statistical significance at p = 0.038. More broadly, perceptions differed significantly across age groups, but not across residency years. That pattern is notable because it suggests that attitudes toward soft body cadavers are shaped more by a trainee’s generational exposure to different teaching technologies than by how far along they are in their program. Seniority, in other words, does not determine whether a resident values lifelike specimens; the era in which they trained does.

The study was conducted in accordance with the Declaration of Helsinki and received ethical approval from the University Malaya Medical Centre Medical Research Ethics Committee, under approval number MECID No. 2024324-13572, with written informed consent obtained from all participants. The work also carries a human dimension that the authors’ institutional affiliations make visible: Universiti Malaya’s Silent Mentor Centre is part of a broader movement in Asian medical education toward honoring body donors, whose gifts make surgical training possible. As demand grows for soft-embalmed and fresh-frozen specimens, so too does the importance of donor programs that treat donated bodies with dignity while enabling the highest quality of surgical education.

What emerges from the Malaysian data is less a verdict than a blueprint. Soft body cadavers excel where learning quality matters most—motivation, structural differentiation, three-dimensional orientation, and realism—while formalin specimens remain the workhorses of high-volume laboratory teaching, and fresh frozen cadavers occupy a premium niche for self-directed revision. For training programs designing postgraduate anatomy curricula, the implication is that no single preservation method is sufficient. A blended approach, matching specimen type to educational purpose, appears to reflect what residents themselves already understand: the anatomy of the head and neck is too complex, and the stakes of surgical mastery too high, to rely on any one tool. As soft-fix techniques spread and donor programs expand, the formalin-soaked anatomy lab of the twentieth century may gradually give way to something that looks, feels, and teaches far more like the living body it is meant to represent.

Subject of Research: Perceptions of soft body cadaver use in postgraduate otorhinolaryngology anatomical education in Malaysia

Article Title: Evaluation on the perception of soft body cadavers usage among malaysian otorhinolaryngology residents during postgraduate anatomical education

Article References: Leong, J. E., Toong, L. Y., & Ghauth, S. (2026). Evaluation on the perception of soft body cadavers usage among malaysian otorhinolaryngology residents during postgraduate anatomical education. BMC Medical Education. https://doi.org/10.1186/s12909-026-10520-3

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10520-3

Keywords: anatomical education, soft body cadavers, formalin preservation, fresh frozen cadavers, otorhinolaryngology, surgical residents, postgraduate training, Malaysia, medical education, anatomy, cadaveric dissection, surgical simulation