Introduction <p>Gross anatomy forms the foundation of medical education, yet traditional cadaver dissection faces challenges from cadaver shortages, costs, and curriculum changes, prompting increased use of alternatives such as anatomical models, virtual dissection software, and textbooks. Evidence on their comparative effectiveness remains mixed, particularly in resource-limited settings. This study compared gross anatomy examination performance between medical students exposed to human cadaver dissection and those taught using only non-cadaveric methods in a Nigerian setting.</p> Methods <p>This comparative cross-sectional study involved 120 first-year medical students at Ambrose Alli University, Nigeria. Participants were grouped according to their actual practical teaching exposure during extremity anatomy training: Group A (<i>n</i> = 69, cadaver dissection) and Group B (<i>n</i> = 51, non-cadaveric methods only). Performance was assessed using identical institutional final examinations consisting of 50 MCQs and essay questions. Data were analysed with descriptive statistics, Pearson correlation, independent t-tests (Welch’s correction), Cohen’s d, and chi-square tests.</p> Results <p>Students in Group A achieved higher mean scores than Group B in MCQs (69.90% vs. 55.79%), essays (61.16% vs. 52.92%), and total scores (65.00% vs. 54.82%; all <i>p</i> &lt; 0.001), with large effect sizes (Cohen’s d = 0.70–1.09). The cadaver dissection group also had higher distinction rates and lower failure rates.</p> Conclusion <p>In this cohort, exposure to human cadaver dissection was associated with higher gross anatomy examination performance compared to non-cadaveric methods alone. While these findings suggest that cadaver-based teaching remains valuable in resource-limited settings, the observational design limits causal inference. Further multi-institutional studies are warranted.</p>