Anonymous body or first patient? A status report and needs assessment regarding the personalization of donors in dissection courses in German,Austrian, and Swiss Medical Schools

Many Anglo‐American universities have undertaken a paradigm shift in how the dissection of human material is approached, such that students are encouraged to learn about the lives of body donors, and to respectfully “personalize” them as human beings, rather than treating the specimens as anonymous cadavers. For the purposes of this study, this provision of limited personal information regarding the life of a body donor will be referred to as “personalization” of body donors. At this time, it is unknown whether this paradigm shift in the personalization of body donors can be translated into the German‐speaking world. A shift from donor anonymity to donor personalization could strengthen students' perception of the donor as a “first patient,” and thereby reinforce their ability to empathize with their future patients. Therefore, this study aimed to collect data about the current status of donation practices at German‐speaking anatomy departments (n = 44) and to describe the opinions of anatomy departments, students (n = 366), and donors (n = 227) about possible donor personalization in medical education. Anatomy departments in Germany, Austria, and Switzerland were invited to participate in an online questionnaire. One‐tenth of registered donors at Ulm University were randomly selected and received a questionnaire (20 items, yes‐no questions) by mail. Students at the University of Ulm were also surveyed at the end of the dissection course (31 items, six‐point Likert‐scale). The majority of students were interested in receiving additional information about their donors (78.1%). A majority of donors also supported the anonymous disclosure of information about their medical history (92.5%). However, this information is only available in about 28% of the departments surveyed and is communicated to the students only irregularly. Overall, 78% of anatomy departments were not in favor of undertaking donor personalization. The results appear to reflect traditional attitudes among anatomy departments. However, since students clearly preferred receiving additional donor information, and most donors expressed a willingness to provide this information, one could argue that a change in attitudes is necessary. To do so, official recommendations for a limited, anonymous personalization of donated cadaveric specimens might be necessary. Anat Sci Educ 11: 282–293. © 2017 American Association of Anatomists.     

Anticipatory Feelings About Dissection: An Exercise for the First Day of a Gross Anatomy Course

Studies have demonstrated that students experience a variety of intense emotions in anticipation of human anatomical dissection, including enthusiasm, gratitude, responsibility, apprehension, detachment, anxiety, and spiritual or moral reflection. The exercise described here provides an opportunity to start a conversation about the complexity of students’ emotional reactions to the anatomy experience. The intention of this exercise is to normalize the variety of emotions that anatomy students experience, both to demonstrate to students that their emotions are normal and to encourage the empathy for others' reactions which may differ from their own. In the lecture hall setting before the first day of dissection, students are asked to draw how they feel about the dissection experience and are provided an opportunity to discuss their drawings with their peers. The course director then provides a slide show demonstration of drawings from previous years, and experienced anatomy faculty facilitate a large group discussion in which students react to the drawing exercise and slide show and ask questions which are addressed by the faculty. This exercise provides an opportunity for students to practice appropriately communicating about emotionally complex experiences in a professional setting. The exercise is straightforward to implement and is easily modifiable for different class sizes and curricular structures.     

Survey of Gross Anatomy Education in China: The Past and the Present

Medical education in mainland China has undergone massive expansion and reforms in the past decades. A nation-wide survey of the five-year clinical medicine programs aimed to examine the course hours, pedagogies, learning resources and teaching staff of anatomy both at present and over the past three decades (1990–1999, 2000–2009, and 2010–2018). The directors or senior teachers from 90 out of the 130 five-year clinical medicine programs were invited to fill out a factual questionnaire by email. Ultimately, sixty-five completed questionnaires were received from 65 different schools. It was found that the total number of gross anatomy course hours has decreased by 11% in the past 30 years and that systematic and regional anatomy have been increasingly taught separately among the surveyed medical schools. Problem-based learning has been adopted in thirty-five (54%) of the surveyed schools, and team-based learning is used in ten (15%) of the surveyed schools. The surveyed schools reported receiving more donated cadavers in recent years, with the average number increasing from 20.67 ± 20.29 in 2000–2009 to 36.10 ± 47.26 in 2010–2018. However, this has not resulted in a decrease in the number of students who needed to share one cadaver (11.85 ± 5.03 in 1990–1999 to 14.22 ± 5.0 in 2010–2018). A decreasing trend regarding the teacher-student ratio (1:25.5 in 2000–2009 to 1:33.2 in 2010–2018) was also reported. The survey demonstrated the historical changes in gross anatomy education in China over the past thirty years.     

Attitudes of Anatomy Students toward Commemorations for Body Donors: A Multicultural Perspective

Many medical schools practice commemorative ceremonies to honor body donors. Attitudes of medical education stakeholders toward these ceremonies have not yet been fully investigated. The aim of this study was to explore anatomy students' attitudes toward commemorations at a multicultural institution which has not introduced these ceremonies yet. A survey was carried out on different groups of anatomy students that were exposed and not yet exposed to human remains. The survey was used to record basic demographic data from the respondents, ask if they would support the establishment of an anatomy commemoration and in which format. A total of 756 anatomy students participated in the survey (response rate 69.8%). The majority (76.3%) were in favor of introducing a commemoration for donors. The associations of students' gender, attitude toward body donation, and level of exposure to human remains with attitudes toward commemoration for donors were identified (P < 0.05), whereas ethnicity and religion seemed to have no influence on attitudes (P > 0.05). Most students believed that anatomy staff and students should organize the commemoration. There was a preference for the commemoration to be secular with revealed identities of donors, and not recorded for social media. The support for the establishment of commemorations transcended cultural and religious differences and confirmed students' respectful attitude toward donors. Anatomy commemorations seem to have potential not only to engage students with one another, and donor families, but also to pave the way for students to become life-long ethical and empathetic learners and practitioners.     

The Role of History and Ethics of Anatomy in Medical Education

While time spent on anatomical education in medical school curricula has been diminishing over the last decades, the recognized role of anatomical dissection has expanded. It is perceived by many students and faculty not only as the means of learning the structure and function of the human body, but also as an opportunity for the acquisition of professional competencies such as team work, patient–doctor interaction, medical epistemology, self-awareness, and an understanding of medical ethics. This viewpoint article proposes that this learning process can be supported effectively through studying examples from the history of anatomy, as insights from this history can help illuminate contemporary ethical issues in anatomy and medicine. Anatomical education can thus provide not only the opportunity of gaining awareness of ethical questions, but also a chance to practice these new insights within the protected environment of the laboratories, in interaction with the dead and the living. Consequently, a new role has developed for anatomists, which includes the interweaving of the scholarly exploration of the history and ethics of anatomy with the practical application of research results into a reframed concept of anatomical education. Anatomy, as a foundational discipline in the medical curriculum, can thus provide a first step on the educational path of empathetic and humane medical caregivers.     

Fear of Death and Examination Performance in a Medical Gross Anatomy Course with Cadaveric Dissection

Cadaveric dissection offers an important opportunity for students to develop their ideas about death and dying. However, it remains largely unknown how this experience impacts medical students' fear of death. The current study aimed to address this gap by describing how fear of death changed during a medical gross anatomy dissection course and how fear of death was associated with examination performance. Fear of death was surveyed at the beginning of the course and at each of the four block examinations using three of the eight subscales from the Multidimensional Fear of Death Scale: Fear of the Dead, Fear of Being Destroyed, and Fear for the Body After Death. One hundred forty-three of 165 medical students (86.7%) completed the initial survey. Repeated measures ANOVA showed no significant changes in Fear of the Dead (F (4, 108) = 1.45, P = 0.222) or Fear for the Body After Death (F (4, 108) = 1.83, P = 0.129). There was a significant increase in students' Fear of Being Destroyed (F (4, 108) = 6.86, P < 0.0005) after beginning dissection. This increase was primarily related to students' decreased willingness to donate their body. Concerning performance, there was one significant correlation between Fear for the Body After Death and the laboratory examination score at examination 1. Students with higher fears may be able to structure their experience in a way that does not negatively impact their performance, but educators should still seek ways to support these students and encourage body donation.     

Assessing the Impact of a Ceremony in Honor of the Body Donors in the Development of Ethical and Humanistic Attitudes among Medical Students

Activities related to body donation programs, such as donor memorial ceremonies, provide the opportunity to complement student training, especially with regard to the ethical and humanistic elements involved in medical training. This study sought to assess the impact of a ceremony in honor of the body donors has on ethical and humanistic attitudes in medical students. Medical students were surveyed about their perceptions of changes in themselves, respect for donors and donor families, and their relationship with patients. The effect of the students' contact with the family of the donor was analyzed in students who had contact with the cadaver in the dissection room and had either participated or not participated in the donor memorial ceremony. A total of 370 questionnaires were answered by first-, second-, and third-year medical students at the Federal University of Health Sciences of Porto Alegre in 2017. The students who participated in the ceremony presented more positive responses in relation to commitment to their studies, reflection on death, and positive development of empathy when compared to those who did not attend the ceremony. Most of the students that attended the ceremony suggested the event led to an improvement in the doctor–patient relationship. These results suggest that cadaver dissection with accompanied memorial ceremony involving contact with donor families is an effective means of fostering ethical and humanistic attitudes among medical students from the beginning of the course.     

Higher-Order Assessment in Gross Anatomy: A Comparison of Performance on Higher- Versus Lower-Order Anatomy Questions between Undergraduate and First-Year Medical Students

Gross anatomy is considered by many the backbone of medical education. While learning anatomy has a reputation of requiring mainly rote memorization, modern day anatomy education often involves instruction and assessment at cognitive levels that foster higher-order thinking. In many instances, these higher-order anatomical concepts are taught to graduate students in healthcare-related fields, such as medicine. At this level, students are expected to apply and analyze anatomical information since that is what will ultimately be expected of them as professionals. In contrast, undergraduate anatomy education is typically more introductory in nature and often takes place in the setting of a large-enrollment course that serves as a prerequisite for many health sciences degree programs. In this study, variables related to the assessment of higher-order concepts in clinical anatomy were compared between first-year medical students and undergraduate students enrolled in an upper-level human gross anatomy course. Results demonstrate that undergraduate students perform lower than medical students overall, but the degree of difference in how they perform on higher- versus lower-order questions is comparable. The most notable exception is on practical examinations, where undergraduate students tend to struggle more with applying and analyzing information. Exploration of additional variables provides insight into how the cognitive level being assessed affects the time it takes to answer a question and how different practical examination question types and formats influence student performance. Findings presented in this study have implications for designing anatomy courses and underscore the importance of blueprinting assessments.     

Participation in Dissection Affects Student Performance on Gross Anatomy Practical and Written Examinations: Results of a Four-Year Comparative Study

The role of human dissection in modern medical curricula has been a topic of intense debate. In part, this is because dissection can be time-consuming and curricular hours are being monitored more carefully. This has led some to question the efficacy and importance of dissection as a teaching method. While this topic has received considerable attention in the literature, the question of how dissection impacts learning has been difficult to evaluate in a real-world, high-stakes setting since participation in dissection is often one of many variables. In this study, this challenge was overcome due to a change in the curriculum of a Special Master Program (SMP) that permitted a comparison between two years of students that learned anatomy using prosection only and two years of students that participated in dissection laboratories. Since each class of SMP students took courses in the medical school, and the medical school anatomy curriculum was constant, medical student performance served as a control throughout the study period. Results demonstrate that SMP students who learned through prosection had lower performance on anatomy practical and written examinations compared to medical students. When the SMP program changed and students started participating in dissection, there were measurable improvements in both practical and written examinations. These findings provide evidence of dissection’s role in learning and applying anatomy knowledge both within and outside the gross anatomy laboratory.     

Not Just a Specimen: A Qualitative Study of Emotion,Morality, and Professionalism in One Medical School Gross Anatomy Laboratory

Medical schools are increasingly integrating professionalism training into their gross anatomy courses, teaching ethical behavior and humanistic attitudes through the dissection experience. However, many schools continue to take a traditional, technical approach to anatomical education while teaching professionalism in separate courses. This interview-based study explored how students viewed the body donor and the professional lessons they learned through dissection at one such medical school. All students oscillated involuntarily between seeing the cadaver as a specimen for learning and seeing the cadaver as a person, with some students intentionally cultivating one of these ways of seeing over the other. These views shaped students’ emotional and moral responses to the experiences of dissection. The “specimen” view facilitated a technical, detached approach to dissection, while the “person” view made students engage emotionally. Further, students who intentionally cultivated a “specimen” view generally felt less moral distress about dissection than students who intentionally cultivated a “person” view. The concept of respect gave students permission to perform dissections, but “person-minded” students developed more complex rules around what constituted respectful behavior. Both groups of students connected the gross anatomy experience to their professional development, but in different ways. “Specimen-minded” students intentionally objectified the body to learn the emotional control physicians need, while “person-minded” students humanized the body donor to promote the emotional engagement required of physicians. These findings support efforts to integrate professionalism teaching into gross anatomy courses, particularly content, addressing the balance between professional detachment and concern.     

Investigating Student Perceptions of a Dissection-Based Undergraduate Gross Anatomy Course Using Q Methodology

The demand for upper-level undergraduate dissection-based anatomy courses is growing, as professional programs require more advanced anatomy training prior to matriculation. To address this need, Indiana University School of Medicine (IUSM) partnered with Indiana University-Purdue University Indianapolis—a large, urban, life science-focused campus nearby to IUSM—to offer an undergraduate, dissection-based course in regional gross anatomy. Because this is a new course, a deeper post-course evaluation of student perceptions was conducted using Q methodology. In this study, Q methodology was used to evaluate student views of the overall course structure, pre-laboratory materials and activities, assessments, and quality of instruction. Of the 15 students in the spring semester 2018 cohort, 80% (n = 12) participated in the evaluation, and 10 of those students followed up with written explanations for their rationale in selecting the four statements with which they most strongly agreed and disagreed. The Q methodology sorted the students into one of three statistically significant groups: Motivated Dissectors (n = 6), Traditional Students (n = 3), and Inspired Learners (n = 3). Motivated Dissectors and Inspired Learners felt strongly that the course did not encourage self-directed learning and that the pre-laboratory materials were not adequate to prepare them for quizzes. Traditional Students, however, disagreed, having a favorable opinion of the pre-laboratory materials, even though this group felt most strongly that the amount of material covered in the course was overwhelming. This study demonstrates the utility of Q methodology to evaluate courses to elucidate student perspectives and inform future course modifications.     

Reflective Writing on the Cadaveric Dissection Experience: An Effective Tool to Assess the Impact of Dissection on Learning of Anatomy,Humanism, Empathy,Well-Being,and Professional Identity Formation in Medical Students

Growing evidence supports the use of reflective writing activities centered around the human cadaveric dissection experience to support and assess elements of medical student wellness. Dissection may promote personal and professional development, increase resilience, and foster a sense of connection and community. This study employed a qualitative analysis of a reflective writing exercise to explore the question: “What is the impact of the cadaveric dissection anatomy experience on the personal and professional development of medical students?” This cross-sectional study was conducted at the conclusion of the first-year anatomy module. A total of 117 United States allopathic medical students were given a questionnaire designed to elicit the students' experiences and introspection. The exercise included four reflective questions that were provided to 20 groups of six students. Grounded theory analysis was used to explore themes that arose in students' responses. Participants exhibited several common reactions to cadaveric dissection. After analyzing all responses, 266 unique open codes were identified for all four questions. These open codes were sorted into ten distinct axial codes, which are broader categorical themes of open codes. The aims of our study were to identify themes that emerged as students reflected on the impact of their dissection experience using reflective writing as a tool to capture these themes and to gather information to inform pedagogical methodologies. The researchers observed that the educational effects of dissection captured in the reflective writing resembled those found in other areas of medical education that emphasize professional identity formation and important humanistic qualities.     

Anatomy education for medical students in the United Kingdom and Republic of Ireland in 2019: A 20-year follow-up

Anatomical education in the United Kingdom (UK) and Ireland has long been under scrutiny, especially since the reforms triggered in 1993 by the General Medical Council's “Tomorrow's Doctors.” The aim of the current study was to investigate the state of medical student anatomy education in the UK and Ireland in 2019. In all, 39 medical schools completed the survey (100% response rate) and trained 10,093 medical students per year cohort. The teachers comprised 760 individuals, of these 143 were employed on full-time teaching contracts and 103 were employed on education and research contracts. Since a previous survey in 1999, the number of part-time staff has increased by 300%, including a significant increase in the number of anatomy demonstrators. In 2019, anatomy was predominantly taught to medical students in either a system-based or hybrid curriculum. In all, 34 medical schools (87%) used human cadavers to teach anatomy, with a total of 1,363 donors being used per annum. Gross anatomy teaching was integrated with medical imaging in 95% of medical schools, embryology in 81%, living anatomy in 78%, neuroanatomy in 73%, and histology in 68.3%. Throughout their five years of study, medical students are allocated on average 85 h of taught time for gross anatomy, 24 h for neuroanatomy, 24 h for histology, 11 h for living anatomy, and 10 for embryology. In the past 20 years, there has been an average loss of 39 h dedicated to gross anatomy teaching and a reduction in time dedicated to all other anatomy sub-disciplines.     

A Surgical View of Anatomy: Perspectives from Students and Instructors

As curricular emphasis on anatomy in undergraduate medical education continues to evolve, new approaches to anatomical education are urgently needed to prepare medical students for residency. A surgical anatomy class was designed for third- and fourth-year medical students to explore important anatomical relationships by performing realistic surgical procedures on anatomical donors. Under the guidance of both surgeons and anatomists, students in this month-long elective course explored key anatomical relationships through performing surgical approaches, with the secondary benefit of practicing basic surgical techniques. Procedures, such as left nephrectomy, first rib resection for thoracic outlet syndrome, and carotid endarterectomy, were adapted from those used clinically by multiple surgical subspecialties. This viewpoint commentary highlights perspectives from students and instructors that suggest the value of a surgical approach to anatomical education for medical students preparing for procedure-oriented residencies, with the goals of: (1) describing the elective at the authors' institution, (2) promoting similar efforts across different institutions, and (3) encouraging future qualitative and quantitative studies of similar pedagogic efforts.     

Anatomy as the backbone of an integrated first year medical curriculum: design and implementation

Morehouse School of Medicine chose to restructure its first year medical curriculum in 2005. The anatomy faculty had prior experience in integrating courses, stemming from the successful integration of individual anatomical sciences courses into a single course called Human Morphology. The integration process was expanded to include the other first year basic science courses (Biochemistry, Physiology, and Neurobiology) as we progressed toward an integrated curriculum. A team, consisting of the course directors, a curriculum coordinator, and the Associate Dean for Educational and Faculty Affairs, was assembled to build the new curriculum. For the initial phase, the original course titles were retained but the lecture order was reorganized around the Human Morphology topic sequence. The material from all four courses was organized into four sequential units. Other curricular changes included placing laboratories and lectures more consistently in the daily routine, reducing lecture time from 120 to 90 minute blocks, eliminating unnecessary duplication of content, and increasing the amount of independent study time. Examinations were constructed to include questions from all courses on a single test, reducing the number of examination days in each block from three to one. The entire restructuring process took two years to complete, and the revised curriculum was implemented for the students entering in 2007. The outcomes of the restructured curriculum include a reduction in the number of contact hours by 28%, higher or equivalent subject examination average scores, enhanced student satisfaction, and a first year curriculum team better prepared to move forward with future integration.     

Body Donation,Teaching, and Research in Dissection Rooms in Spain in Times of Covid-19

The state of alarm due to Covid-19 pandemic in Spain stopped all educational and most university research activities. The Spanish Anatomical Society (SAE) Consensus Expert Group on Body Donations piloted a study based on a questionnaire to know the status of body donations and dissection activities during the lockdown, as well as the future implications of Covid-19 pandemic for body donation programs and anatomy teaching. The questionnaire results show that Spanish Universities refused body donations and stopped all dissection research and teaching. The Covid-19 expected influence on anatomy teaching was referred to the increase in teaching workforce and resources required to apply the new safety measures to future practical activities, as well as to prepare and adapt teaching material for online-only programs. The application of reinforced safety measures was expected to be perceived by the respondent's students as a gain in teaching quality, while the transformation of the anatomy courses in online-only programs will be perceived as a quality decrease. The respondent's concerns about future institutional implications of the pandemic were related to increased costs of the adaptation of the facilities and the reinforced preventive measures, as well as the eventual decrease in donations. The complete lockdown applied to dissection rooms was not justified by scientific evidence and represented a break of the confidence deposed in the institutions by the donors. A consensus is required for the adoption of a renewed, comprehensive protocol for present and future body donations including the evidence Covid-19 pandemic has contributed to create.     

How Computer-Assisted Learning Influences Medical Students' Performance in Anatomy Courses

Anatomy is an essential subject of the medical curriculum. Despite its relevance, the curricular time and logistical resources devoted to teaching anatomy are in decline, favoring the introduction of new pedagogical approaches based on computer-assisted learning (CAL). This new pedagogical approach provides an insight into students' learning profiles and features, which are correlated with knowledge acquisition. The aim of this study was to understand how training with CAL platforms can influence medical students' anatomy performance. A total of 611 medical students attending Musculoskeletal Anatomy (MA) and Cardiovascular Anatomy (CA) courses were allocated to one of three groups (MA Group, CA Group, and MA + CA Group). An association between the performance in these anatomy courses and the number of CAL training sessions was detected. In the MA Group (r = 0.761, P < 0.001) and the MA + CA Group (r = 0.786, P < 0.001), a large positive correlation was observed between musculoskeletal anatomy performance and the number of CAL training sessions. Similarly, in the CA Group (r = 0.670, P < 0.001) and the MA + CA Group (r = 0.772, P < 0.001), a large positive correlation was observed between cardiovascular anatomy performance and the number of CAL training sessions. Multiple linear regression models were performed, considering either musculoskeletal or cardiovascular anatomy performance as the dependent variable. The results suggest that using CAL platforms to study has a positive dose-dependent effect on anatomy performance. Understanding students' individual features and academic background may contribute to the optimization of the learning process.     

The Benefits of an Augmented Reality Magic Mirror System for Integrated Radiology Teaching in Gross Anatomy

Early exposure to radiological cross-section images during introductory anatomy and dissection courses increases students’ understanding of both anatomy and radiology. Novel technologies such as augmented reality (AR) offer unique advantages for an interactive and hands-on integration with the student at the center of the learning experience. In this article, the benefits of a previously proposed AR Magic Mirror system are compared to the Anatomage, a virtual dissection table as a system for combined anatomy and radiology teaching during a two-semester gross anatomy course with 749 first-year medical students, as well as a follow-up elective course with 72 students. During the former, students worked with both systems in dedicated tutorial sessions which accompanied the anatomy lectures and provided survey-based feedback. In the elective course, participants were assigned to three groups and underwent a self-directed learning session using either Anatomage, Magic Mirror, or traditional radiology atlases. A pre- and posttest design with multiple choice questions revealed significant improvements in test scores between the two tests for both the Magic Mirror and the group using radiology atlases, while no significant differences in test scores were recorded for the Anatomage group. Furthermore, especially students with low mental rotation test (MRT) scores benefited from the Magic Mirror and Anatomage and achieved significantly higher posttest scores compared to students with a low MRT score in the theory group. Overall, the results provide supporting evidence that the Magic Mirror system achieves comparable results in terms of learning outcome to established anatomy learning tools such as Anatomage and radiology atlases.     

Gross anatomy videos: Student satisfaction,usage, and effect on student performance in a condensed curriculum

Anatomy educators are being tasked with delivering the same quantity and quality of material in the face of fewer classroom and laboratory hours. As a result they have turned to computer‐aided instruction (CAI) to supplement and augment curriculum delivery. Research on the satisfaction and use of anatomy videos, a form of CAI, on examination performance continues to grow. The purpose of this study was to describe the usage and effect on examination scores of a series of locally produced anatomy videos after an 11% curriculum reduction. First‐year medical students (n = 40) were given access to the videos and the prior year's students (n = 40) were used as historical controls. There was no significant difference in demographics between the two groups. The survey response rate was 85% (n = 34) in the experimental group. The students found the videos to be highly satisfying (median = 5 on a five‐point Likert scale, interquartile range = 1) and used them on average 1.55 times/week (SD ± 0.77). Availability of the videos did have a statistically significant effect (4% improvement) on the final laboratory examination (p = 0.039). This suggests that the videos were a well‐received form of CAI that may be useful in bridging the gap created by a reduction in gross anatomy course contact hours. Anat Sci Educ 7: 273–279. © 2013 American Association of Anatomists.