Medical student attitudes to the autopsy and its utility in medical education: A brief qualitative study at one UK medical school

Attending postmortems enables students to learn anatomy and pathology within a clinical context, provides insights into effects of treatment and introduces the reality that patients die. Rates of clinical autopsies have declined and medical schools have cut obligatory autopsy sessions from their curricula making it difficult to assess medical student perceptions of, and attitudes towards, the educational value of autopsy. Our aim was to investigate these perceptions by designing a brief qualitative study comprising nominal technique and focus group discussions with Cambridge Graduate Course students, all of whom had attended autopsies. Three general themes emerged from the focus group discussions: the value of autopsy as a teaching tool and ways the experience could be improved, the initial impact of the mortuary and the autopsy itself, and the “emerging patient”—an emotional continuum running from cadaver to autopsy subject and living patient. Educational benefits of autopsy‐based teaching included greater understanding of anatomy and physiology, greater appreciation of the role of other health care professionals and an enhanced appreciation of psycho‐social aspects of medical practice. Students suggested improvements for ameliorating the difficult emotional consequences of attendance. We conclude that autopsy‐based teaching represents a low‐cost teaching technique which is highly valued by students and has application to many diverse medical specialties and skills. However, careful preparation and organization of sessions is required to maximize potential educational benefits and reduce any negative emotional impact. Anat Sci Educ 7: 87–96. © 2013 American Association of Anatomists.     

Keeping dissection alive for medical students

Traditional dissection teaching is being reduced in a number of medical schools, particularly in the United Kingdom. In response to this, 12 medical students from Warwick University, UK, traveled to the Island of Grenada for an intensive extracurricular dissection course at St. George's University. This course not only benefited the host university through the creation of prosections for teaching but also allowed the participants to completely immerse themselves in anatomical study, by developing their dissection skills and consolidating anatomical knowledge. We believe that similar courses could be easily implemented by other medical schools, thereby allowing future students to keep traditional dissection alive. Anat Sci Educ 2: 302–303, 2009. © 2009 American Association of Anatomists.     

Medical students' attitudes toward the anatomy dissection room in relation to personality

Assessment of the personalities of medical students could enable medical educators to formulate strategies for the best development of academic and clinical competencies. In this article, we focus on the experience of students in the anatomy dissecting room. While there have been many attempts to evaluate the emotional responses of medical students to human cadaveric dissection, there has been no investigation into how different personality traits affect the responses. The main hypothesis tested was that there is a relationship between personality traits and attitudes toward the dissection room. For the present study, a group of French medical students (n = 403; mean age 21.3 ± 1.6; 65.3% female) completed a "Big Five" personality inventory and a questionnaire to assess their attitudes in regard to human dissection. The findings are consistent with our hypothesis, in that we found a relationship between reporting anxiety and four of the "Big Five" dimensions (all except openness). The rated level of anxiety was positively correlated with negative affectivity, more strongly at the beginning than at the end of the course. There were significant gender differences in attitudes toward dissection. The findings are discussed in relation to the possibility of preparing students for the dissecting room experience and also in relation to the students' understanding of mortality issues.     

A randomized trial comparing cadaveric dissection and examination of prosections as applied surgical anatomy teaching pedagogies

Anatomy is an important component in the vertical integration of basic science and clinical practice. Two common pedagogies are cadaveric dissection and examination of prosected specimens. Comparative studies mostly evaluate their immediate effectiveness. A randomized controlled trial design was employed to compare both the immediate and long-term effectiveness of dissection and prosection. Eighty third-year medical students undergoing their surgical rotation from the Yong Loo Lin School of Medicine were randomized into two groups: dissection and prosection. Each participated in a one-day hands-on course following a similar outline that demonstrated surgical anatomy in the context of its clinical relevance. A pre-course test was conducted to establish baseline knowledge. A post-course test was conducted immediately after and at a one-year interval to evaluate learner outcome and knowledge retention. A post-course survey was conducted to assess participant perception. Thirty-nine and thirty-eight participants for the dissection and prosection groups, respectively, were included for analysis. There was no significant difference between mean pre-course test scores between the dissection and prosection groups [12.6 (3.47) vs. 12.7 (3.16), P > 0.05]. Both the mean immediate [27.9 (4.30) vs. 24.9 (4.25), P < 0.05] and 1 year [23.9 (4.15) vs. 19.9 (4.05), P < 0.05] post-course test scores were significantly higher in the dissection group. However, when adjusted for course duration [dissection group took longer than prosection group (mean 411 vs. 265 min)], these findings were negated. There is no conclusive evidence of either pedagogy being superior in teaching surgical anatomy. Based on learner surveys, dissection provides a greater learner experience.     

Benefits of extracurricular participation in dissection in a prosection‐based medical anatomy program

The purpose of this study was to evaluate the extracurricular cadaveric dissection program available to medical students at an institution with a modern (time‐compressed, student‐centered, and prosection‐based) approach to medical anatomy education. Quantitative (Likert‐style questions) and qualitative data (thematic analysis of open‐ended commentary) were collated from a survey of three medical student cohorts who had completed preclerkship. Perceived benefits of dissection included the hands‐on learning style and the development of anatomy expertise, while the main barrier that limited participation was the time‐intensive nature of dissection. Despite perceived benefits, students preferred that dissection remain optional. Analysis of assessments for the MD2016 cohort revealed that dissection participation was associated with enhanced performance on anatomy items in each systems‐based unit examination, with the largest benefits observed on discriminating items that assessed knowledge application. In conclusion, this study revealed that there are academic and perceived benefits of extracurricular participation in dissection. While millennial medical students recognized these benefits, these students also indicated strong preference for having flexibility and choice in their anatomy education, including the choice to participate in cadaveric dissection. Anat Sci Educ 11: 294–302. © 2017 American Association of Anatomists.     

Attitudes to cadaveric organ donation in Irish preclinical medical students

There is a worldwide shortage of organs for transplantation. It has been shown that the attitude of healthcare professionals can improve the rates of organ donation, and that educational programs aimed at improving both attitudes and knowledge base of professionals can have positive outcomes. Although there has been research carried out on this topic, there has been none in Ireland. Anatomy dissection can be a stressor to medical students-we investigate the attitudes of Irish students to organ donation and how they change with exposure to anatomy dissection. A questionnaire was administered to first year students in the School of Medicine in University College Dublin, Ireland, three times over a nine-week period at the commencement of classes in an academic year. The attitudes of the students were positive throughout regarding organ donation by a stranger, a family member, or themselves. There was, however, a significant decrease in support for the donation of a family member's organs in a minority of students. Irish students' attitudes to postmortem organ donation are positive and are not changed by exposure to the dissecting room. There is support for the donation of organs, and willingness among students to donate their own organs and support donation by family members.     

Outcomes and satisfaction of two optional cadaveric dissection courses: A 3‐year prospective study

Teaching time dedicated to anatomy education has been reduced at many medical schools around the world, including Nova Medical School in Lisbon, Portugal. In order to minimize the effects of this reduction, the authors introduced two optional, semester‐long cadaveric dissection courses for the first two years of the medical school curriculum. These courses were named Regional Anatomy I (RAI) and Regional Anatomy II (RAII). In RAI, students focus on dissecting the thorax, abdomen, pelvis, and perineum. In RAII, the focus shifts to the head, neck, back, and upper and lower limbs. This study prospectively analyzes students' academic achievement and perceptions within the context of these two, newly‐introduced, cadaveric dissection courses. Students' satisfaction was assessed anonymously through a questionnaire that included items regarding students' perception of the usefulness of the courses for undergraduate teaching, as well as with regards to future professional activity. For each of the three academic years studied, the final score (1 to 20) in General Anatomy (GA), RAI, and RAII was on average 14.26 ± 1.89; 16.94 ± 1.02; 17.49 ± 1.01, respectively. The mean results were lower in GA than RAI or RAII (P < 0.001). Furthermore, students who undertook these courses ranked them highly with regards to consolidating their knowledge of anatomy, preparing for other undergraduate courses, and training for future clinical practice. These survey data, combined with data on participating students' academic achievement, lend strong support to the adoption of similar courses as complementary and compulsory disciplines in a modern medical curriculum. Anat Sci Educ 10: 127–136. © 2016 American Association of Anatomists.     

Learning from human cadaveric prosections: Examining anxiety in speech therapy students

Human anatomy education often utilizes the essential practices of cadaver dissection and examination of prosected specimens. However, these exposures to human cadavers and confronting death can be stressful and anxiety‐inducing for students. This study aims to understand the attitudes, reactions, fears, and states of anxiety that speech therapy students experience in the dissection room. To that end, a before‐and‐after cross‐sectional analysis was conducted with speech therapy students undertaking a dissection course for the first time. An anonymous questionnaire was administered before and after the exercise to understand students' feelings and emotions. State‐Trait Anxiety Inventory questionnaires (STAI‐S and STAI‐T) were used to evaluate anxiety levels. The results of the study revealed that baseline anxiety levels measured using the STAI‐T remained stable and unchanged during the dissection room experience (P > 0.05). Levels of emotional anxiety measured using the STAI‐S decreased, from 15.3 to 11.1 points (P < 0.05). In the initial phase of the study, before any contact with the dissection room environment, 17% of students experienced anxiety, and this rate remained unchanged by end of the session (P > 0.05). A total of 63.4% of students described having thoughts about life and death. After the session, 100% of students recommended the dissection exercise, giving it a mean score of 9.1/10 points. Anatomy is an important subject for students in the health sciences, and dissection and prosection exercises frequently involve a series of uncomfortable and stressful experiences. Experiences in the dissection room may challenge some students' emotional equilibria. However, students consider the exercise to be very useful in their education and recommend it. Anat Sci Educ 10: 487–494. © 2017 American Association of Anatomists.     

Factors influencing students' decisions to participate in a short “dissection experience” within a systemic anatomy course

Changes in medical education have affected both curriculum design and delivery. Many medical schools now use integrated curricula and a systemic approach, with reduced hours of anatomy teaching. While learning anatomy via dissection is invaluable in educational, professional, and personal development, it is time intensive and supports a regional approach to learning anatomy; the use of prosections has replaced dissection as the main teaching method in many medical schools. In our graduate‐entry medical degree, we use an integrated curriculum, with prosections to teach anatomy systemically. However, to not exclude dissection completely, and to expose students to its additional and unique benefits, we implemented a short “Dissection Experience” at the beginning of Year 2. Students attended three two‐hour anatomy sessions and participated in dissection of the clinically relevant areas of the cubital fossa, femoral triangle, and infraclavicular region. This activity was voluntary and we retrospectively surveyed all students to ascertain factors influencing their decision of whether to participate in this activity, and to obtain feedback from those students who did participate. The main reasons students did not participate were previous dissection experience and time constraints. The reasons most strongly affecting students' decisions to participate related to experience (lack of previous or new) and new skill. Students' responses as to the most beneficial component of the dissection experience were based around practical skills, anatomical education, the learning process, and the body donors. We report here on the benefits and practicalities of including a short dissection experience in a systemic, prosection‐based anatomy course. Anat Sci Educ 6: 225–231. © 2013 American Association of Anatomists.     

Student perspectives of imaging anatomy in undergraduate medical education

Radiological imaging is gaining relevance in the acquisition of competencies in clinical anatomy. The aim of this study was to evaluate the perceptions of medical students on teaching/learning of imaging anatomy as an integrated part of anatomical education. A questionnaire was designed to evaluate the perceptions of second‐year students participating in a clinical anatomy course over three consecutive academic years. A principal component analysis was used to evaluate the dimensionality of the questionnaire. The variables were summarized using frequencies, mean, median, 25th percentile, 75th percentile, minimum, and maximum. The results demonstrated that students felt the teaching of imaging anatomy influenced learning in the clinical anatomy course (mean = 4.5, median = 5.0) and subsequent clinical courses (mean = 4.4, median = 4.0). Regarding the imaging techniques used in the demonstration of anatomical structures, computed tomography (median = 5.0) and magnetic resonance imaging (median = 5.0) were highly rated. Students suggested the use of additional support material (37.6%) and favored a more practical approach. In conclusion, the results of this work highlight the value of imaging anatomy in learning human anatomy. Students' comments pointed out a need to focus teaching/learning programs toward a more practical rather than theoretical approach as well as a need to provide a better fit between sectional anatomy and clinical cases using imaging anatomy. In order to provide an optimal learning environment to students, it also seems important to create improved media material as an additional resource tool. Anat Sci Educ. © 2013 American Association of Anatomists.     

Surgeons as medical school educators: an untapped resource

Despite extensive experience teaching residents, surgeons are an untapped resource for educating medical students. We hypothesized that by involving surgeons as teachers earlier in the medical school curriculum, medical students' interest in surgery will increase and their opinions of surgeons will improve. Five programs designed to involve surgeons as educators in the medical school curriculum were implemented. The first program, started in 2008, introduced surgical faculty into the first-year medical student anatomy dissection laboratories. Other programs initiated in 2008 included: Surgical Clinical Correlates in Anatomy, which involved faculty teaching through cadaver surgery; Clinical Pathologic Conferences in Anatomy, a surgeon-led conference based on clinical cases; and a women's faculty-student mentorship program. Table Rounds, a surgeon-led anatomy review that used clinical scenarios to quiz students was begun in 2009. All five programs were successfully integrated into the medical school curriculum. While student opinion of surgeons as educators improved, there were no significant changes in student interest in surgery as a career nor change in performance on written examinations over the Anatomy content covered by the surgeons. Surgical faculty and trainees can be integrated into the medical school curriculum. Involving surgeons as educators earlier in the medical school curriculum may have longer term effects than could be observed in this study. At a minimum, the experience improved student opinion of surgeons as educators.     

Resident perceptions of anatomy education: a survey of medical school alumni from two different anatomy curricula and multiple medical specialties

In 2004, the University of Michigan Medical School reduced its gross anatomy curriculum. To determine the effect of this reduction on resident perceptions of their clinical preparedness, we surveyed alumni that included residents from the original and new shortened curricula. A Likert-scale survey was sent to four classes of alumni. Respondents were compared in old curriculum (OC) and new curriculum (NC) groups, surgical specialty (SS) and nonsurgical specialty (NS) groups, and subgroups of SS and NS were compared for differences between OC and NC. Mean response scores were compared using independent samples T-tests. As a single population (n = 110), respondents felt their anatomy education prepared them well for residency, that a more robust anatomy curriculum would be helpful, that dissection was important to their residency preparation, and that a 4th year anatomy elective was effective in expanding their anatomy education and preparing them for residency. No significant difference existed between OC and NC groups, neither as a whole nor as SS and NS subgroups. The SS group felt dissection was more important to their residency preparation than the NS group (P = 0.001) and that a more robust anatomy curriculum would have better prepared them for residency (P = 0.001). Thirty percent of SS respondents who did not take a 4th year elective commented that they wish they had. Fourth year anatomy electives were highly valued by residents, and respondents felt that they should be offered to students as a way of revisiting anatomy following the 1st year of clinical training.     

Learning anatomy through Thiel‐ vs. formalin‐embalmed cadavers: Student perceptions of embalming methods and effect on functional anatomy knowledge

Thiel‐embalmed cadavers, which have been adopted for use in anatomy teaching in relatively few universities, show greater flexibility and color retention compared to formalin‐embalmed cadavers, properties which might be considered advantageous for anatomy teaching. This study aimed to investigate student attitudes toward the dissection experience with Thiel‐ compared to formalin/ethanol‐embalmed cadavers. It also aimed to determine if one embalming method is more advantageous in terms of learning functional anatomy through the comparison of student anterior forearm functional anatomy knowledge. Student opinions and functional anatomy knowledge were obtained through use of a questionnaire from students at two medical schools, one using Thiel‐, and one using more traditional formalin/ethanol‐embalmed cadavers. Both the Thiel group and the formalin group of students were surveyed shortly after completing an anterior forearm dissection session. Significant differences (P‐values <0.01) in some attitudes were found toward the dissection experience between cohorts using Thiel‐ vs. formalin‐embalmed cadavers. The Thiel group of students felt more confident about recognizing anatomy in the living individual, found it easier to identify and dissect anatomical structures, and indicated more active exploration of functional anatomy due to the retained flexibility of the cadaver. However, on testing, no significant difference in functional anatomy knowledge was found between the two cohorts. Overall, although Thiel embalming may provide an advantageous learning experience in some investigated areas, more research needs to be carried out, especially to establish whether student perception is based on reality, at least in terms of structure identification. Anat Sci Educ 11: 166–174. © 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.     

Anatomy education in a changing medical curriculum in India: Medical student feedback on duration and emphasis of gross anatomy teaching

Authors report here a survey of medical student feedback on the effectiveness of two different anatomy curricula at Christian Medical College, Vellore, India. Undergraduate medical students seeking the Bachelor in Medicine and Bachelor in Surgery (M.B.B.S.) degrees were divided into two groups by the duration of their respective anatomy curriculum. Group 1 students had completed a longer, 18‐month curriculum whereas Group 2 counterparts followed a shorter, 12‐month curriculum. Students' responses to a questionnaire were studied. Analysis of feedback from Groups 1 and 2 contrasted the effectiveness of the two anatomy curricula. The coverage of gross anatomy was rated adequate or more than adequate by 98% of Group 1 and 91% of Group 2. A desire for greater emphasis on gross anatomy teaching was expressed by 24% of Group 1 and 50% of Group 2 (P = 0.000). Two‐thirds of all students felt that the one‐year program was not adequate, and 90% of Group 1 and 74% of Group 2 felt that clinically oriented anatomy teaching required more emphasis. Dissection was helpful or very helpful for 94% of Group 1 and 88% of Group 2. This study suggests that a better understanding of gross anatomy was gained from a course of longer duration (18 months with 915 contact hr vs. 12 months with 671 contact hr). Students who completed the longer anatomy course had greater appreciation of the need for clinically oriented anatomy teaching and dissection. Anat Sci Educ 2:179–183, 2009. © 2009 American Association of Anatomists.     

Does an Audiovisual Dissection Manual Improve Medical Students' Learning in the Gross Anatomy Dissection Course?

The gross anatomy dissection course is considered to be one of the most important subjects in medical school. Advancing technology facilitates the production of e-learning material that can improve the learning of topographic anatomy during the course. The purpose of this study was to examine a locally produced audiovisual dissection manual's effects on performance in dissection, formal knowledge gained, motivation, emotions, learning behavior, and learning efficiency of the medical students. The results, combined with the total effort put into the production of the manual, should support decisions on further implementation of this kind of audiovisual e-learning resource into the university's curriculum. First-year medical students (n = 279) were randomly divided into three groups for two weeks within the regular dissection course hours during the dissection of the anterior and posterior triangles of the neck. Two groups received an audiovisual dissection manual (n = 96) or an improved written manual (n = 94) as an intervention, the control group (n = 89) received the standard dissection manual. After dissection, each student filled out tests and surveys and their dissections were evaluated. The audiovisual dissection manual did not have any significant positive effects on the examined parameters. The effects of the audiovisual dissection manual on the medical students' learning experience, as observed in this study, did not support further curriculum implementation of this kind of e-learning resource. This study can serve as an orientation for further evaluation and design of e-learning resources for the gross anatomy dissection course.     

Cultural acceptability and personal willingness of Iranian students toward cadaveric donation

Cadaver dissection stands as a crucial component in medical curricula around the world, although computer‐based multimedia programs have been introduced in order to replace the need for cadaver donations. Due to a decrease in the number of unclaimed bodies and rather few donations, there is an insufficient number of cadavers for anatomical studies in Iran. This study was carried out to evaluate medical students' awareness and willingness regarding body donation in Kashan University of Medical Sciences, Iran. In this study, a questionnaire was designed to focus on the cultural acceptability and personal willingness to donate one's body after death. Students from the university's anatomy classes (n = 331) participated in this study. Seventy‐seven percent of the students expressed their agreement toward the idea of utilizing body donation services, though only 25.4% of participants were willing to donate their own bodies. None of the demographic factors were associated with cultural acceptability or personal willingness towards body donation. These findings indicated that besides “payment”, other factors were associated with students' willingness to become donors. All factors of awareness except “previous awareness of organization” were associated with cultural acceptability. In this study, students suggested that encouraging people to register for body donation using mass media (25.6%) and teaching students to respect cadavers in the dissection environment (24.8%) were the best solutions for addressing the lack of cadavers. These findings indicated that a lack of awareness about body donation might be the main factor responsible for unwillingness towards body donation; therefore, improving the public's awareness and addressing the willingness of students regarding body donation may help overcome the current lack of donated cadavers. Anat Sci Educ 10: 120–126. © 2016 American Association of Anatomists.     

Impact of Background Music on Medical Student Anxiety and Performance During Anatomical Dissections: A Cluster Randomized Interventional Trial

Anatomical dissection on cadavers can be a source of anxiety for medical students. Studies in other stressful settings have shown a reduction in anxiety when there is background music. The objective of this study was to determine if music can have an impact on student anxiety, student satisfaction, and student performance in dissection room. This cluster randomized interventional trial included 187 second-year medical students. The intervention was standardized background music, selected based on the literature, with a tempo of between 60 and 80 bpm. Six balanced clusters were randomized (1:1) to music or no music during dissection sessions. The main assessment criterion was a validated self-evaluation scale score for anxiety, the State Trait Anxiety Inventory. Student satisfaction was measured using a visual analog scale and dissection performance was evaluated by an examination. The outcomes were analyzed with mixed models adjusted on group effect, chronic anxiety, and confounding factors. A significant (58%) relative decrease in acute anxiety, odds ratio 0.423 [0.160; 0.710] was found for the music intervention group. Music also had a positive impact on performance with students in the intervention group attaining higher grades than those in the control group (0.42/10 higher, P = 0.0016). The study also showed a nonsignificant increase in satisfaction with 0.37 extra points (P = 0.137) in the intervention group. Background music had a significant impact on anxiety in the dissection room and on technical and theoretical performance in the subsequent anatomy examination. This music intervention could be extended to other stressful work environments.