1
|
Abdullah NK, Ahmad NA, Ramli SB, Razak NA. The need for mandatory autopsy teaching in Forensic Medicine for medical students. Autops Case Rep 2024; 14:e2024509. [PMID: 39176103 PMCID: PMC11340820 DOI: 10.4322/acr.2024.509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Accepted: 05/27/2024] [Indexed: 08/24/2024]
Abstract
The effectiveness of the autopsy as an educational tool in forensic medicine courses has been widely acknowledged, and medical students were expected to attend regularly. Nevertheless, the use of autopsies for teaching has dramatically declined in recent years and worldwide despite their high-value benefits. This study aims to understand the importance and relevance of attending autopsies during forensic teaching sessions and identify any challenges that may impede attendance. A self-administered online questionnaire that assesses the knowledge, attitudes, and practices related to autopsies attendance was distributed to fourth-year medical students at the National Defence University of Malaysia and Universiti Sains Islam Malaysia. A total of 99 respondents were involved in this study. Our findings indicate that most respondents (over 85%) demonstrated good knowledge of forensic medicine. Pearson's statistical test revealed a significant correlation between the knowledge and students' attitudes toward autopsy. This study demonstrates the need to strategically integrate autopsy attendance into medical curricula to encourage constructive attitudes and practices among medical students. Students gain the most benefits from frequently attending autopsies. Passionate educators can conduct preparatory sessions to set expectations and address concerns, encourage students to process their experiences, and reinforce learning outcomes in the mortuary setting. Mandatory autopsy teaching should be integrated into the curriculum to ensure medical students have the necessary skills and knowledge to become competent doctors.
Collapse
Affiliation(s)
| | - Nur Arina Ahmad
- Universiti Sains Islam Malaysia, Forensic Medicine Unit, Nilai, Negeri Sembilan, Malaysia
| | | | - Nadiawati Abdul Razak
- National Defence University of Malaysia (NDUM), Faculty of Medicine and Defence Health, Forensic Medicine Unit, Sungai Besi, Kuala Lumpur, Malaysia
| |
Collapse
|
2
|
Tannenbaum AP, Lilley CM. Perspectives from two recent medical school graduates on exposure to pathology during undergraduate medical education: A narrative inquiry. Acad Pathol 2023; 10:100094. [PMID: 37840650 PMCID: PMC10568268 DOI: 10.1016/j.acpath.2023.100094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/04/2023] [Accepted: 08/05/2023] [Indexed: 10/17/2023] Open
Abstract
The field of pathology is facing an inflection point where the demand for pathology services is not being met by a corresponding rise in recruitment into the field. Many of the myths about the field of pathology have been dispelled elsewhere, but there have not been many formal accounts of the experience medical students' face when finding their path to pathology. Because of challenges in the visibility of pathology as a specialty and not simply a subject required for United States Medical Licensing Examination Step 1, students tend to fall into one of two categories: early differentiators or late discoverers. Here, we provide anecdotal accounts of these two paths at institutions with different curricular designs and provide a first-hand account of the challenges we faced and opportunities discovered in our journeys to pathology. Based on these experiences, we offer suggestions for ways to address some of the issues medical students must navigate when trying to explore pathology in curricula not built for such exploration.
Collapse
Affiliation(s)
- Alex P. Tannenbaum
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | |
Collapse
|
3
|
Wu A, Xiao QY, McWatt S, Utomo R, Talis A, Saraci K, Brassett C, Sagoo MG, Wingate R, Chien CL, Traxler H, Waschke J, Vielmuth F, Yamada Y, Sakurai T, Zeroual M, Olsen J, El-Batti S, Viranta-Kovanen S, Keay K, Stewart W, Kunzel C, Bernd P, Kielstein H, Noël GPJC. The Anatomy Course During COVID-19: The Impact of Cadaver-Based Learning on the Initiation of Reflection on Death. MEDICAL SCIENCE EDUCATOR 2022; 32:1033-1044. [PMID: 36097588 PMCID: PMC9453724 DOI: 10.1007/s40670-022-01609-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 05/28/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, in-person cadaveric dissection laboratories for teaching anatomy were omitted by many schools around the world. While knowledge domains can be easily evaluated via remote exams, non-traditional discipline-independent skills such as those encouraged through reflection on the topic of death are often overlooked. This study investigated how different anatomy course formats played a role in initiating students' reflections on death during the COVID-19 pandemic. METHOD In fall 2020, 217 medical, dental, premedical, and health sciences students from 13 international universities discussed differences in their anatomy courses online. Formats of anatomy courses ranged from dissection-based, prosection-based, hybrid (combination of dissection and prosection) to no laboratory exposure at all. Students' responses to the question, "Did/does your anatomy course initiate your thinking about life's passing?" were collected, and they self-reported themes that were present in their reflections on death using a multiple-choice prompt. Statistical analyses to detect differences between students with and without exposure to cadavers were performed using the chi-squared test. RESULTS When comparing students who had exposure to human anatomical specimens to those who had no exposure, the majority of students with exposure thought that the course did initiate thoughts about life's passing, compared to students without exposure (P < 0.05). Reflection themes were consistent across groups. DISCUSSION These findings indicate that anatomy dissection courses are important for the initiation of students' feelings about the topic of death. Omission of cadaveric dissection- or prosection-based laboratories will decrease the likelihood that students initiate reflection on this topic and gain important transferable skills.
Collapse
Affiliation(s)
- Anette Wu
- Department of Medicine and Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY USA
| | - Que Yun Xiao
- Department of Medicine and Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY USA
| | - Sean McWatt
- Department of Anatomy and Cell Biology, McGill University, Montreal, Canada
| | - Rachel Utomo
- Department of Medicine and Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY USA
| | - Austin Talis
- Department of Medicine and Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY USA
| | - Kerstin Saraci
- Institute of Anatomy, Faculty of Medicine, Vegetative Anatomy, Ludwig Maximilian University, Munich, Germany
| | - Cecilia Brassett
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Mandeep Gill Sagoo
- Department of Anatomy and Neurobiology, School of Centre for Education, King’s College London, London, UK
| | - Richard Wingate
- Department of Anatomy and Neurobiology, School of Centre for Education, King’s College London, London, UK
| | - Chung-Liang Chien
- Department of Anatomy and Cell Biology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hannes Traxler
- Center for Anatomy and Cell Biology, Medical University Vienna, Vienna, Austria
| | - Jens Waschke
- Institute of Anatomy, Faculty of Medicine, Vegetative Anatomy, Ludwig Maximilian University, Munich, Germany
| | - Franziska Vielmuth
- Institute of Anatomy, Faculty of Medicine, Vegetative Anatomy, Ludwig Maximilian University, Munich, Germany
| | - Yukari Yamada
- Kyoto University Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeshi Sakurai
- Department of Medicine and Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY USA
- Kyoto University Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Mina Zeroual
- Department of Anatomy and Cell Biology, McGill University, Montreal, Canada
| | - Jorgen Olsen
- Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Salma El-Batti
- Department of Cardiovascular Surgery, University of Paris, Paris, France
| | | | - Kevin Keay
- Discipline of Anatomy and Histology, The University of Sydney, Sydney, Australia
| | - William Stewart
- Anatomy Section, Department of Surgery, Yale University, New Haven, CT USA
| | - Carol Kunzel
- Department of Medicine and Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY USA
| | - Paulette Bernd
- Department of Medicine and Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY USA
| | - Heike Kielstein
- Institute for Anatomy and Cell Biology, Medical Faculty, Martin Luther University, Halle-Wittenberg, Germany
| | - Geoffroy P. J. C. Noël
- Anatomy Division, Department of Surgery, University of California San Diego, San Diego, CA USA
| |
Collapse
|
4
|
Pakanen L, Tikka J, Kuvaja P, Lunetta P. Autopsy-Based Learning is Essential But Underutilized in Medical Education: A Questionnaire Study. ANATOMICAL SCIENCES EDUCATION 2022; 15:341-351. [PMID: 33730442 DOI: 10.1002/ase.2073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 03/13/2021] [Accepted: 03/14/2021] [Indexed: 06/12/2023]
Abstract
To this day, autopsies and dissections have been essential in medical education, but declining autopsy numbers have endangered this long-standing tradition. Students' perceptions of these teaching methods should be constantly updated to help educators understand how to achieve their teaching goals. The purpose of this study was to explore the state of autopsy- and dissection-based teaching in two Finnish universities based on the experiences of the students, survey their perceptions of such teaching, and to compare the Finnish situation with students' perceptions in other countries as it emerges from medical literature. A questionnaire went to 859 second-, fourth-, and sixth-year medical students. The questions concerned dissection and autopsy classes these students had attended, the views of the students in regard to the number of classes, and the benefits of and attitudes towards autopsy teaching. An open question of how to improve autopsy teaching was included. The response rate was 19.4%. Most respondents requested more autopsy and dissection classes, especially practical education. They found autopsies most beneficial in learning anatomy and dealing with one's own emotions related to death. Their experiences proved least beneficial for interaction with the relatives of a deceased patient and for people skills. Integrational methods and focusing on the main learning outcomes were suggested as improvements. Overall, students found dissection and autopsy teaching important, but felt concerned about the diminishing autopsy numbers. Focusing on main learning objectives and better integration of autopsies in the teaching of different specialties could help to utilize autopsies to a greater extent.
Collapse
Affiliation(s)
- Lasse Pakanen
- Forensic Medicine Unit, Finnish Institute for Health and Welfare, Oulu, Finland
- Department of Forensic Medicine, Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Julius Tikka
- Forensic Medicine Unit, Finnish Institute for Health and Welfare, Turku, Finland
| | - Paula Kuvaja
- Forensic Medicine Unit, Finnish Institute for Health and Welfare, Oulu, Finland
- Department of Pathology, Oulu University Hospital, Oulu, Finland
| | - Philippe Lunetta
- Department of Forensic Medicine, Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu, Oulu, Finland
- Department of Biomedicine, Forensic Medicine, University of Turku, Turku, Finland
| |
Collapse
|
5
|
Vaduva AO, Serban CL, Lazureanu CD, Cornea R, Vita O, Gheju A, Jurescu A, Mihai I, Olteanu EG, Lupu V, Pup A, Cornianu M, Mureșan A, Taban S, Dema ALC. Three-Dimensional Virtual Pathology Specimens: Decrease in Student Performance upon Switching to Digital Models. ANATOMICAL SCIENCES EDUCATION 2022; 15:115-126. [PMID: 33319472 DOI: 10.1002/ase.2041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 12/04/2020] [Accepted: 12/11/2020] [Indexed: 06/12/2023]
Abstract
Several alternatives to formalin-stored physical specimens have been described in medical literature, but only a few studies have addressed the issue of learning outcomes when these materials were employed. The aim of this study was to conduct a prospective controlled study to assess student performance in learning anatomic pathology when adding three-dimensional (3D) virtual models as adjunct teaching materials in the study of macroscopic lesions. Third-year medical students (n = 501) enrolled at the Victor Babes University of Medicine and Pharmacy in Timisoara, Romania, were recruited to participate. Student performance was assessed through questionnaires. Students performed worse with new method, with poorer results in terms of overall (mean 77.6% ±SD 11.8% vs. 83.6% ±10.5) and individual question scores (percentage of questions with maximum score 34.6% ±25.6 vs. 47.7 ± 24.6). This decreased performance was generalizable, as it was observed across all language divisions and was independent of the teaching assistant involved in the process. In an open-ended feedback evaluation of the new 3D specimens, most students agreed that the new method was better, bringing arguments both for and against these models. Although subjectively the students found the novel teaching materials to be more helpful, their learning performance decreased. A wider implementation as well as exposure to the technique and use of virtual specimens in medical teaching could improve the students' performance outcome by accommodating the needs for novel teaching materials for digital natives.
Collapse
Affiliation(s)
- Adrian O Vaduva
- Discipline of Morphopathology, Department of Microscopic Morphology, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Costela L Serban
- Discipline of Medical Informatics and Biostatistics, Department of Functional Studies, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
- Department of Genetics, Louis Turcanu Clinical Emergency Children's Hospital, Timisoara, Romania
| | - Codruta D Lazureanu
- Discipline of Morphopathology, Department of Microscopic Morphology, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Remus Cornea
- Discipline of Morphopathology, Department of Microscopic Morphology, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Octavia Vita
- Discipline of Morphopathology, Department of Microscopic Morphology, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Adelina Gheju
- Discipline of Morphopathology, Department of Microscopic Morphology, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Aura Jurescu
- Discipline of Morphopathology, Department of Microscopic Morphology, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Ioana Mihai
- Discipline of Morphopathology, Department of Microscopic Morphology, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Emilian G Olteanu
- Discipline of Morphopathology, Department of Microscopic Morphology, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
- Center for Gene and Cellular Therapies in Cancer Treatment - Oncogen, Pius Branzeu Emergency County Hospital, Timisoara, Romania
| | - Vlad Lupu
- Discipline of Morphopathology, Department of Microscopic Morphology, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Alexandra Pup
- Discipline of Morphopathology, Department of Microscopic Morphology, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Marioara Cornianu
- Discipline of Morphopathology, Department of Microscopic Morphology, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Anca Mureșan
- Discipline of Morphopathology, Department of Microscopic Morphology, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Sorina Taban
- Discipline of Morphopathology, Department of Microscopic Morphology, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Alis L C Dema
- Discipline of Morphopathology, Department of Microscopic Morphology, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| |
Collapse
|
6
|
Wilhelm J, Mattingly S, Gonzalez VH. Perceptions, satisfactions, and performance of undergraduate students during Covid-19 emergency remote teaching. ANATOMICAL SCIENCES EDUCATION 2022; 15:42-56. [PMID: 34859608 PMCID: PMC9011711 DOI: 10.1002/ase.2161] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/13/2021] [Accepted: 11/29/2021] [Indexed: 06/12/2023]
Abstract
Due to the Covid-19 pandemic, the education system worldwide faced sudden and unforeseen challenges. Many academic institutions closed their doors, forcing both educators and students to transition to Emergency Remote Teaching (ERT) for the remainder of the semester. This transition eliminated hands-on experiences, increased workload, and altered curricula. However, these aspects, as well as students' perceptions, study habits, and performance in response to ERT remain poorly documented. This contribution describes changes in the curriculum of an undergraduate cadaver-based laboratory, and explores students' performance, self-perceived learning, and overall satisfaction during this educational crisis. Online content delivery for this course included both asynchronous instruction and synchronous discussion sessions. While formative assessments remained the same, online spotter examinations included short answer, multiple choice, multiple answer, ordering, and true and false questions. Despite examination grades improving 20% during ERT, students reported lower levels of learning, confidence, and engagement with the course materials when compared to the face-to-face portion of the class. The most prevalent challenges identified by students were those related to the loss of access to cadaver-based learning, including difficulty identifying and visualizing structures in three dimensions, and the loss of context and sensorial cues. Flexibility in taking examinations and learning the material at their own pace were recognized as positive outcomes of the ERT transition. While the resulting student perceptions and performances are unsurprising, they offer insight into the challenges of fostering a productive learning environment in a future threatened by epidemic outbreak and economic uncertainty.
Collapse
Affiliation(s)
- Jessica Wilhelm
- Department of Ecology and Evolutionary BiologyCollege of Liberal Arts and SciencesUniversity of KansasLawrenceKansasUSA
| | - Spencer Mattingly
- Department of Ecology and Evolutionary BiologyCollege of Liberal Arts and SciencesUniversity of KansasLawrenceKansasUSA
| | - Victor H. Gonzalez
- Department of Ecology and Evolutionary BiologyCollege of Liberal Arts and SciencesUniversity of KansasLawrenceKansasUSA
- Undergraduate Biology ProgramCollege of Liberal Arts and SciencesUniversity of KansasLawrenceKansasUSA
| |
Collapse
|
7
|
Rosendahl A, Mjörnheim B, Eriksson LC. Autopsies and quality of cause of death diagnoses. SAGE Open Med 2021; 9:20503121211037169. [PMID: 34394931 PMCID: PMC8351029 DOI: 10.1177/20503121211037169] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 07/16/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: The consequences of a low autopsy rate are not considered in determining the cause of death. Method: We have analyzed the Cause of Death Register of the Swedish National Board of Health and Welfare since it started 1969 to and including 2016 to visualize the decline in the frequency of clinical autopsies over time and evaluated the effect on the quality of the cause of death diagnoses. Results: Over the five decades studied, the frequency of clinical autopsies declined from almost 40% to less than 5%. The rate of decline was not even. Political decisions and changes of healthcare organization in Sweden affected the slope of decline of autopsies superimposed on a linear decline over time reflecting changes in clinical routines. A request of clinical autopsies was highly dependent on the level of care at the time of death, with the lowest number of requests for persons who died in nursing homes. The age at the time of death was a major factor affecting the number of autopsies, resulting in an autopsy rate of less than 1% in the ages where most persons die. Although men were autopsied more often than women, a gender-specific difference was not seen after correction for the age of death. We also found a higher rate of unspecific and irrelevant diagnosis in the cases not autopsied and we know from earlier studies by us and other authors that the cause of death diagnoses were missed in between 30% and 50% of the cases not autopsied. Conclusion: The decline in the clinical autopsy rate reduced the value of the death certificate register. An increase in the number of autopsies performed will improve the understanding of disease and cause of death, as well as to better inform next of kin.
Collapse
Affiliation(s)
- Anders Rosendahl
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Berit Mjörnheim
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lennart C Eriksson
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
8
|
Keleş Ş, Gül Ş, Yıldız A, Karabulut SD, Eren H, İskender MD, Baykara ZG, Yalım NY. Ethical Discourse of Medical Students on the Phenomenon of Death: A Qualitative Study. OMEGA-JOURNAL OF DEATH AND DYING 2021; 87:146-176. [PMID: 34018435 DOI: 10.1177/00302228211014772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study is to discover medical students' ideas on the phenomenon of death; produce information on how these students interpret the value-related problems regarding death that they come across in different units of hospitals; and assess this data in ethical terms. This study included a qualitative research in which 12 focus group interviews were conducted with 92 fifth- and sixth-year medical students. Data obtained from interviews were assessed using a thematic content secondary analysis. The main themes were specified according to the medical students' statements and were reviewed under the contexts of the "dying process"; "effects of death"; "attitude and behavior of health professionals"; "seeing a dead body/looking at a dead body"; "accepting death"; and "forms of expressions of death." Medical students' encounters with death in different units of hospitals leads them to question their values and familiarize themselves with the borders of their areas of profession.
Collapse
Affiliation(s)
- Şükrü Keleş
- Department of Medical History and Ethics, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Şenay Gül
- Fundamentals of Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
| | - Abdullah Yıldız
- Department of Medical History and Ethics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Seyhan Demir Karabulut
- Department of Medical History and Ethics, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Handan Eren
- Department of Nursing, Health Sciences Faculty, Yalova University, Yalova, Turkey
| | | | | | | |
Collapse
|
9
|
Holland JC, Ní Dhónaill R, Clarke M, Joyce P. Physician Associate Students' Experience of Anatomy Dissection. ANATOMICAL SCIENCES EDUCATION 2021; 14:52-61. [PMID: 32452170 DOI: 10.1002/ase.1984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 05/15/2020] [Accepted: 05/16/2020] [Indexed: 06/11/2023]
Abstract
The role of physician assistant/associate (PA) has expanded from its inception in the United States over 50 years ago, to European countries including Ireland. While there is an increasing body of evidence exploring the role and training of PAs in clinical settings, there is a scarcity of research exploring PA students' perspectives in relation to their experience of anatomy dissection, or how these experiences may contribute to the development of their core professional identity. Students in the first two cohorts of PA Program at the Royal College of Surgeons in Ireland program were invited to interviews which solicited them to reflect and report on their own experiences of anatomical dissection during their course. Participants' responses were analyzed using a thematic inductive approach; common themes and patterns were organized into a hierarchical structure, which generated the final framework of themes. Ten participants took part in the study; only one had previous personal experience of dissection, while two further participants had some familiarity with prosected specimens. The first theme concerned the participants' expectation of anatomical dissection, with sub-themes of preconceptions, smell, and emotions. The second theme involves discussion of coping strategies that the participants used, including talking, viewing the cadaver as their first patient, and naming (or not naming) the cadaver. The third theme includes how the participants' talked about respect and compassion in the dissection room, development of team working skills, and awareness of bereavement and organ donation. A number of recommendations were also made for the experience and orientation of future students in such a program.
Collapse
Affiliation(s)
- Jane C Holland
- Department of Anatomy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Maeve Clarke
- Department of Oncology, Beaumont Hospital, Dublin, Ireland
| | - Pauline Joyce
- Physician Associate Program, Royal College of Surgeons in Ireland, Dublin, Ireland
| |
Collapse
|
10
|
Autopsy Observation as Experiential Learning for Nurse Practitioner Students in an Online Advanced Pathophysiology Course. Nurse Educ 2020; 45:111-113. [PMID: 32106149 DOI: 10.1097/nne.0000000000000684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Many instructional classrooms now exist in the online environment, where it is difficult to integrate experiential teaching strategies. Autopsy-based education has been shown to be a valuable teaching tool for pathophysiology in a medical school curriculum. PROBLEM There is a gap in the literature about the use of an autopsy observation in nurse practitioner (NP) education. APPROACH The purpose of this project was to develop and evaluate the effectiveness of an autopsy experience for NP students in an online advanced pathophysiology course. OUTCOMES Based on a review of course evaluations and reflective essays, the majority of students found this to be a valuable learning experience. The main barrier was locating a facility and scheduling the autopsy observation. CONCLUSION The benefits outweigh the barriers to providing experiential learning with an autopsy observation in an online pathophysiology course. As such, it should be considered in similar course offerings.
Collapse
|
11
|
Abuhaimed AK, Almulhim AM, Alarfaj FA, Almustafa SS, Alkhater KM, Al Yousef MJ, Al Bayat MI, Madadin M, Menezes RG. Histologic Reliability of Tissues from Embalmed Cadavers: Can They be Useful in Medical Education? SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2020; 8:208-212. [PMID: 32952513 PMCID: PMC7485655 DOI: 10.4103/sjmms.sjmms_383_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/29/2019] [Accepted: 07/09/2020] [Indexed: 12/02/2022]
Abstract
Background: Current trends in medical curricula are shifting from teaching histology and pathology as stand-alone disciplines. Therefore, it would be useful to examine the potential value of integrating these into the anatomical dissection experience. Objectives: The aim of this study was to assess the histologic reliability of tissues taken from embalmed cadavers in an anatomy laboratory. Materials and Methods: A total of 112 tissue samples were obtained using standard autopsy techniques from various organs (heart, lung, thyroid, skeletal muscle, bone and skin) of 11 cadavers available at the anatomy laboratory of Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia, in 2019. Samples were prepared using the standard paraffin procedure followed by cutting sections at 4-μm thickness and staining with standard hematoxylin and eosin stain. Using predefined criteria, the quality of the samples was evaluated by two board-certified histopathologists and each slide was categorized as good, satisfactory or poor. Results: Overall, 34.2% and 60.3% of the slides were of good and satisfactory quality, respectively. A significant difference in tissue quality was found between various organs. Thick skin and bone tissues had the highest “good” rating (84.6% and 81.8%, respectively), while thyroid and lung tissues had the highest “poor” rating (20% and 13.6%, respectively). Conclusion: Most of the tissues acquired from the embalmed cadavers were of good or satisfactory quality, thereby indicating the beneficial use of histological tissue from cadavers for educational purposes. Future research into how these findings translate into meaningful medical education would be beneficial.
Collapse
Affiliation(s)
| | - Abdulaziz M Almulhim
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Faris A Alarfaj
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Salam S Almustafa
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Khulood M Alkhater
- Department of Anatomy, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammed J Al Yousef
- Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Methal I Al Bayat
- Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammed Madadin
- Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ritesh G Menezes
- Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| |
Collapse
|
12
|
Khin-Htun S, Kushairi A. Twelve Tips for Developing Clinical Reasoning Skills in the Pre-Clinical and Clinical Stages of Medical School. MEDICAL TEACHER 2019; 41:1007-1011. [PMID: 30299197 DOI: 10.1080/0142159x.2018.1502418] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Clinical reasoning (CR) is a complex skill required in future clinicians. The best way to develop CR has not been fully elucidated in existing literature. Barriers to CR development include content, environmental, and teacher or expert physician factors. We have reviewed literature, interviewed medical students and teaching staff at the University of Nottingham, and evaluated our teaching delivery. We identified twelve strategies to combat barriers to CR learning at our university. The foundation for CR must be built early through lectures and case-based learning. We emphasize the irreplaceable nature of ward-based learning and add on methods of optimizing time on wards. Placement on acute wards with trained teaching staff to facilitate CR teaching was suggested. Ward time should be supplemented with symptom-focused teaching, patient workshops, simulation sessions, virtual case banks, and clinical skills practice. However, ward time is the utmost priority and must not be replaced.
Collapse
Affiliation(s)
- Swe Khin-Htun
- School of Medicine, University of Nottingham , Nottingham , United Kingdom
| | - Anisa Kushairi
- School of Medicine, University of Nottingham , Nottingham , United Kingdom
| |
Collapse
|
13
|
Rae G, Newman WP, McGoey R, Donthamsetty S, Karpinski AC, Green J. The histopathologic reliability of tissue taken from cadavers within the gross anatomy laboratory. ANATOMICAL SCIENCES EDUCATION 2018; 11:207-214. [PMID: 29024453 DOI: 10.1002/ase.1743] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 09/11/2017] [Accepted: 09/12/2017] [Indexed: 06/07/2023]
Abstract
The purpose of this study was to examine the histopathologic reliability of embalmed cadaveric tissue taken from the gross anatomy laboratory. Tissue samples from hearts, livers, lungs, and kidneys were collected after the medical students' dissection course was completed. All of the cadavers were embalmed in a formalin-based fixative solution. The tissue was processed, embedded in paraffin, sectioned at six micrometers, and stained with H&E. The microscope slides were evaluated by a board certified pathologist to determine whether the cellular components of the tissues were preserved at a high enough quality to allow for histopathologic diagnosis. There was a statistically significant relationship between ratings and organ groups. Across all organs, there was a smaller proportion of "poor" ratings. The lung group had the highest percentage of "poor" ratings (23.1%). The heart group had the least "poor" ratings (0.0%). The largest percentage of "satisfactory" ratings were in the lung group (52.8%), and the heart group contained the highest percentage of "good" ratings (58.5%) The lung group had the lowest percentage of "good" ratings (24.2%). These results indicate that heart tissue is more reliable than lung, kidney, or liver tissue when utilizing tissue from the gross anatomy laboratory for research and/or educational purposes. This information advises educators and researchers about the quality and histopathologic reliability of tissue samples obtained from the gross anatomy laboratory. Anat Sci Educ 11: 207-214. © 2017 American Association of Anatomists.
Collapse
Affiliation(s)
- Guenevere Rae
- Department of Cell Biology and Anatomy School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - William P Newman
- Department of Pathology School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Robin McGoey
- Department of Pathology School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | | | - Aryn C Karpinski
- School of Foundations, Leadership, and Administration, Kent State University, Kent, Ohio
| | - Jeffrey Green
- Department of Cell Biology and Anatomy School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| |
Collapse
|
14
|
Minhas PS, Enogieru IE, Mitchell RN, Mata DA. Passport to pathology: transforming the medical student pathology elective from a passive educational experience to an exciting, immersive clinical rotation. Hum Pathol 2017; 68:34-39. [PMID: 28893532 DOI: 10.1016/j.humpath.2017.08.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 08/21/2017] [Accepted: 08/25/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Paras S Minhas
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Palo Alto, CA 94305
| | | | | | - Douglas A Mata
- Department of Pathology Brigham and Women's Hospital Harvard Medical School, Boston, MA 02115.
| |
Collapse
|
15
|
Brooks EG, Thornton JM, Ranheim EA, Fabry Z. Incorporation of autopsy case-based learning into PhD graduate education: a novel approach to bridging the "bench-to-bedside" gap. Hum Pathol 2017; 68:1-6. [PMID: 28315694 DOI: 10.1016/j.humpath.2017.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 02/12/2017] [Accepted: 03/02/2017] [Indexed: 11/28/2022]
Abstract
Given the current rapid expansion of biological knowledge and the challenges of translating that knowledge into clinical practice, finding effective methods of teaching graduate students clinical medicine concepts has become even more critical. The utility of autopsy in medical student and resident education has been well established. Multiple studies have reported it to be a helpful means of teaching anatomy, pathophysiology, clinical problem-solving skills, and medical diagnostic techniques. Although various models of training PhD candidates in clinical medicine have been reported, an autopsy-based curriculum has not been previously described. For over 4 years, our pathology department has offered a novel semester-long autopsy-based course to educate future Cellular and Molecular Pathology scientists about clinical medicine. Our results indicate that this "hands-on" approach is a popular as well as effective means of teaching the pathogenesis of disease at the level of the cell, organ, and patient. The course reputation has recently led to requests to open registration to graduate students from other university programs as well as undergraduate students. Additionally, it has played an important role in our Cellular and Molecular Pathology program's recent receipt of a 5-year renewal National Institutes of Health-funded T32 award. Overall, this course model has been successful at our own institution and could provide a useful template for other institutions seeking to provide graduate investigators with in-depth exposure to clinical medicine.
Collapse
Affiliation(s)
- Erin G Brooks
- Department of Pathology and Laboratory Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, 53792.
| | - Joanne M Thornton
- Department of Pathology and Laboratory Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, 53792
| | - Erik A Ranheim
- Department of Pathology and Laboratory Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, 53792
| | - Zsuzsanna Fabry
- Department of Pathology and Laboratory Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, 53792
| |
Collapse
|
16
|
Geldenhuys EM, Burger EH, van Helden PD, Mole CG, Kotzé SH. Optimizing the use of cadavers by integrating pathology during anatomy dissection. ANATOMICAL SCIENCES EDUCATION 2016; 9:575-582. [PMID: 27144468 DOI: 10.1002/ase.1617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 03/11/2016] [Accepted: 04/09/2016] [Indexed: 06/05/2023]
Abstract
An accurate knowledge of anatomy, especially natural variation within individuals, is of vital clinical importance. Cadaver dissection during anatomical training may be a valuable introduction to pathology for undergraduate students, which can contribute greatly to a successful medical career. The purpose of this study was to determine the extent and type of pathology lesions in a cadaver population (n = 127) used for medical dissection. This was done to gauge whether sufficient pathology lesions representative of all the organ systems were present in the cadaver population to warrant the use of cadavers as an additional pathology learning resource. This study demonstrated a wide variety of pathology lesions in different organ systems. The respiratory system was most affected with pulmonary tuberculosis (TB) lesions being the most common finding (seen in 76% of cadavers) followed by bronchopneumonia and emphysema. Other common pathology findings included atherosclerosis, colonic diverticula, and chronic pyelonephritis. Skeletal fractures and degenerative joint disease were also noted. This study shows that cadaveric dissection offers a chance to alert and expose students to a wide variety of gross pathology and histopathology. It has been suggested that most medical students will practice in primary health care and as such more attention should be given to the pathology of commonly encountered diseases. This is particularly true for developing countries, where diseases such as TB are commonly encountered. The integration of pathology into the dissection hall may therefore be beneficial to student learning while simultaneously optimizing the use of cadaver material. Anat Sci Educ 9: 575-582. © 2016 American Association of Anatomists.
Collapse
Affiliation(s)
- Elsje-Márie Geldenhuys
- Division of Anatomy and Histology, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Elsie Helena Burger
- Division of Forensic Medicine, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Paul David van Helden
- Department of Science and Technology/National Research Foundation Center of Excellence for Biomedical Tuberculosis Research, Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Calvin Gerald Mole
- Division of Anatomy and Histology, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Sanet Henriët Kotzé
- Division of Anatomy and Histology, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
| |
Collapse
|
17
|
Goodwin D, Machin L, Taylor A. The social life of the dead: The role of post-mortem examinations in medical student socialisation. Soc Sci Med 2016; 161:100-8. [DOI: 10.1016/j.socscimed.2016.05.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 05/23/2016] [Accepted: 05/25/2016] [Indexed: 10/21/2022]
|
18
|
Bieri U, Moch H, Dehler S, Korol D, Rohrmann S. Changes in autopsy rates among cancer patients and their impact on cancer statistics from a public health point of view: a longitudinal study from 1980 to 2010 with data from Cancer Registry Zurich. Virchows Arch 2015; 466:637-43. [PMID: 25749838 DOI: 10.1007/s00428-015-1734-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 01/14/2015] [Accepted: 02/02/2015] [Indexed: 11/24/2022]
Abstract
During the last decades, autopsy rates have dramatically decreased in many countries. The Cancer Registry Zurich, which exists since 1980, provides the opportunity to address to what extent the number of autopsies in cancer patients has changed over a longer period of time and how often autopsies provide a diagnosis of clinically undetected cancer. Data from the Cancer Registry Zurich consisting of 102,434 cancer cases among 89,933 deceased patients between 1980 and 2010 were analyzed by means of descriptive statistics. The autopsy rate declined from 60 % in 1980 to 7 % in 2010. The total number of autopsies performed decreased from 1179 in 1986 to 220 in 2010. Furthermore, there was also a decline in the rate of newly detected tumours based on autopsy information. In 1980, the rate of newly detected tumours through autopsy was 42 % compared with 2010, when the rate had declined to 17 %. A consequence of the reduced autopsy rate is the reduction of incidental findings at autopsy in cancer registration. However, this reduction has not negatively affected the total incidence of cancer. It seems that the state-of-the-art diagnostic tools used for tumour detection are sufficiently reliable, allowing the scientific community to trust the quality of data provided by cancer registries in spite of decreasing autopsy rates.
Collapse
Affiliation(s)
- Uwe Bieri
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute (EPBI), University of Zurich, Hirschengraben 84, 8001, Zürich, Switzerland
| | | | | | | | | |
Collapse
|
19
|
Diaz-Perez JA, Raju S, Echeverri JH. Evaluation of a teaching strategy based on integration of clinical subjects, virtual autopsy, pathology museum, and digital microscopy for medical students. J Pathol Inform 2014; 5:25. [PMID: 25191624 PMCID: PMC4141419 DOI: 10.4103/2153-3539.137729] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 06/13/2014] [Indexed: 11/17/2022] Open
Abstract
Background: Learning pathology is fundamental for a successful medical practice. In recent years, medical education has undergone a profound transformation toward the development of an integrated curriculum incorporating both basic science and clinical material. Simultaneously, there has been a shift from a magisterial teaching approach to one centered around problem-based learning. Now-a-days, informatics tools are expected to help better implement these strategies. Aim: We applied and evaluated a new teaching method based on an active combination of clinical problems, gross pathology, histopathology, and autopsy pathology, all given through informatics tools, to teach a group of medical students at the Universidad de Santander, Colombia. Design: Ninety-four medical students were followed in two consecutive semesters. Students were randomized to receive teaching either through traditional methodology or through the new integrated approach. Results: There was no significant difference between the intervention group and the control group at baseline. At the end of the study, the scores in the intervention group were significantly higher compared to the control group (3.91/5.0 vs. 3.33/5.0, P = 0.0008). Students and tutors endorsed the benefits of the integrated approach. Participants were very satisfied with this training approach and rated the program an 8.7 out of 10, on average. Conclusion: This study confirms that an integrated curriculum utilizing informatics systems provides an excellent opportunity to associate pathology with clinical medicine early in training of medical students. This can be possible with the use of virtual microscopy and digital imaging.
Collapse
Affiliation(s)
- Julio A Diaz-Perez
- Department of Pathology, University of Santander, Bucaramanga, Colombia ; Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Sharat Raju
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Jorge H Echeverri
- Department of Pathology, University of Santander, Bucaramanga, Colombia
| |
Collapse
|