The Role of History and Ethics of Anatomy in Medical Education

Learning cardiac embryology on YouTube-What videos are there to view?

In modern medical curricula, embryology is typically taught through lectures, with a few institutions providing tutorials. The use of 3-D videos or animations enables students to study these embryological structures and how they change with time. The aim of this study was to assess the quality of cardiac embryology videos available on YouTube. A systematic literature review regarding the use of YouTube in teaching or learning cardiac embryology identified no papers that examined this specific question, and next, a systematic search of YouTube was performed. A total of 1200 cardiac embryology videos were retrieved using 12 specific search terms, with 370 videos retrieved under two or more search terms and excluded. A further 511 videos were excluded under additional, specific criteria. The remaining 319 videos were evaluated with the YouTube Video Assessment Criteria (UTvAC), with 121 rated as "useful." Videos on YouTube are uploaded with a wide audience in mind, from children to cardiologists, and content control is imperfect. Multiple videos were identified as duplicates of videos from original channels, typically without attribution. While 49 videos showed operations or human material, none contained an ethical statement regarding consent, and only 10 of these included an age restriction or graphical advisory. While there are useful videos for medical students studying cardiac embryology on YouTube, intuitive search strategies will also identify many with irrelevant content and of variable quality. Digital competence and search strategies are not innate skills, so educators should teach students to assess information so as to avoid overload or "filter failure."

Anatomage virtual dissection versus traditional human body dissection in anatomy pedagogy: insights from Ghanaian medical students

BACKGROUND

Although traditional human body dissection has been the mainstay method for gross anatomy pedagogy, the popularity of virtual teaching methods has increased in recent years. The Anatomage table offers a life-size digital representation of the human body and allows visualization, manipulation, and virtual dissection. This study investigated the perception of medical students towards virtual dissection vis-à-vis traditional dissection in anatomy pedagogy.

METHODS

The cross-sectional survey included medical students at the University of Ghana who completed an internet-based questionnaire administered using Google® Forms. The questionnaire comprised 20 close-ended questions that solicited information on demographics, experience with traditional human body dissection and virtual dissection, and perception of virtual dissection. Data was summarized as frequencies and percentages with 95% confidence intervals.

RESULTS

Of the 297 participants, 295 [99.4% (95% CI = 97.3-99.9)] participated in human body dissection from which 93.2% had a positive and 6.8% had poor experiences. Whereas 223 [75.1% (95% CI = 69.7-79.8)] of the participants would participate in dissection again given the opportunity, 74 [24.9% (95% CI = 20.2-30.3)] were unwilling. Of 297 participants, 205 [69.0% (95% CI = 69.7-74.2)] had used Anatomage table, while 92 [31.0% (95% CI = 25.8-36.6)] had not. About 68% (95% CI = 60.8-74.0) of the 205 agreed with the relative ease of operation and use of the Anatomage table compared to traditional human body dissection while 9.4% disagreed. Inadequate operational skills [51% (95% CI = 48.9-53.4)] and limited accessibility [39% (95% CI = 35.2-42.3)] were limitations to Anatomage use. 66.8% (95% CI = 59.9-73.1) of participants agreed virtual dissection had a positive influence on learning anatomy while 6.6% disagreed. Of the 205, 87.9% (95% CI = 82.3-91.8) discouraged virtual anatomy dissection completely replacing traditional human body dissection.

CONCLUSION

Virtual dissection is an effective supplement to traditional body dissection but not a replacement. Its use alongside traditional methods improves anatomy learning. Integrating technology into anatomy education will enhance student engagement and learning.

Terminologia Anatomica 2nd edition: perspectives from anatomy educators in the United Kingdom

English anatomical terminology has evolved over the long history of anatomical practice, with major influences from ancient Greek, classical Latin, Arabic, and post-classical Latin. Beginning in the nineteenth century, there have been various attempts to standardise and rationalise anatomical language, beginning in 1887, and culminating in the publication in 2019 of the second edition of the Terminologia Anatomica. This paper presents a brief historical overview of the development of anatomical terminology and usage in English, followed by a summary of the results of an anonymised survey of current practices that was sent out by email to anatomy educators at 45 medical schools in the United Kingdom. This is followed by personal reflections by six senior academics and/or clinicians, reviewing their extensive experience of teaching, researching, and communicating the language of anatomy within United Kingdom medical and clinical institutions.

Ethical concerns surrounding artificial intelligence in anatomy education: Should AI human body simulations replace donors in the dissection room?

The potential effects of artificial intelligence (AI) on the teaching of anatomy are unclear. We explore the hypothetical situation of human body donors being replaced by AI human body simulations and reflect on two separate ethical concerns: first, whether it is permissible to replace donors with AI human body simulations in the dissection room when the consequences of doing so are unclear, and second, the overarching ethical significance of AI use in anatomy education. To do this, we highlight the key benefits of student exposure to the dissection room and body donors, including nontechnical, discipline-independent skills, awareness and interaction with applied bioethics, and professional identity formation. We suggest that the uniqueness of the dissection room experience and the importance of the key benefits accompanying this exposure outweigh the potential and so far unknown benefits of AI technology in this space. Further, the lack of engagement with bioethical principles that are intimately intertwined with the dissection room experience may have repercussions for future healthcare professional development. We argue that interaction with body donors must be protected and maintained and not replaced with AI human body donor simulations. Any move away from this foundation of anatomy education requires scrutiny. In light of the possible adoption of AI technologies into anatomy teaching, it is necessary that medical educators reflect on the dictum that the practice of healthcare, and anatomy, is a uniquely human endeavor.

Inspired anatomy education: Might God be relevant?

Anatomy education is essential for developing healthcare professionals, and discussion continues about factors that impact and improve the anatomy learning environment. Neglected in this discussion is a consideration of the diverse religious assumptions and beliefs that college students bring to anatomy learning. Surveys of religion among United States college students indicate that many identify as religious and Christian. This viewpoint commentary summarizes main elements of Christian theology and anthropology, discusses the holistic and positive view of the body presented in Christian scripture, and outlines how these Christian beliefs inform and impact student preparation for anatomy education and human body dissection, address ethical issues in body donation, and support professionalism for future career practice.

Exploring alternatives for securing anatomical structures in capturing digital images: A comparative analysis

Teaching veterinary anatomy using digital platforms requires improved image quality, which may influence the fixation process. This study aimed to compare four embalming solutions for high-colour-quality images of different tissues compared to the original image. Four equine left pelvic limbs were cut into metameres and divided equally for application of 10% formaldehyde, 96% glycerine, 33% hypersaturated NaCl solution and modified Larssen solution, respectively, which was maintained for 3 days. After drying for 3 days at room temperature, photographs were obtained at time 0 (T0), without any fixation process (original colour); time 1 (T1), immediately after removal from the solutions; and every 24 h for 3 days (T2-T4). The image colour quality was investigated by digitally evaluating the cortical bone, tendon and bone marrow using histograms and CIEDE2000 as well as by 10 specialists in an online survey. CIEDE2000 and histograms revealed that all fixation solutions changed the original tissue colour at all the time points (p < 0.0001). According to the specialists, the 33% saline solution produced the best results compared to the original one. The modified Larssen solution demonstrated better results for the tendon, marrow and cortical bone at T3 (p = 0.0015). Considering the colour of digital images, the modified Larssen solution provided the best results; however, the visual evaluation by the specialists revealed the 33% saline solution as the best.

First patient project: Engaging pathology through the donor dissection experience and its role in professionalism

The peer-reviewed anatomical education literature thoroughly describes the benefits and drawbacks of donor dissection. Gross anatomy laboratory environments utilizing donor dissection are generally considered to be a premier environment where students foster non-traditional discipline-independent skills (NTDIS), including the acquisition of professionalism, empathy, resilience, emotional intelligence, and situational awareness. Therefore, this IRB-approved study explored the impact of a formal humanism and pathology thread, the first patient project (FPP), on the personal and professional development of pre-professional undergraduate students in a gross anatomy dissection-based course. Five reflections from each student were collected across four cohorts (n = 74 students, 370 reflections). A post-course questionnaire collected data on student perceptions of the project. The framework method was used to analyze reflection and free response data and descriptive statistics were performed on Likert-style items using Excel. Three themes were identified to encompass the impacts of the FPP on professional development and include: Socialization (through collective dissection experience and pathology), Humanistic Qualities (respect for the donor and their history, and introspection), and Content and Skills (technical and NTDIS, anatomical knowledge). The end of course FPP survey was completed by 29 students across three cohorts (65%) and their perspectives were generally favorable regarding the promotion of respect, empathy, and humanization of their donors. This study underscores the value of incorporating humanism, pathology, and reflection, facilitated through formal curriculum for pre-professional undergraduate students. It provides evidence of the positive impact on their personal and professional development, supporting the integration of NTDIS in curricula across various disciplines.

The Anatomical Collection at the University of Jena: Reinventing an exhibition of human remains based on ethical considerations

Emphasizing scientific and cultural-historical aspects of human remains, we describe the historical background and present status of the Anatomical Collection at the University of Jena. In addition to safekeeping issues and exhibition practice, we provide typical examples of provenance research in the Collection and refer to relevant literature and recommendations. A reappraisal of the Anatomical Collection culminated in the implementation of a new exhibition concept that diverts attention away from dead bodies as mere anatomical objects and emphasizes ethical considerations, such as consented body donation. The visitor is encouraged to respect the deceased as human subjects who are individuals with their personal biography and entitled to human dignity also after death. A particular focus of our approach is on contexts of colonial injustice and racism, which require a high degree of ethical sensitivity. By providing practical hints on how to conduct provenance research, we want to encourage other anatomists to have a closer look at their historical collections. While some human remains can be restituted, others will probably stay in the collections for various reasons. Concepts for the appropriate handling of these remains have yet to be developed. In conclusion, we argue that, with a renewed understanding and sensitivity, the importance and value of the historical anatomical collections can be recognized once again.

Analyzing the Evolution of Medical Ethics Education: A Bibliometric Analysis of the Top 100 Cited Articles

Ethics education plays a pivotal role in healthcare by providing professionals and students with the essential competencies to navigate intricate ethical challenges. This study conducts a comprehensive bibliometric analysis of the most-cited articles on ethics education, investigating parameters such as citation count, document types, geographical origin, journal analysis, publication year, author analysis, and keyword usage. The findings reveal a substantial impact characterized by high citation counts and the influence of a prominent publication focusing on the hidden curriculum and structure of medical education. Moreover, the analysis demonstrates a discernible increase in research output since 2000, signaling a growing recognition of the significance of ethics education in the healthcare domain. Notably, specific journals, particularly those dedicated to medical education and ethics, emerge as major contributors in this field, publishing many articles. Renowned authors have made noteworthy contributions, and emerging themes encompass the ethical implications of virtual reality and artificial intelligence in healthcare education. Additionally, undergraduate medical education garners significant attention, emphasizing the importance of establishing ethical values and professionalism early. Overall, this study highlights the imperative of interdisciplinary collaboration and the necessity for effective ethics education programs to equip healthcare professionals with the requisite skills to navigate complex ethical challenges. The findings inform educators, curriculum developers, and policymakers about enhancing ethics education and ensuring the ethical competence of future healthcare practitioners.

Determinants of Learning Anatomy in an Immersive Virtual Reality Environment - A Scoping Review

Given the decline of cadavers as anatomy teaching tools, immersive virtual reality (VR) technology has gained popularity as a potential alternative. To better understand how to maximize the educational potential of VR, this scoping review aimed to identify potential determinants of learning anatomy in an immersive VR environment. A literature search yielded 4523 studies, 25 of which were included after screening. Six common factors were derived from secondary outcomes in these papers: cognitive load, cybersickness, student perceptions, stereopsis, spatial understanding, and interactivity. Further objective research investigating the impact of these factors on anatomy examination performance is required.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-022-01701-y.

Effect of interprofessional education on cadaver dissection seminar

In 2010, WHO published a "Framework for action on interprofessional education and collaborative practice." Interprofessional education (IPE) is now being conducted in various ways. We have been holding cadaver dissection seminars to provide opportunities for medical students, nursing students, and nurse practitioner (NP) students to learn together. In this study, we investigated the effect of learning about IPE in cadaver dissection seminars. The seminars were held for 5 days each in 2021 and 2022 (the number of days of participation was arbitrary). In the seminars, teams of 3-5 participants with the same theme collaborated to dissect a single donated cadaver. Teams were made up of participants with different departments: 29 medical students, 12 NP students, and 20 nursing students participated in the seminar, and participants were surveyed before and after the seminars. The Readiness for Interprofessional Learning Scale (RIPLS) scores before and after the dissection seminar increased significantly overall. The scores of medical and nursing students increased significantly, but those of NP students did not significantly change. In terms of the number of days of participation, a significant increase in scores was found for participants who participated for ≥ 2 days. Overall, a significant positive correlation was found between intrinsic motivation to learn and RIPLS scores. For medical students, a significant negative correlation was noted between extrinsic motivation and RIPLS scores. Cadaver dissection seminars conducted by medical, nursing, and NP students demonstrated IPE learning effect on medical students and undergraduate nursing students.

New virtual platform for teaching comparative animal neuroanatomy based on metameric slices of the central nervous system

With the limitations imposed by the COVID-19 pandemic, new technologies were used as methods to continue teaching and learning activities. This scenario brought forth the need to develop online tools for teaching. Therefore, this research aimed to develop a digital platform linking the knowledge about the central nervous system (CNS) anatomy from feline, equine, and sheep models. The platform was produced from the analysis of a collection of mesoscopic slides made from the sequenced cross-section of the CNS of a feline, an equine, and a sheep. All sections were analysed and stained using the Paul-Wiegert modified technique. The platform was organized in four modules: (1) Neuroanatomy of the Central Nervous System; (2) Neuroanatomy of Feline; (3) Neuroanatomy of Equine; and (4) Neuroanatomy of sheep. For each module, an explanatory document in PDF was developed, as well as video lectures and a descriptive atlas identifying the structures present in the encephalon and in the cervical part of the spinal cord. Even though there are numerous online platforms that allow the study of veterinary anatomy of different species and organs, the veterinary neuroanatomy platform presented here is the first platform that conjointly addresses the CNS anatomy of felines, equines, and sheep. Future research applying this platform as an aid to the study of neuroanatomy by students, teachers, and veterinary professionals should validate its use as a complementary tool for teaching and learning animal neuroanatomy.

The Lifecycle of a Clinical Cadaver: A Practice-Based Ethnography

PhenomenonCadavers have long played an important and complex role in medical education. While research on cadaver-based simulation has largely focused on exploring student attitudes and reactions or measuring improvements in procedural performance, the ethical, philosophical, and experiential aspects of teaching and learning with cadavers are rarely discussed. In this paper, we shed new light on the fascinating philosophical moves in which people engage each and every time they find themselves face to face with a cadaver. ApproachOver a two-year period (2018/19-2019/20), we applied ethnographic methods (137 hours of observation, 24 interviews, and the analysis of 22 documents) to shadow the educational cadaver through the practical stages involved in cadaver-based simulation: 1. cadaver preparation, 2. cadaver-based skill practice with physicians and residents, and 3. interment and memorial services. We used Deleuze and Guattari's concepts of becoming and acts of creation to trace the ontological "lifecycle" of an educational cadaver as embedded within everyday work practices. FindingsWe delineated six sub-phases of the lifecycle, through which the cadaver transformed ontologically from person to donor, body, cadaver, educational cadaver, teacher, and loved one/legacy. These shifts involved a network of bureaucratic, technical, educational, and humanistic practices that shaped the way the cadaver was perceived and acted upon at different moments in the lifecycle. By highlighting, at each phase, 1) the ontological transitions of the cadaver, itself, and 2) the practices, events, settings, and people involved in each of these transitions, we explored questions of "being" as it related to the ontological ambiguity of the cadaver: its conceptualization as both person and tool, simultaneously representing life and death. InsightsEngaging deeply with the philosophical questions of cadaver-based simulation (CBS) helped us conceptualize the lifecycle as a series of meaningful and purposeful acts of becoming. Following the cadaver from program entry to interment allowed us to contemplate how its ontological ambiguity shapes every aspect of cadaver-based simulation. We found that in discussions of fidelity in medical simulation, beyond both the physical and functional, it is possible to conceive of a third type: ontological. The humanness of the cadaver makes CBS a unique, irreplaceable, and inherently philosophical, practice.

The Impact of a Gross Anatomy Curriculum With Donor Family Interaction: Thematic Analysis of Student Letters to Silent Mentors

PURPOSE

Tzu Chi University's anatomy curriculum incorporates interaction with donors' families and regards body donors as silent teachers and altruistic role models. In this silent mentor program (SMP), students learn about their donor's life before dissection to better appreciate the selfless donation. This study explores the influence of the program on students' humanistic literacy based on student letters to silent mentors, which students wrote near the end of the program and laid by the silent mentor during the coffining ceremony.

METHOD

The study included 125 letters from third-year medical students who took the gross anatomy curriculum in academic years 2015, 2016, and 2017. With student consent, the program collated and published the letters in the open-access SMP yearbook. Using thematic analysis, the authors manually analyzed the letters in their original Mandarin, with the names of students made anonymous to ensure the authors were blind to students' identity throughout the study.

RESULTS

The analysis identified 3 themes and 11 subthemes. Theme 1, my silent mentor, included 3 subthemes: life characteristics, altruistic attitude, and expectation of offering body. Theme 2, connection to silent mentor and family, included 4 subthemes: intersubjective bonding, emotive first encounter, spiritual communication, and encouragement from silent mentor. Theme 3, reflection and transformation, included 4 subthemes: reflection on life and death, professional self-expectation, inner transformation, and feedback action.

CONCLUSIONS

The findings suggest that interactions with donors' families increased students' appreciation of the donation and enhanced students' humanistic literacy. Further, the letters seem to indicate that the SMP inspired students to develop a grateful, respectful, and empathic attitude toward life and their career. Thus, by implementing similar programs, gross anatomy curricula could go beyond the acquisition of structural knowledge to the cultivation of medical students' humanistic literacy.

The evolving ethics of anatomy: Dissecting an unethical past in order to prepare for a future of ethical anatomical practice

Anatomical practice has arguably one of the most ethically challenging histories in the medical sciences. Among the oldest scientific disciplines in medicine, dissection of the human body for scientific purposes occurred as early as the third century Before the Common Era. Throughout the history of anatomical practice, human dissection has occurred in ways that cross the line from progressing medical science to violating the sanctity of the human body. The dissection of the human body creates ethical dilemmas which stem from the need for anatomical science to gain medical knowledge in juxtaposition with prevailing religious and moral views surrounding anatomy as a threat to the sanctity of the human body. This article examines the unethical history of human dissection throughout the ages and explores the rationale behind the unethical practices. In addition, this article explores imperative modern day ethical standards in anatomy including, the ethical handling of human bodies, respecting human life, and ensuring informed consent for dissection of bodies that are donated. Finally, this article explores the question of which ethical prism we should use when dealing with anatomy collections or works of the past. Learning both the history of unethical practices in anatomy and the rationale behind them is imperative so that the discipline can prepare for an ethical, diverse, and inclusive future. This article provides a foundation for understanding the evolution of ethics in anatomical practice and is a valuable resource for students and anatomists alike.

Anatomy education in US Medical Schools: before, during, and beyond COVID-19

BACKGROUND

Anatomy education in US medical schools has seen numerous changes since the call for medical education reform in 2010. The purpose of this study was to survey US medical schools to assess recent trends in anatomy education, the impact of the COVID-19 pandemic on anatomy teaching, and future directions of medical school anatomy curricula.

METHODS

We sent a 29-item survey to anatomy course directors of 145 AAMC-associated allopathic medical schools inquiring about their schools' anatomy curricula. The survey contained objective discrete questions concerning the curricula changes preceding COVID-19 and those directly related to COVID-19. We also asked subjective and open-ended questions about the impact of COVID-19 and future directions of anatomy education.

RESULTS

A total of 117/143 course directors (82%) completed the survey. Most schools (60%) reported a major change to their anatomy course within the past five years, including a decrease in total course time (20%), integration of anatomy into other courses (19%), and implementation of a "flipped classroom" (15%) teaching style. Due to COVID-19, there was a decrease in the fraction of course time dedicated to "hands-on" learning (p < 0.01) and teaching of clinical correlates (p = 0.02) and radiology (p < 0.01). Most course directors (79%) reported that COVID-19 had a negative impact on quality of learning due to decreased interactive or in-person (62%) learning and lack of dissection (44%). Incorporation of virtual-reality applications or 3D anatomy software (23%) and a decrease in cadaver dissection (13%) were the most common future anticipated changes.

CONCLUSION

The constraints conferred by COVID-19 highlight the importance of maximizing interactive learning in the discipline of anatomy. In an era of social distancing and decreased emphasis on conventional anatomy dissection, adaptations of new technologies and teaching modalities may allow for traditional educational rigor to be sustained.

Re-examining our roots: Queer history and anatomy

Since its establishment as one of the major authorities on the human body, Anatomy has played a crucial role in social and political spheres. In this article, I review how the history of Anatomy has intersected with queer history and how the effects of these interactions have affected queer lives today. In these historical cases, I aim to demonstrate how Anatomy has affected the social organization of human culture and society and also how society has affected anatomical knowledge in return. As this reciprocal connection between Anatomy and societal organization is elucidated, I argue that anatomists, clinicians, and educators have an ethical duty to address the connections of this history, both in our research and our classrooms. This historical tour begins in the ancient world, which established a connection between sexuality and physiology and reproduction. This is followed by an exploration of the Renaissance and Enlightenment, which highlight the connections between anatomical knowledge, the law, and social organization. The progressive and modern eras are explored next via modern research into the anatomical and biological origins of same-sex attraction and the use of modern technology in these investigations. Finally, the article ends with a call for reform along with suggestions for future steps.

The evolution of epistemological methodologies in anatomy: From antiquity to modern times

Present day scenario regarding epistemological methods in anatomy is in sharp contrast to the situation during ancient period. This study aimed to explore the evolution of epistemological methodologies in anatomy across centuries. In ancient times Egyptian embalmers acquired anatomical knowledge from handling human bodies and likewise anatomical studies in India involved human dissection. Ancient Greeks used theological principles-based methods, animal dissection and human dissection in practice of anatomy. Human dissection was also practiced in ancient China for gaining anatomical knowledge. Prohibition of human dissection led to use of animal dissection in ancient Rome and the trend continued in Europe through Middle Ages. Epistemological methods used by Muslim scholars during Middle Ages are not clearly chronicled. Human dissection returned as primary epistemological method in Renaissance Europe and empirical methods were reinstated after ancient period in human dissection during 16th century. The situation further improved with introduction of pragmatic experiment based approach during 17th century and autopsy-based methods during 18th century. Advances in anatomical knowledge continued with advent of microscope-based methods and emergence of anatomical sections in practice of human dissection in 19th century. Introduction of human observational studies, medical imaging, and molecular methods presented more options in terms of epistemological methods for investigating the human body during 20th century. Onset of 21st century has witnessed dominance of technology-based methods in anatomy. Limited emphasis on ethics in epistemological methodologies since antiquity is a dark aspect of otherwise an eventful evolutionary journey but recent developments are in positive direction.

Introduction of human anatomy before modern China: The preface of anatomical education in mainland China

Anatomy is an early researched discipline of natural science. Ancient civilizations (e.g., Greece, Egypt, Mesopotamia, and China) made significant contributions to our current understanding of medicine, including human anatomy. However, in modern China (from 1912 to the present), some contemporary scholars prefer to overlook the fact that anatomy was studied before modern China. Therefore, the author chronologically lists typical hallmark events and publications related to human anatomy before modern China, summarizes the influences of anatomy on traditional Chinese medicine, and analyzes the reasons for the slow progression of anatomy before modern China. The purpose is to better understand the history and culture of anatomy before modern China, serving as the first step of anatomical education for medical students in mainland China.

Pandemics, Protests, and Pronouns: The Changing Landscape of Biomedical Visualisation and Education

Events in early 2020 changed the landscape of education for the foreseeable future, perhaps permanently. Three events had a significant impact; (1) the Coronavirus disease 2019 (COVID-19) pandemic, (2) the death of George Floyd, which resulted in the most recent Black Lives Matter (BLM) protests, and (3) the Twitter storm, the resultant societal fallout and freedom of speech campaigns, following comments made by author JK Rowling which many deemed transphobic. These events had a differential impact on biomedical sciences, when compared to other sectors. COVID-19 resulted in a global lockdown, with higher education institutions closing campuses and moving to online-only delivery. This rapid change required radical shifts in the use of technology, with mass delivery of teaching at short notice. The BLM protests further raised awareness of the inequalities within society, particularly those experienced by Black people and other oppressed groups. As a result, there have been calls for the decolonisation of the curriculum. The implications of these three key events have led institutions to rethink their policies, teaching delivery, assessment, curricula, and physical environments. This chapter considers (1) the implications of a swift change in the primary mode of curriculum delivery within Higher Education to online formats and (2) how recent adverse events have resulted in calls for much-needed changes in visual representations within biomedical sciences. Finally, we consider (3) the role of the hidden curriculum and the potential impact of visual representations in curricula on the delivery of healthcare and the fight against health inequalities, which are often as a result of implicit biases. The year 2020 has proven timely in presenting the opportunity for change, provided through the power of imagery.

Books, bones and bodies: The relevance of the history of anatomy in Nazi Germany for medical education today

The history of anatomy in Nazi Germany highlights the consequences to humanity when the destructive potentials immanent to all science and medicine are enabled by an anti-democratic, totalitarian regime. Anatomy presents an example of ethical transgressions by scientists and health care professionals that were amplified in the criminal political climate of the Nazi regime. This can happen anywhere, as science is never apolitical. This article gives a short account of anatomy in Nazi Germany, which is followed by an outline of the tangible and intangible legacies from this history, to then discuss implications for anatomy education today. While Jewish and politically dissident anatomists were forced out of their positions and country by the Nazi regime, the majority of the remaining anatomists joined the Nazi party and used bodies of Nazi victims for education and research. Some anatomists even performed deadly human experiments. Patterns and legacies that emerge from this history can be traced into the present and concern research ethics in general and anatomical body procurement specifically. They shed light on current practices and controversies in the anatomical sciences, including anthropology. It will be argued here that the history of anatomy in Nazi Germany can inform current anatomy education in a concept of anatomy as the first "clinical discipline." By integrating insights from the history of anatomy into the learning process, anatomy education can model an approach to medicine that includes a full appreciation of the shared humanity of medical practitioners and patients.

Anatomy as a Model Environment for Acquiring Professional Competencies in Medicine: Experiences at Harvard Medical School

Anatomy education provides students with opportunities to learn structure and function of the human body, to acquire professional competencies such as teamwork, interpersonal skills, self-awareness, and to reflect on and practice medical ethics. The fulfillment of this wide potential can present challenges in courses that are part of an integrated curriculum and shorter than traditional courses. This new reality, together with students' increasing concern about the stresses within medical education, led to efforts at Harvard Medical School to implement practical steps toward an optimal learning environment in anatomy. These were based on core elements of ethical anatomy education and principles of trauma-informed care. Anatomy is conceptualized here as the "first clinical discipline," with relational interactions between anatomical educators, medical students, and body donors/patients. Essential prerequisites for the implementation of this work were support by the medical school leadership, open partnership between engaged students and faculty, faculty coordination, and peer-teaching. Specific interventions included pre-course faculty development on course philosophy and invitations to students to share their thoughts on anatomy. Student responses were integrated in course introductions, combined with a pre-dissection laboratory visit, an introductory guide, and a module on the history and ethics of anatomy. During the course, team-building activities were scheduled, and self-reflection encouraged, for example, through written exercises, and elective life-body drawing. Students' responses to the interventions were overall positive, but need further evaluation. This first attempt of a systematic implementation of an optimal learning environment in anatomy led to the identification of areas in need of adjustment.

Digital and Social Media in Anatomy Education

The use of images in various forms (drawing, photography, digital applications) has always been intrinsically associated with anatomy; however, the way in which anatomy educators and students create, access, view and interact with images has changed dramatically over the last 20 years. The method that anatomy educators use to engage with students and the wider public and how students engage with each other and faculty has also changed since the turn of the century, largely due to the emergence of social media. These two facets, the move towards digital images and the use of social media, are now intricately interlinked because social media enable anatomy educators to share digital learning resources easily and instantly to a global audience. This new trend of using social media to share digital images has created some ethical dilemmas that anatomy educators are researching and seeking guidance on to ensure that they are representing the potential conflicting needs and/or requirements of different stakeholders, including donors, donor families, students, the public, regulators and anatomy educators themselves. Meeting the various needs of stakeholders is complex; however, this chapter suggests an ethical approach for how digital images and social media can continue to be part of anatomy education.

Human anatomy education and management of anatomic specimens during and after COVID-19 pandemic: Ethical, legal and biosafety aspects

COVID-19 is an infection caused by the SARS-CoV-2 virus, initially identified in the city of Wuhan, China, in December 2019. Since then, the virus has spread to the continents, causing a major pandemic. The impacts of this pandemic on the education of human anatomy interfere in at least two aspects: (1) receiving and managing anatomical specimens in anatomy laboratories and (2) adaptations for classes on remote virtual teaching. Therefore, this study reviewed and discussed the legal and bioethical aspects, considering the scenario of a South American Country, aiming to stimulate the debate on these two relevant themes in the international community. Because of the COVID-19 pandemic and the impossibility of mass testing, anatomists and other workers in the field must deal with the risk of receiving bodies infected with SARS-CoV-2. In this situation, additional care measures in biosafety practices are essential to protect the staff. Such measures are: the bodies must be preserved by the perfusion of formaldehyde or other fixative solutions; embalming must be performed in ventilated rooms with a good air exhaust system; to avoid excessive manipulation of bodies and procedures such as pulmonary insufflation or craniotomy; and proper use of personal protective equipment, including lab coat, gloves and masks. As for exposure of body images in online classes, this review showed that there are no legal impediments to this end. However, anatomists must adopt measures aimed at protecting the memory of the deceased, such as using secure digital platforms with restricted access; family authorization/consent and student awareness.

"Inform the Head, Give Dexterity to the Hand, Familiarise the Heart": Seeing and Using Digitised Eighteenth-Century Specimens in a Modern Medical Curriculum

Recent years have seen an explosion of interest in digitising museum collections. Among the objects of interest are anatomical and pathological specimens found in medical museums. As researchers increasingly produce digital replicas of these preparations, ways of integrating these resources into the medical curriculum must be explored. This article takes a medical humanities approach to this topical question, comparing the historic use of anatomical specimens to modern intentions, and exploring the potential for using digital anatomy to help integrate humanities into the curriculum. The use of anatomical specimens by William Hunter (1718-1783), whose collection is now kept at the Hunterian in the University of Glasgow, provides a key historic focus. The teaching intentions for his private courses of anatomy are examined, to investigate how specimens were used in an eighteenth-century "curriculum". The motivations behind digitisation and the use of digital anatomy in modern curriculums are then examined and compared. Many of these motivations are shared with Hunter's: the desire to maintain a unique anatomical resource, the need to provide multisensory engagement in learning, and a desire to attempt to show "natural" anatomy without the interference of human processes. The balance between fostering empathy and maintaining detachment is also key for both. Using digital replicas of historic specimens to teach anatomy also opens up a unique opportunity to educate students in the medical humanities in a fully integrated way. Understanding the full story of the specimens they use, as explored in the first half of the article, allows students to place themselves, their dissection subjects, and healthcare as a whole in a historical context. As well as fostering empathy in the dissection lab, the stories behind the specimens can be used to introduce key humanities topics, including ethics, institutional bias, and social aspects of health and disease. It is essential that this potential is explored now while digital anatomy is still a relatively young field, and therefore collaborations between anatomists and medical humanities practitioners can be built and included from the ground up.

The practice of ethics in the context of human dissection: Setting standards for future physicians

It is a much desirable skill among physicians that clinical practice should be guided by ethical norms. The dissection room experience provides an opportunity for nurturing the principles of ethical practice among medical students early in the curriculum. When the exercise of human dissection is followed within the boundaries of ethics it effectively props an ideal example for the young minds to emulate in the future. Hence in every stage of dissection room activity precious human body needs to be handled in an ethical manner so as to set a standard for the students. The present review is an attempt to collate the recommendations documented by researchers as per ethical guidelines in the context of human dissection. The review highlights on the ethical norms which needs to be adhered to while receiving the human body of a donor and during preservation of the same. It reflects on ideal ethical behaviour in the dissection room during the act of dissection and finally emphasize on the respectful disposal of the human remains in an ethical manner. The intended purpose of this article is to support uniform adoption of the recommendations for ethical handling of human bodies used in anatomical dissection.

Ethical Perspectives on Body Donation Following Physician-Assisted Death

The increasing availability of physician-assisted death (PAD) has opened up a novel means of making donated bodies available for anatomical dissection. This practice has come to the fore in Canada, but is unlikely to be confined to that country as legislation changes in other countries. The ethical considerations raised by this development are placed within the framework of the ethical guidelines on body donation promulgated by the International Federation of Associations of Anatomists. The discussion centers on understanding the ethical dimensions of moral complicity, and whether it is accepted or rejected. If rejected it is possible to separate ethical concerns regarding PAD from subsequent use of donated bodies, as long as there is fully informed consent and complete ethical and procedural separation of the two. Openness about the origin of bodies for dissection is essential. Students should be instructed on the nuances of moral complicity, and consideration be given to those with moral doubts about PAD. Two issues are raised in considering whether these moves represent an ethical slippery slope: the attraction represented by obtaining relatively "high quality" bodies, and the manner in which organ donation following PAD has led to challenges to the dead donor rule. Although body donation raises fewer concerns, the ethical dimensions of the two are similar. The ethical constraints outlined here have the capacity to prevent an ethical slippery slope and constitute a sound basis for addressing an innovative opportunity for anatomists.

Social Media Guidelines for Anatomists

Social Media has changed the way that individuals interact with each other - it has brought considerable benefits, yet also some challenges. Social media in anatomy has enabled anatomists all over the world to engage, interact and form new collaborations that otherwise would not have been possible. In a relatively small discipline where individuals may be working as the only anatomist in an institution, having such a virtual community can be important. Social media is also being used as a means for anatomists to communicate with the current generation of students as well as members of the public. Posting appropriate content is one of the challenges raised by social media use in anatomy. Human cadaveric material is frequently shared on social media and there is divided opinion among anatomists on whether or not such content is appropriate. This article explores the uses and challenges of social media use in the field of anatomy and outlines guidelines on how social media can be used by anatomists globally, while maintaining professional and ethical standards. Creating global guidelines has shown to be difficult due to the differences in international law for the use of human tissue and also the irregularities in acquiring informed consent for capturing and sharing cadaveric images. These nuances may explain why cadaveric images are frequently shared on social media. This article proposes that as standard practice, anatomists obtain informed consent from donors before sharing images of cadaveric material on social media and ensure posts include a statement stating the same.

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.

Forced Disruption of Anatomy Education in Australia and New Zealand: An Acute Response to the Covid-19 Pandemic

Australian and New Zealand universities commenced a new academic year in February/March 2020 largely with "business as usual." The subsequent Covid-19 pandemic imposed unexpected disruptions to anatomical educational practice. Rapid change occurred due to government-imposed physical distancing regulations from March 2020 that increasingly restricted anatomy laboratory teaching practices. Anatomy educators in both these countries were mobilized to adjust their teaching approaches. This study on anatomy education disruption at pandemic onset within Australia and New Zealand adopts a social constructivist lens. The research question was "What are the perceived disruptions and changes made to anatomy education in Australia and New Zealand during the initial period of the Covid-19 pandemic, as reflected on by anatomy educators?." Thematic analysis to elucidate "the what and why" of anatomy education was applied to these reflections. About 18 anatomy academics from ten institutions participated in this exercise. The analysis revealed loss of integrated "hands-on" experiences, and impacts on workload, traditional roles, students, pedagogy, and anatomists' personal educational philosophies. The key opportunities recognized for anatomy education included: enabling synchronous teaching across remote sites, expanding offerings into the remote learning space, and embracing new pedagogies. In managing anatomy education's transition in response to the pandemic, six critical elements were identified: community care, clear communications, clarified expectations, constructive alignment, community of practice, ability to compromise, and adapt and continuity planning. There is no doubt that anatomy education has stepped into a yet unknown future in the island countries of Australia and New Zealand.

Ethical Rationales and Guidelines for the Continued Use of Archival Collections of Embryonic and Fetal Specimens

Benefits from the use of cadavers in anatomical education are well described. Historically, human embryos and fetal cadavers were used in anatomy education to understand development and congenital malformations. Recently, three-dimensional printed models produced from archival fetal specimens, and online repositories of images from archival collections of embryos and fetuses, have been used as an educational tool in human development courses. Given that the archival specimens were likely obtained prior to the era of informed consent, this raises questions about their appropriate and ethical use. Because some institutions in the United States retain archival collections of embryonic and fetal specimens that were once used as educational tools, their existence and utility require frequent reexamination against contemporary ethical frameworks to guide appropriate use or utilization. Four ethical rationales for uses of these collections are examined, including destruction, indefinite storage, use in research, and use in health professions education. Guidelines for the use of archival collections of human embryos and fetuses are presented. Indefinite storage and use in health professions education are supported, while use in research is also permitted, however, such use is limited and dependent on circumstance and purpose. The development of current digital repositories and three-dimensionally printed models based on archival collections that were collected without informed consent, or those promoting commercial opportunity, are not supported. New embryonic and fetal donations obtained with informed consent should include reference to potential uses with new technology and virtual, genetic, or imaging applications.

How does Donor Dissection Influence Medical Students' Perceptions of Ethics? A Cross-Sectional and Longitudinal Qualitative Study

The contribution of donor dissection to modern anatomy pedagogy remains debated. While short-term anatomy knowledge gains from dissection are questionable, studies suggest that donor dissection may have other impacts on students including influencing medical students' professional development, though evidence for such is limited. To improve the understanding of how anatomy education influences medical student professional development, the cross-sectional and longitudinal impacts of donor dissection on medical students' perceptions of ethics were explored. A cross-sectional and longitudinal qualitative study was undertaken at an Australian university where student responses to online discussion forums and in-person interviews were analyzed. Data were collected across the 1.5 years that undergraduate medical students received anatomy instruction (three semesters during first and second years). A total of 207 students participated in the online discussion forums, yielding 51,024 words; 24 students participated in at least 1 of 11 interviews, yielding over 11 hours of interview data. Framework analysis identified five themes related to ethics in an anatomical education context: (1) Dignity, (2) Beneficence, (3) Consent, (4) Justification for versus the necessity of dissection, and (5) Dichotomy of objectification and personification. The dominant themes of students' ethical perceptions changed with time, with a shift from focusing on donors as people, toward the utility of donors in anatomy education. Additionally, themes varied by student demographics including gender, ancestry, and religiosity. Together this study suggests a strong impact of donor dissection on priming students' focus on medical ethics and provides further advocacy for formal and purposeful integration of medical ethics with anatomy education.