Anatomical instruction and training for professionalism from the 19th to the 21st centuries

Historical trends and current experiences of anatomical body donation in two Zimbabwean medical schools

BACKGROUND

Body donation is integral to anatomy education, but procurement can be ethically fraught. While voluntary donation is preferred, the use of unclaimed bodies, although considered unethical, is a primary means for body procurement in some countries. This mixed methods study examined historical trends and anatomy technical staff perspectives on body donation in two Zimbabwean medical schools.

METHODOLOGY AND MAIN FINDINGS

In Phase 1, 194 cadaver paper records from January 1984 to January 2021 were reviewed. Unclaimed bodies accounted for 67% while 33% (all white Zimbabweans) were voluntarily donated. Most cadavers were black Africans (62.4%) followed by white Zimbabweans (34.0%). Race was not indicated in seven (3.6%) records. In Phase 2, semi-structured interviews were conducted with seven technicians responsible for sourcing cadavers at the two institutions. Data were thematically analysed resulting in the development of eight themes, arranged into three domains. Cadaver procurement themes related to (1) cadaver source, (2) adherence to procurement guidelines, (3) screening for suitability, and (4) cultural and religious beliefs. Cadaver embalmment focused on (5) embalming practices, and (6) hospital mortuary-based embalming. Finally, (7) disposal processes and (8) resource constraints were found to influence cadaver disposal practices.

CONCLUSIONS

Contrary to best practice, there is continued reliance on the use of unclaimed bodies to support anatomy education in the two Zimbabwean medical schools. Improving the ethical sourcing of bodies requires increased efforts to educate all Zimbabweans, especially the black majority, about the role and importance of voluntary body donation in medical education. Additionally, well-structured, and well-resourced body donation programs could enhance ethical procurement.

Leading the transition to ethical human body sourcing in Africa: The South African experience

BACKGROUND

The use of human bodies for anatomy education and research forms an integral part of the training of health professionals around the world. However, the ethical acquisition of human remains for this purpose has been a challenge in many countries, particularly for those on the African continent. South African institutions have however, been able to progressively transition to a more ethical approach to human body acquisition. The aim of the current study was to investigate the provenance of human bodies and the number used in South African health sciences institutions during the period 2017-2021.

METHODS

an online self-administered anonymised questionnaire was circulated to all health sciences institutions in South Africa. Questions were focused on establishing the provenance and the associated number of bodies and body donor programmes.

RESULTS

responses were received from thirteen of the fourteen South African institutions. All thirteen institutions use human bodies for teaching and research, with the majority of the institutions being reliant on bequests (77%) and family donations (62%), and less on unclaimed remains (46%). Most institutions have established body donor programmes. Four institutions were negatively affected by the effects of the pandemic. Memorial services, which continued during the pandemic, were conducted by eight of the thirteen institutions.

CONCLUSION

South Africa is leading the transition to the ethical acquisition of human remains on the African continent. It is hoped that South African institutions will soon transform to the exclusive sourcing of bodies through willed donation and provide guidance and support for the other countries on the continent.

Plastinate Library: A Tool to Support Veterinary Anatomy Learning

The shortage of both time for anatomy courses in the new veterinary medicine curriculum and instructors prepared to teach biomedical sciences has raised a crisis in anatomical education. Often, students spend time out of their classes trying to learn not only concepts but also laboratory-wise content from 2D materials such as books and videos. In addition, since the global COVID-19 pandemic lockdown, studying and habits have been reviewed, with many people adopting an at-home style. The purpose of this study was to evaluate students' acceptance of taking plastinate anatomical specimens to study at home. Thirty-three students were divided into three groups. G1 took home a set of kidneys composed of equine, bovine, and swine materials; G2 took home a pig kidney; and G3 (control) did not take any plastinate specimen home. Acceptance was assessed using an anonymous survey and interview. The method had high acceptance by the students, who believed that having the plastinate library was advantageous from different perspectives, including aiding with learning the differences between kidneys from different species, time flexibility, no commute to study after hours of laboratory classes, and time redistribution to prioritize the laboratory topics. The plastinate library has the potential to be a supportive tool for anatomy students in the contemporaneous veterinary curriculum paradigm, considering that the G1 and G2 groups used the plastinate specimens at home to complement the time they spent in the laboratory.

Educator perspectives on non-technical, discipline-independent skill acquisition: An international, qualitative study

Gross anatomy education utilizing body donors and human specimens assists the acquisition of non-traditional, discipline-independent skills (NTDIS) such as teamwork, communication, and leadership. Alterations to anatomy curricula, such as those resulting from the COVID-19 pandemic, likely impact NTDIS acquisition, yet how this manifests is unclear. This study, therefore, explored anatomy educator perspectives on NTDIS acquisition as a response to changes in teaching delivery. Gross anatomy educators across different countries were recruited and took part in one-on-one, semi-structured interviews that were audio recorded and transcribed. Data were analyzed using the framework method. Basic statistical analyses were performed on demographic and categorical data. Fifteen educators from five continents were interviewed (average length 32.5 min, range 17-51 min). Educator experience ranged from 0-4 years (n = 3) to 20+ years (n = 7). Most taught using dissection (n = 14) with prosection use (n = 13) also common. Themes relating to NTDIS included expected content (respect for donors, teamwork, communication skills, humanistic values), assessable content, assessment challenges, and impact of curriculum changes; NTDIS unique to anatomy education included cultural, ethical, and social considerations around dead bodies, including boundaries, and social norms. Informed by curriculum alterations during the COVID-19 pandemic, this first empirical study of anatomy educator perspectives on NTDIS highlights the potentially adverse educational impacts of decreased interaction with body donors and human specimens on NTDIS acquisition and difficulties with NTDIS assessment. Findings support gross anatomy education as unique in providing NTDIS that cannot easily be replicated elsewhere. Recommendations around NTDIS-specific educator competencies and promoting NTDIS are provided.

The Future of Morphological Science Education: Learning and Teaching Anatomy in the Wake of the COVID-19 Pandemic

The COVID-19 Pandemic has conveyed an unprecedented worldwide challenge. Although there is much emphasis on caring for patients and communities, the high incidence of SARS-CoV-2 had seriously disturbed education and calls for prompt as well as serious consideration from educators in medical schools. The necessity to teach and prepare prospective medics, as well as clinicians, has certainly not been as intense as it is currently. The global effects of coronavirus disease 2019 may cause a permanent change in the education of future clinicians. The COVID-19 era presented logistical and practical obstacles and fears for the patients' well-being, taking into consideration the fact that students may be potential channels for the spread of the virus when asymptomatic and may get infected while being in training and attending lectures. This paper discusses the present state of morphological science education, depicting the effect of COVID-19 on learning environments, as well as highlights the probable effects of COVID-19 on medical instruction in the future.

"Preparing them for the profession": An interpretative phenomenological analysis of anatomy educators coping with complexity in the United Kingdom curriculum

Efforts to integrate the basic sciences into the ever-changing curriculum are a trending area of research in health professions education. Low-stakes, high-frequency assessment methods such as the progress test are now widely implemented in the United Kingdom and Northern Ireland as a means of furthering curricular integration toward contemporary goals of competency and professional identity formation. The anatomy educator's experience vis-à-vis these curricular changes is not well understood. This study aimed to explore how anatomy educators make sense of the shifting demands of their role. The interviews were semi-structured, particularly concerned with the phenomenon of teachers adapting to the complexity of their learning environment. The study used interpretative phenomenological analysis (IPA) to focus on the lived experiences of participants coping with the phenomena in question: how do anatomy educators make sense of the learning environment in the United Kingdom? Interviews were transcribed verbatim and interpreted inductively, identifying four key themes: confidence through connectedness, variations in appraisals of curricular integration, managing expectations to perform in paradoxical situations, and the emergence of innovative teaching. Results point to the learning environment as a complex system and highlight the importance of feeling support from and connection to colleagues, enabling individual educators to develop confidence, meet the top-down demands of changing curricula, and experience personal identity development and uncertainty tolerance within their role. This IPA study offers insight into the lived experiences of anatomy educators whose experiential interpretations of a complex and changing curriculum can uniquely inform stakeholders in health professions education.

Anatomy in Practice: How Do Equine and Production Animal Veterinarians Apply Anatomy in Primary Care Settings?

To successfully prepare veterinary undergraduates for the workplace, it is critical that anatomy educators consider the context in which developing knowledge and skills will be applied. This study aimed to establish how farm animal and equine general practitioners use anatomy and related skills within their daily work. Qualitative ethnographic data in the form of observations and semi-structured interviews were collected from 12 veterinarians working in equine or farm animal first-opinion practice. Data underwent thematic analysis using a grounded theory approach. The five themes identified were relevant to both equine and farm animal veterinarians and represented the breadth and complexity of anatomy, its importance for professional and practical competence, as well as the requirement for continuous learning. The centrality and broad and multifaceted nature of anatomy was found to challenge equine and farm animal veterinarians, highlighting that essential anatomy knowledge and related skills are vital for their professional and practical competence. This aligns with the previously described experiences of companion animal clinicians. In equine practice, the complexity of anatomical knowledge required was particularly high, especially in relation to diagnostic imaging and assessing normal variation. This resulted in greater importance being placed on formal and informal professional development opportunities. For farm animal clinicians, anatomy application in the context of necropsy and euthanasia was particularly noted. Our findings allow anatomy educators to design appropriate and effective learning opportunities to ensure that veterinary graduates are equipped with the skills, knowledge, and resources required to succeed in first-opinion veterinary practice.

Changing paradigms in anatomy teaching-learning during a pandemic: Modification of curricular delivery based on student perspectives

Objectives

Methods

Results

Conclusion

Digital Feast and Physical Famine: The Altered Ecosystem of Anatomy Education due to the Covid-19 Pandemic

This article explores the effects of the coronavirus disease 2019 (Covid-19) pandemic on the evolution of both physical and digital cadavers within the unique ecosystem of the anatomy laboratory. A physical cadaver is a traditional and established learning tool in anatomy education, whereas a digital cadaver is a relatively recent phenomenon. The Covid-19 pandemic presented a major disturbance and disruption to all levels and types of education, including anatomy education. This article constructs a conceptual metaphor between a typical anatomy laboratory and an ecosystem, and considers the affordances, constraints, and changing roles of physical and digital cadavers within anatomy education through an ecological lens. Adaptation of physical and digital cadavers during the disturbance is analyzed, and the resiliency of digital cadaver technology is recognized. The evolving role of the digital cadaver is considered in terms of increasing accessibility and inclusivity within the anatomy laboratory ecosystem of the future.

Promoting cultural awareness, professionalism, and communication skills in medicine through anatomy: The Deaf culture session

The anatomy curriculum is a place where professionalism can be learned and practiced, including training in cultural competence and communication skills for working with diverse populations. One population that has received little attention in terms of medical education are d/Deaf and hard of hearing (d/DHH) patients, although there is much evidence to support health care disparities in this population. Several major contributing factors include differing views of deafness between medical professionals and those who are culturally Deaf, a lack of understanding of Deaf culture and American Sign Language (ASL) by medical professionals, a lack of educational resources in ASL, and poor experiences in health care. To address this need, a Deaf Culture Applied Anatomy session was incorporated into the first-year curriculum at Morehouse School of Medicine while medical students were studying anatomy of the ear and hearing. Panelists, who were culturally Deaf, hard of hearing, and hearing children of deaf adults, shared their experiences in healthcare, including challenges they faced with communication and care. Surveys were provided to students before and after the panel session. Surveys indicated a lack of knowledge prior to this session, while also demonstrating that this 90-min session improved students' understanding of effective communication with future patients and issues related to deafness. Qualitative feedback also suggested that the students found the session to be personally and professionally beneficial. Implementing the Deaf Culture session was an effective means for introducing students to Deaf culture and working with d/DHH 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.

Development of a virtual reality clinically oriented temporal bone anatomy module with randomised control study of three-dimensional display technology

Objective

To investigate the effectiveness of a virtual reality (VR), three-dimensional (3D) clinically orientated temporal bone anatomy module, including an assessment of different display technologies.

Methods

A clinically orientated, procedural and interactive anatomy module was generated from a micro-CT of a cadaveric temporal bone. The module was given in three different display technologies; 2D, 3D with monoscopic vision, and 3D with stereoscopic vision. A randomised control trial assessed the knowledge acquisition and attitudes of 47 medical students though a pretutorial and post-tutorial questionnaire. The questionnaire included questions identifying anatomic structures as well as understanding structural relations and clinical relevance. Furthermore, a five-point Likert scale assessed the students’ attitudes to the module and alternative learning outcomes, such as interest in otology and preparedness for clinical rotations.

Results

As a whole cohort, the total test score improved significantly, with a large effect size (p≤0.005, Cohen’s d=1.41). The 23 students who returned the retention questionnaire had a significant improvement in total test score compared with their pretutorial score, with a large effect size (p≤0.005, Cohen’s d=0.83). Display technology did not influence the majority of learning outcomes, with the exception of 3D technologies, showing a significantly improvement in understanding of clinical relevance and structural relations (p=0.034). Students preferred 3D technologies for ease of use, perceived effectiveness and willingness to use again.

Conclusions

The developed VR temporal bone anatomy tutor was an effective self-directed education tool. 3D technology remains valuable in facilitating spatial learning and superior user satisfaction.

'Knowing everything and yet nothing about her': medical students' reflections on their experience of the dissection room

Anatomy education by cadaveric dissection teaches medical students not only the formal curriculum in human anatomy, but also a 'hidden curriculum' whereby they learn the attitudes, identities and behaviours expected of doctors. While dissection has been investigated as a challenge to and training in emotional regulation, little attention has been paid hitherto to the forms of medical knowledge and identity which students encounter and develop in the dissection room. This study analyses a corpus of 119 tributes written by three consecutive cohorts of first-year medical students at a university to their cadaveric donors. We employ a Foucauldian discourse analysis methodology, seeking to elucidate the features of the subject position, the narrative 'I' or 'we' of the tributes, and the modes of knowledge which operate between that subject position and its object, the donor. We observe that students find themselves in a transitional state between personal and scientific modes of knowledge of the human, which correspond to different models of the subject position occupied by the student. While in many tributes these modes exist in an uneasy disjunction, others employ creative reflection to suggest new modes of knowledge and identity which may inform ethical practice.

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.

Analysis of Population Representation Among Willed Whole-Body Donors to Facilitate the Construction of a Body Donation Program in China: From the Perspective of Medical Students and Anatomists

The body donation program of Peking Union Medical College was established in May 1999. From May 1999 to December 2017, a total of 5,576 registrants registered and 1,459 donors donated their bodies. Demographic and medical characteristics of the donors were analyzed. The top four causes of death were neoplasms, heart diseases, respiratory diseases, and cerebrovascular diseases. Age at death among donors who died of neoplasms were significantly lower than other causes of death (all p < .05), and the interval between registration and donation among donors who died of neoplasms was significantly shorter than that among donors with other causes (all p < .001). The age of donors when they registered (p < .001) and donated (p < .001) was significantly older than that of general Beijing population. This study may provide a guide for medical colleges or research institutions to establish or enhance their own body donation programs.

Cadaverless anatomy: Darkness in the times of pandemic Covid-19

The pandemic Covid-19 is responsible for a major education crisis globally and has a drastic impact on medical training as well. The objective of the present study was to envision the present and future impact of Covid-19 on anatomy learning and research. The virtual education is the only mode of teaching in current scenario. Every anatomist is unlocking technology to deliver best education however understanding of the subject without dissections or other practical teaching aids like bones, specimens, embryology models, microscopic slides etc. is challenging. This approach misses the feel and human visual impacts. Potential educational disruption is felt currently and will be experienced even after the pandemic is over due to scarcity of cadavers. As the body donor may be carrier or died of Covid-19 and there is no proven screening to rule out this infection in donor, so the acceptance of body donations is not advisable for the safety of medical students and health care workers. To conclude, anatomy education is cadaverless currently due to Covid-19 lockdown and it is prophesied that after the pandemic, real cadavers will be replaced by virtual cadavers because of paucity of cadavers. Research in the field of anatomy will also be adversely affected.

An Insight into Professional Identity Formation: Qualitative Analyses of Two Reflection Interventions During the Dissection Course

The professional behavior of future doctors is increasingly important in medical education. One of the first subjects in the curriculum to address this issue is gross anatomy. The Tuebingen Medical Faculty implemented a learning portfolio and a seminar on medical professionalism during the dissection course. The aims of this research project are to get an overview of how students form a professional identity in the dissection course and to compare the content of both their oral and written reflections on the course. A qualitative analysis was conducted of the oral and written reflections on the dissection laboratory experience. This study was conducted during winter term 2013/2014 with a cohort of 163 participants in the regular dissection course. Written reflection texts (from n = 96 students) and audio recordings from four oral reflection seminar discussions (with n = 11 students) were transcribed and deductively categorized with Mayring's qualitative content analysis method. Both qualitative analyses show that students reflected on many topics relevant to professional development, including empathy, respect, altruism, compassion, teamwork, and self-regulation. Quantitative analysis reveals that students who attended the oral reflection wrote significantly more in their written reflection than students who did not. There is, however, no difference in the reflection categories. Reflection content from students corresponds with categories derived from existing competency frameworks. Both the seminar (oral reflections) and the learning portfolio (written reflections) present excellent opportunities to foster professional development during anatomy education; the key is using them in conjunction with the dissection course.

Cadaveric Simulation Training in Cardiothoracic Surgery: A Systematic Review

Simulation training has become increasingly relevant in the educational curriculum of surgical trainees. The types of simulation models used, goals of simulation training, and an objective assessment of its utility and effectiveness are highly variable. The role and effectiveness of cadaveric simulation in cardiothoracic surgical training has not been well established. The objective of this study was to evaluate the current medical literature available on the utility and the effectiveness of cadaveric simulation in cardiothoracic surgical residency training. A literature search was performed using PubMed, Cochrane Library, Embase, Scopus, and CINAHL from inception to February 2019. Of the 362 citations obtained, 23 articles were identified and retrieved for full review, yielding ten eligible articles that were included for analysis. One additional study was identified and included in the analysis. Extraction of data from the selected articles was performed using predetermined data fields, including study design, study participants, simulation task, performance metrics, and costs. Most of these studies were only descriptive of a cadaveric or perfused cadaveric simulation model that could be used to augment clinical operative training in cardiothoracic surgery. There is a paucity of evidence in the literature that specifically evaluates the utility and the efficacy of cadavers in cardiothoracic surgery training. Of the few studies that have been published in the literature, cadaveric simulation does seem to have a role in cardiothoracic surgery training beyond simply learning basic skills. Additional research in this area is needed.

Effects of Commemorations and Postdonation Services on Public Willingness to Donate Bodies in China

Multiple body donation programs have been established throughout China over the last 20 years, but these programs remain challenged by an insufficient supply of cadavers for medical education. The commemoration of body donors is a feature of many successful programs, and adopting this practice throughout the country could be an important element of raising public awareness and encouraging body donation among the public. The present study aimed to investigate public views on the commemoration of whole-body donors and postdonation services in China by analyzing the factors that influence participants' willingness to donate. A survey was conducted using convenience sampling with a non-probability sampling method, and data were analyzed using chi-square and post hoc multiple comparisons tests. A total of 1,800 questionnaires were distributed, 1,717 were returned, and 1,605 were considered valid. Of the respondents, 20.87% were willing to donate, and 64.80% thought that it is necessary to commemorate donors. The results of multiple comparisons demonstrated that the elderly and those with a higher educational level were more willing to donate than participants in other groups. Education was also found to influence views on donation memorial activities, and the chi-square test revealed that conducting commemorations and improving postdonation services can promote the establishment of successful donor programs in China and improve the social acceptance of body donation.

Naming the Dead: What information do Physical Therapy and Physician Assistant Anatomy Faculty Share With Students?

In this novel study, the researchers quantify cadaver information provided to Physical Therapy (PT) and Physician Assistant (PA) anatomy faculty and ask what portion of that information is then shared with students. Descriptive statistics were used to the describe demographics of the study respondents and to report survey responses. The majority (60% or greater) of faculty who teach anatomy to PT and PA students have clinical degrees matching the student groups they teach. Chi-square analysis showed no appreciable difference (P < 0.001) between PT and PA anatomy faculty in the amount of cadaver information they receive or then share with students. There was a difference in the type of cadaver information (identifying vs. non-identifying) that is received and then shared by these faculty. Faculty are more likely to receive non-identifying cadaver information (93%) than identifying information (40%) (P < 0.0001) and share non-identifying information (83%) than identifying information (26%) with students (P < 0.0003). Interestingly, there is no consensus as to whether sharing cadaver information is respectful or disrespectful to those who donate their bodies for anatomy education and research. Further research is warranted into the reasons anatomy faculty withhold cadaver information from students and in the value, if any, for students knowing more about the cadavers they are learning from.

Quantifying Cadaver Use in Physician Assistant Anatomy Education

PURPOSE

To quantify the number of cadavers used in physician assistant (PA) anatomy education and to ascertain the origins of those cadavers.

METHODS

An electronic survey was generated and distributed to all schools that had been accredited by the Accreditation Review Commission on Education for the Physician Assistant. Responses were reported using descriptive statistics.

RESULTS

The survey had a 49% response rate. Among the responding programs, 79% reported working with 655 cadavers, with an average of one cadaver per 5.72 students. Programs reported that 21% receive cadavers from multiple sources. Of all programs using cadavers, 62% receive cadavers from medical schools, 23% from in-house anatomical gift programs, 19% from state anatomy boards, 9% from private organizations, and 8% from other sources. Anatomy educators reported that 55% know the origins of the cadavers in their programs, 18% do not, and 27% are uncertain. In categorizing cadavers at their programs, 56% were reported as registered donors, 4% as next-of-kin donations, 1% as unclaimed dead, 17% as uncertain origin, and 22% as unaccounted for by respondents.

CONCLUSIONS

Among educators who teach anatomy to PA students, 45% do not know or are uncertain of the origins of the cadavers in their programs. Of the reported 655 cadavers used in PA education, 289 were not categorized as registered donors. Facing the expansion of PA programs, educators need to be aware of cadavers' origins to ensure that all aspects of PA education are consistent with the ethics that the students are being taught. Those ethics include the need for informed consent for all cadavers involved in PA education.

Body Donation after Medically Assisted Death: An Emerging Consideration for Donor Programs

Around the world, the recent introduction of assisted death laws has meant that undertaking medical assistance in dying (MAID) is now an option for some persons wishing to end their life. Some of these people donate their bodies to medical science, and by doing so have created a new route from which donor programs can now receive bodies. Such donations have also illuminated a myriad of novel ethical questions. This article considers the emotive and controversial topic of MAID in relation to body donation, describing the experiences of McMaster University, Canada, where several MAID body donors have been received by the anatomical donor program. It provides background on the development and implementation of MAID in Canada, and describes the experience of staff and students at McMaster to MAID donations. It also explores the relevance of MAID to body donation programs, and discusses several of the ethical challenges facing body donation programs who may encounter MAID body donors. These include the appropriateness of accepting MAID donors, issues with informed consent, the effect of personal engagement with MAID donors, information sharing around MAID donations, governance issues, and negative historical parallels between MAID and euthanasia. Suggestions on how to manage MAID body donation focus on how issues affecting institutions, faculty, and students may be approached utilizing appropriate transparency and communication, some of which may facilitate student professional development around the topic of MAID. It is also suggested that the development of ethically appropriate guidelines on MAID body donations may positively guide the anatomical community.

The Role of History and Ethics of Anatomy in Medical Education

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

Building Professionalism in Human Dissection Room as a Component of Hidden Curriculum Delivery: A Systematic Review of Good Practices

The core values in medical practice which are essential for the humane outlook of a physician are clubbed within the domain of medical professionalism. Professionalism along with other discipline-independent skills (human skills) is propagated implicitly in medical schools as components of a "hidden curriculum." Evidence suggests a strong association between "hidden curriculum" delivery and development of professionalism in the human dissection room. In this review article, the authors have tried to highlight a few exclusive practices adopted by medical schools which enhance the implementation of the "hidden curriculum" within the practice of human dissection and successfully inculcate the key components of professionalism such as integrity, respect, and compassion among students. These distinctive concepts are aimed at humanizing the experience of anatomical dissection by revealing the identity of the donors along with their personal details either through display of video clips of donor interviews, interactions with the family members of the donor over a meal or recognition of the donor as a mentor and organizing memorial services in honor of donors after conclusion of the dissection in the presence of their family members. The resounding success of these good practices in building professionalism among medical students from the onset of the academic curriculum has signaled a new chapter in anatomical sciences education. It has become imperative to recognize the visionary efforts of a select few medical educators and begin incorporating these recent trends into the delivery of the "hidden curriculum" within the evolving gross anatomy education model.

Cadaver Dissection Is Obsolete in Medical Training! A Misinterpreted Notion

Cadaver dissection (CD) is considered a tool for studying the structural details of the human body. Lately, conflicting opinions regarding the utility of this modality in medical training have been published in medical literature. This review of the literature examines the status of anatomy teaching with CD in traditional, modern, and postgraduate medical training across the world. Literature published in the En-glish language on topics related to CD in the past 3 decades was scrutinized using different search engines. About 200 full texts were reviewed. We describe how medical schools have continued to include CD in anatomy teaching in the traditional or modified form. Medical schools that stopped or decreased CD have learnt from their experiences, and have restarted it in modified forms by integrating it vertically with medical training. In addition, CD activities have increased in postgraduate anatomy courses, surgery training, and voluntary/optional CD programs. CD, when integrated vertically, still has a part to play in medical training in modified ways. This overview may help curriculum designers to place CD in medical curricula and training programs in a justified manner.

A preliminary survey of professionalism teaching practices in anatomy education among Indian Medical Colleges

Professionalism and ethics have gained widespread recognition as competencies to be fulfilled, taught, and assessed within medical education. The role of the anatomy course in developed nations has evolved over time and now encompasses multiple domains, including knowledge, skills, and the inculcation of professionalism and ethics. The Medical Council of India recently recommended the integration of professionalism teaching in undergraduate medical curricula. The authors investigated whether the initial orientation lectures and instructions given by faculty at the outset of undergraduate medical anatomy courses throughout India served a "hidden curriculum" regarding professionalism practices, and whether these orientation messages could serve as an early exposure to medical professionalism and ethics for medical students. An online survey was carried out among 102 anatomy faculty members across India requesting details about specific professionalism protocols and instructions regarding behavior in the dissection hall that are routinely given to preclinical students, as well as the importance that they placed on professional behavior. It was found that most faculty members regularly instruct students regarding expected behavior during the anatomy course, including dissection practices. These instructions stress attributes of professionalism like humanism, accountability, and honesty. However, there needs to be a more concentrated effort by educators to prohibit such unprofessional practices like dissection hall photography, and better information is required regarding biomedical waste disposal. Despite the absence of clear guidelines for professionalism teaching in medical education in India, the existing framework of anatomy education provides an opportunity to introduce the concept of professionalism to the first-year medical student. This opportunity may provide an early foundation for designing a professionalism-integrated curriculum. Anat Sci Educ 10: 433-443. © 2017 American Association of Anatomists.

Cadaveric dissection as an educational tool for anatomical sciences in the 21st century

Anatomical education has been undergoing reforms in line with the demands of medical profession. The aim of the present study is to assess the impact of a traditional method like cadaveric dissection in teaching/learning anatomy at present times when medical schools are inclining towards student-centered, integrated, clinical application models. The article undertakes a review of literature and analyzes the observations made therein reflecting on the relevance of cadaveric dissection in anatomical education of 21st century. Despite the advent of modern technology and evolved teaching methods, dissection continues to remain a cornerstone of anatomy curriculum. Medical professionals of all levels believe that dissection enables learning anatomy with relevant clinical correlates. Moreover dissection helps to build discipline independent skills which are essential requirements of modern health care setup. It has been supplemented by other teaching/learning methods due to limited availability of cadavers in some countries. However, in the developing world due to good access to cadavers, dissection based teaching is central to anatomy education till date. Its utility is also reflected in the perception of students who are of the opinion that dissection provides them with a foundation critical to development of clinical skills. Researchers have even suggested that time has come to reinstate dissection as the core method of teaching gross anatomy to ensure safe medical practice. Nevertheless, as dissection alone cannot provide uniform learning experience hence needs to be complemented with other innovative learning methods in the future education model of anatomy. Anat Sci Educ 10: 286-299. © 2016 American Association of Anatomists.

Venezuelan surgeons view concerning teaching human anatomical dissection

Currently, the importance of human anatomical dissection have come under debate in many countries but there are not references in Venezuela on this concern. This survey's aim is to assess the insights of Venezuelan surgeons and their outlines of usage of human anatomical dissection in teaching and learning human anatomy. Sixty-five Venezuelan surgeons at the Centro Médico Docente La Trinidad completed an anonymous survey on current and future teaching practices in human anatomy. Eighty-nine point two three percent of surveyed (n=58) conferred importance to human anatomical dissection despite the arrival of new innovations in learning human anatomy. The group surveyed view human anatomical dissection-based teaching as the most beneficial method of teaching human anatomy and it should be bolstered in human anatomical education with matching use of three-dimensional computerized tomography imaging as a complementary form for teaching and learning.

Paying respect to human cadavers: We owe this to the first teacher in anatomy

Every human cadaver which undergoes anatomical dissection enriches medical science and deserves to be treated with utmost respect. The aim of the present study is to identify the practices followed by medical schools across the globe to ensure that the human cadaver is treated with respect and dignity while it is utilized within the domain of medical education. The article undertakes a review of the literature and takes note of the practice of students taking an oath prior to dissecting cadavers whereby they reflect on their conduct and habits in the dissection room. It emphasizes the guidelines adopted by medical schools to ensure respectful handling of human cadavers during dissection and highlights traditional ways to honor them followed in some parts of the world. The article attempts to focus on the noble endeavor of funeral ceremonies to pay homage to the departed soul who enlightened the students with the knowledge of human anatomy. Finally it converges on the memorial services incorporated into anatomy programs to instill in students an appreciation of the humanity of those who went under the knife as a service to mankind. Based on the observations made in the present study some recommendations are also proposed regarding good practices in human cadaveric dissection. In order to bind science and humanity it is critical to realize our responsibility to reciprocate the anatomical gift of a human body with respect, compassion, care and dignity.

Anatomy and humanity: Examining the effects of a short documentary film and first anatomy laboratory experience on medical students

Medical students begin their education inside a laboratory dissecting cadavers to learn human gross anatomy. Many schools use the course experience as a way to instill empathy and some have begun integrating video and recorded interviews with body donors to humanize the experience, but their impact has yet to be measured. This study examines the effects of a brief documentary film and the initial cadaver encounter on student perceptions and attitudes towards the laboratory experience. A pre-test, exposure, post-test design was used with 77 first-year medical students at the University of Central Florida. A previously validated questionnaire was adapted to measure attitudes, emotions, initial reaction to cadaver, perception of the donor as a person, and impressions of the film. An online questionnaire was completed before the first day of laboratory, in which students watched the film Anatomy and Humanity and handled their respective cadavers (no dissection was performed). The post-test was administered immediately following the activities of the first laboratory day. Results indicate an increase in negative attitudes towards dissection, but a more positive initial reaction to the cadaver than originally anticipated. Students also experienced a decrease in emotions like sadness and guilt regarding anatomy laboratory and were less likely to view the cadaver as a once-living person. Findings suggest a higher comfort level, but also greater detachment toward the cadavers from day one despite the video intervention. These results provide novel insight that may aid other interventions aimed at promoting humanism in the anatomy laboratory experience.

Human cadaveric dissection: a historical account from ancient Greece to the modern era

The review article attempts to focus on the practice of human cadaveric dissection during its inception in ancient Greece in 3rd century BC, revival in medieval Italy at the beginning of 14th century and subsequent evolution in Europe and the United States of America over the centuries. The article highlights on the gradual change in attitude of religious authorities towards human dissection, the shift in the practice of human dissection being performed by barber surgeons to the anatomist himself dissecting the human body and the enactment of prominent legislations which proved to be crucial milestones during the course of the history of human cadaveric dissection. It particularly emphasizes on the different means of procuring human bodies which changed over the centuries in accordance with the increasing demand due to the rise in popularity of human dissection as a tool for teaching anatomy. Finally, it documents the rise of body donation programs as the source of human cadavers for anatomical dissection from the second half of the 20th century. Presently innovative measures are being introduced within the body donation programs by medical schools across the world to sensitize medical students such that they maintain a respectful, compassionate and empathetic attitude towards the human cadaver while dissecting the same. Human dissection is indispensable for a sound knowledge in anatomy which can ensure safe as well as efficient clinical practice and the human dissection lab could possibly be the ideal place to cultivate humanistic qualities among future physicians in the 21st century.

Ultrasound simulator-assisted teaching of cardiac anatomy to preclinical anatomy students: A pilot randomized trial of a three-hour learning exposure

Ultrasound simulation allows students to virtually explore internal anatomy by producing accurate, moving, color, three-dimensional rendered slices from any angle or approach leaving the organs and their relationships intact without requirement for consumables. The aim was to determine the feasibility and efficacy of self-directed learning of cardiac anatomy with an ultrasound simulator compared to cadavers and plastic models. After a single cardiac anatomy lecture, fifty university anatomy students participated in a three-hour supervised self-directed learning exposure in groups of five, randomized to an ultrasound simulator or human cadaveric specimens and plastic models. Pre- and post-tests were conducted using pictorial and non-pictorial multiple-choice questions (MCQs). Simulator students completed a survey on their experience. Four simulator and seven cadaver group students did not attend after randomization. Simulator use in groups of five students was feasible and feedback from participants was very positive. Baseline test scores were similar (P = 0.9) between groups. After the learning intervention, there was no difference between groups in change in total test score (P = 0.37), whether they were pictorial (P = 0.6) or non-pictorial (P = 0.21). In both groups there was an increase in total test scores (simulator +19.8 ±12.4%% and cadaver: +16.4% ± 10.2, P < 0.0001), pictorial question scores (+22.9 ±18.0%, 19.7 ±19.3%, P < 0.001) and non-pictorial question scores (+16.7 ±18.2%, +13 ±15.4%, P = 0.002). The ultrasound simulator appears equivalent to human cadaveric prosections for learning cardiac anatomy.

Honoring our donors: a survey of memorial ceremonies in United States anatomy programs

Many anatomy programs that incorporate dissection of donated human bodies hold memorial ceremonies of gratitude towards body donors. The content of these ceremonies may include learners' reflections on mortality, respect, altruism, and personal growth told through various humanities modalities. The task of planning is usually student- and faculty-led with participation from other health care students. Objective information on current memorial ceremonies for body donors in anatomy programs in the United States appears to be lacking. The number of programs in the United States that currently plan these memorial ceremonies and information on trends in programs undertaking such ceremonies remain unknown. Gross anatomy program directors throughout the United States were contacted and asked to respond to a voluntary questionnaire on memorial ceremonies held at their institution. The results (response rate 68.2%) indicated that a majority of human anatomy programs (95.5%) hold memorial ceremonies. These ceremonies are, for the most part, student-driven and nondenominational or secular in nature. Participants heavily rely upon speech, music, poetry, and written essays, with a small inclusion of other humanities modalities, such as dance or visual art, to explore a variety of themes during these ceremonies.

Computed tomography-enhanced anatomy course using enterprise visualization

Rapid changes in medical knowledge are forcing continuous adaptation of the basic science courses in medical schools. This article discusses a three-year experience developing a new Computed Tomography (CT)-based anatomy curriculum at the Sackler School of Medicine, Tel Aviv University, including describing the motivations and reasoning for the new curriculum, the CT-based learning system itself, practical examples of visual dissections, and student assessments of the new curriculum. At the heart of this new curriculum is the emphasis on studying anatomy by navigating inside the bodies of various living individuals utilizing a CT viewer. To assess the students' experience with the new CT-based learning method, an anonymous questionnaire was administered at the end of the course for three consecutive academic years: 2008/2009, 2009/2010, 2010/2011. Based upon the results, modifications were made to the curriculum in the summers of 2009 and 2010. Results showed that: (1) during these three years the number of students extensively using the CT system quadrupled (from 11% to 46%); (2) students' satisfaction from radiologists involvement increased by 150%; and (3) student appreciation of the CT-based learning method significantly increased (from 13% to 68%). It was concluded that discouraging results (mainly negative feedback from students) during the first years and a priori opposition from the teaching staff should not weaken efforts to develop new teaching methods in the field of anatomy. Incorporating a new curriculum requires time and patience. Student and staff satisfaction, along with utilization of the new system, will increase with the improvement of impeding factors.

The validity of multiple choice practical examinations as an alternative to traditional free response examination formats in gross anatomy

Traditionally, an anatomy practical examination is conducted using a free response format (FRF). However, this format is resource-intensive, as it requires a relatively large time investment from anatomy course faculty in preparation and grading. Thus, several interventions have been reported where the response format was changed to a selected response format (SRF). However, validity evidence from those interventions has not proved entirely adequate for the practical anatomy examination, and thus, further investigation was required. In this study, the validity evidence of SRF was examined using multiple choice questions (MCQs) constructed according to different levels of Bloom's taxonomy in comparison with the traditional free response format. A group of 100 medical students registered in a gross anatomy course volunteered to be enrolled in this study. The experimental MCQ examinations were part of graded midterm and final steeplechase practical examination. Volunteer students were instructed to complete the practical examinations twice, once in each of two separate examination rooms. The two separate examinations consisted of a traditional free response format and MCQ format. Scores from the two examinations (FRF and MCQ) displayed a strong correlation, even with higher level Bloom's taxonomy questions. In conclusion, the results of this study provide empirical evidence that the SRF (MCQ) response format is a valid method and can be used as an alternative to the traditional FRF steeplechase examination.

Creating a longitudinal environment of awareness: teaching professionalism outside the anatomy laboratory

Anatomy educators have long understood the role that professionalism education plays in the dissection laboratory. The process of dissecting human material forces students to address such issues as human mortality, their responsibility to the vulnerability of the deceased, their privileged position in society, and their commitment to scientific ideals. Educators have offered a wealth of opinions and curricula dedicated to teaching professionalism in first-year anatomy courses. That they have risen to this challenge is laudable. However, professionalism education is a longitudinal process of acculturation. What happens, then, to students after they leave the anatomy classroom? As it is not taught in other basic science courses, professionalism education effectively becomes a null curriculum, teaching students to compartmentalize professionalism questions so that they can be addressed in anatomy courses or during dedicated professionalism course work. In their training, medical students spend 4 to 12 years navigating this shifting environment of hidden, null, or explicit curricula, which have a significant impact on their attitudes and character.In this perspective, the author highlights, from his experience as a medical student, specific professionalism challenges in anatomy--such as encountering mortality, enacting contracts with society and those who are most vulnerable, and upholding scientific excellence--and discusses how these challenges are addressed by anatomy educators. He then provides analogous examples of opportunities to teach professionalism in other basic science courses, such as pathology, microbiology, and pharmacology. He concludes by describing the goal of incorporating professionalism into all basic science courses--a longitudinal, cohesive environment of awareness.

Doing dissections differently: a structured, peer-assisted learning approach to maximizing learning in dissections

Areas of difficulty faced by our veterinary medicine students, with respect to their learning in dissection classes, were identified. These challenges were both general adult-learning related and specific to the discipline of anatomy. Our aim was to design, implement, and evaluate a modified reciprocal peer-assisted/team-based learning format--Doing Dissections Differently (DDD)--to complement existing dissection classes, with the intention of enhancing both student learning and the student learning experience. Second year veterinary medicine students (n = 193), in their usual dissection groups, were randomly assigned to one of four roles: anatomist, clinician, radiologist, and learning resources manager. Students attended a preparatory workshop outlining the skills required for effective execution of their role. They were then asked to perform their roles throughout five consecutive musculoskeletal dissection classes. Student attitudes to dissection classes before and after DDD were evaluated by questionnaire (146 respondents). There was a significant (P = 0.0001) improvement after DDD in a number of areas: increased perceived value of dissection classes as an anatomy learning aid; improved appreciation of the clinical relevance of anatomy; increased use of resources before and during dissection classes; and longer preparation time for dissection classes. Before DDD, 45% of students felt that at least one peer did not contribute usefully to the group during dissection classes; no improvement was seen in this measure after DDD. Although the new format highlighted a potential need to improve teamwork, most students actively engaged with DDD, with dissection classes valued more highly and utilized more effectively.

Quality management of Body Donation Program at the University of Padova

Quality management improvement has become a recent focus of attention in medical education. The program for the donation of bodies and body parts (Body Donation Program) at the University of Padova has recently been subjected to a global quality management standard, the ISO 9001:2008 certification. The aim of the present work is to show how the above standard is useful in enhancing the efficiency of body donation procedures and the quality and output of medical education. The program is managed by means of the following interlinked procedures: the collection of body donations, death certificates, data, and body parts from living donors; the transportation and identification of cadavers; the management of bodies, body parts, equipment, instruments, purchasing of necessary materials, and setting up anatomical training sessions; the management of preventive and corrective actions; the management of documents and registration; the management of internal and external quality audits; and the review of outcomes and improvement planning. Monitoring indicators are identified in the numbers of donors and of donated body parts per year, education sessions, and satisfaction of learners and donors, as evaluated by questionnaires. The process management approach, the integrated involvement of medical, technical, and administrative staff in defining procedures, and the application of monitoring indicators allow quality improvement in all aspects of the Body Donation Program.

Cadaver treasure hunt: introducing geriatrics concepts in the anatomy class

The objective of this study was to develop an educational program introducing geriatrics to medical students during anatomy. Observational study of an educational intervention in medical school was the design utilized. First-year medical students in an anatomy laboratory were participants. The program consists of a lecture and a workshop. First, a geriatrics lecture early in the course presents demographic data on the cadavers, followed by comparison with national data on leading causes of death. Second, there is a "treasure hunt" in the anatomy laboratory conducted by geriatricians. Each geriatrician spends 45 minutes with one-four-student cadaver group at a time, reviewing anatomical findings and facilitating a discussion of clinical correlations and implications. A list of common anatomical findings, aging- and disease-related, is distributed to the students as an aid in identifying findings of interest. Students have been surprised to learn that the mean age of the 24 cadavers exceeded 80 years (mean 81, median 85 for 2 years), and that causes of death mirrored national data. The students begin understanding aging and appreciate the valuable resource of cadavers. The students acquire a new holistic perspective regarding their cadavers that is not apparent during the dissections. Students and faculty find the experience valuable in understanding the interplay of disease and aging. Evaluations have been mostly positive (82-87% positive responses). The anatomy lecture and "treasure hunt" experience are unique strategies for using cadavers to introduce geriatrics principles into the medical school.