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

Receiving a donation call to dissection tables: various aspects of whole-body donation in northern union territory region medical college of India

Body donation is the act of giving one's body to science for study, practice, and research. This selfless act contributed to the education and training of professionals in the field of medicine. Body donation programs allow medical students to learn about the different aspects of human anatomy, perfect their dissection skills, and develop a better understanding of the relationship between structure and function in the human body. The purpose of article is to improve body donation programs which meet ethical standards and best practices. This article emphasizes the significance of body donation to teaching medical institutions by discussing various aspects of body donation to medical colleges in India and the procedural steps followed, sample proformas and the obstacles faced during the whole process. The process of body donation varies among different countries pertaining to their legal frameworks and the challenges faced. A description of the problems faced in the process of body donation has been discussed with suggestions for potential solutions in this section. The sample formats of the forms filled by donors and the certificates issued by concerned organizations are also provided to clearly understand the process of body donation. The information compiled will pave the way for medical teaching institutions that have yet to start a body donation program.

Teaching respect for body donors: A US medical student perspective

Recent controversies over the mismanagement of body donors in US medical schools have raised public concerns over the ethical treatment of bodies in "anatomical gift" programs. Despite widespread moral outrage at such cases, medical students may still make seemingly inconsequential mistakes or jokes that in fact constitute acts of disrespect. This may partially be attributed to the process of desensitization in working with human remains, and indicates a further need to inculcate into medical students the ethical responsibilities of working with body donors. Donation agreement statements that lack specific information about the respectful treatment of bodies in the anatomy laboratory may serve as an additional point of concern for potential donors seeking reassurance about the future treatment of their bodies. This viewpoint draws from the anecdotal experiences of medical students to portray two scenarios of medical students' disrespectful conduct toward body donors, and constructs an account of moral respect for human remains based on respect for posthumous autonomy and respect in attitude. It then provides suggestions for US medical schools to incorporate this ethical framework into their anatomy curricula to instill respectful dispositions in its students and facilitate a more robust informed consent process for potential donors who entrust their bodies to medical students.

Public human dissection and societal connect of anatomical sciences: A glorious association in the past but ethically forbidden practice at present

Under the futuristic vision of anatomical sciences, a strong societal connection is mandatory. The anatomical practice experienced robust societal participation through public human dissection from the 16th century onward. With a perspective to explore the intersection of spirituality with anatomy, the present study analyzed this momentous period. From a spiritual perspective, the study also reflects on two relevant but presently uncoupled entities of public human dissection and societal connection through the prism of current regulations. Strong representation from the general public during public human dissection was primarily driven by spiritual proclivity and an endorsement from religious authorities. To regulate large gatherings and maintain academic sanctity, anatomical theaters emerged as dedicated spaces for such a merger. With time and growing financial support, the theaters transformed from temporary structures to elaborate architectural marvels, further propelling already robust societal connections associated with the practice. Nevertheless, a confluence of multiple factors led to the violation of spiritual principles and a consequent decrease in societal participation from the early 18th century, eventually culminating in the demise of such spectacle. Presently, public human dissection-when done-is mostly conducted for commercial gains and in contravention of ethical norms. It is against the essence of spirituality and harbors a bleak prospect for societal connection. Contrastingly, measures adopted to promote societal participation (mostly related to body donation) were quite effective and followed the principles of spirituality. Societal connections served anatomy in the past and can lead to its advancement if approached through a righteous path.

Honoring human body donors: Five core themes to consider regarding ethical treatment and memorialization

Dissection of human body donors is a common component of anatomy curricula, as it provides opportunities for tactile and intellectual engagement unmatched otherwise. Additionally, interaction with human body donors contributes to the "hidden curriculum" of allowing students to begin to ethically practice patient care with empathy, respect, and compassion. With this, there have been various proposed guidelines for the ethical treatment of human body donors, with most focusing on student reflections and a final ceremony for honoring the donors, but there are numerous other ways throughout the course to incorporate ethical values and to guide students to consider the humanity of the donor. This article proposes that institutions consider the incorporation of five easily implemented formalized ethical themes for working with human body donations into daily practices: (1) reflect the donor as possessing human dignity, (2) recognize the donor's role of the "First Patient" or "Silent Teacher," (3) honor the gift of human body donation, (4) recognize the decedent's family, and (5) consider inclusivity in memorialization practices. Multiple recommendations for integrating these five themes throughout the course are provided. The incorporation of these five core themes can assist in alleviating the psychological stress that some students struggle with in dissection courses, foster the feelings and attributes that comprise the hidden curriculum and are the desired characteristics of a caring medical provider, and discourage misuse and mistreatment of donors.

A comparison of student perspectives on body donation across healthcare professional programs: From prosection- to dissection-based curricula

Donor-centered education offers students the opportunity to not only acquire visual and tactile experiences for applying anatomical knowledge but also a chance for students to reflect upon fundamental humanistic principles. The exploration of differences in students' viewpoints on body donation and the utilization of body donors in their education remains unexplored across various healthcare professional programs, which has an impact on student learning and experience. This study aimed to qualitatively examine the similarities and differences in student perspectives regarding body donation across three healthcare professional programs. One-page reflections from nursing (n = 37), physical and occupational therapy (n = 49), and medical students (n = 66) regarding their experiences in the anatomy laboratory at McGill University were collected and analyzed using a deductive approach based on themes and sub-themes outlined by Stephens et al. in 2019. Despite differences in their curricula, there were few discrepancies across the programs' reflections suggesting that donor-based learning had similar effects on each user group. Most students across the healthcare professional programs mentioned that their positive laboratory experiences motivated them to donate their bodies, extending the privilege they had to future generations. Nursing students did not reflect upon the notion that working with body donors provided unique learning experiences in the anatomy laboratory. Likewise, physical and occupational therapy (PT/OT) students did not address the importance of maintaining the privacy of body donors by covering certain body parts during lab. These findings show that prosection- and dissection-based exercises encourage reflective practices associated with these of medical ethics, highlighting an important advantage to including donor-based learning in anatomical education.

Cadaver Dissection Experience for First-Time Dissectors: a Hypothetical Three-Pronged Approach for Student Preparation

This systematic review synthesized evidence for the development of a preparatory process for first-time dissectors, geared toward improving cadaver dissection (CD) experiences. Eleven studies focused on pre-CD intervention were selected from a literature search in PubMed, the Education Resources Information Centre (ERIC), Google Scholar, PsycNET, and the Cochrane Library. A three-pronged preparatory process was formulated for first-time dissectors based on the evidence from the review. The process includes (1) background assessment; (2) pre-CD education; and (3) gradual exposure and desensitization. The preparatory process shows some hypothetical potential for decreasing negative CD-related experiences, but it still needs validation before implementation.

Responsible research in the practice of anatomy: Attributes relevant to body donors and human tissues sourced from them

Responsible Research involves setting moral examples before fellow academicians and the society as a whole. The concept of Responsible Research applies appropriately to ethical sourcing and handling of human tissues. The present study was undertaken to analyze present situation regarding implementation of attributes of Relevant Research in relation to body donors in anatomical research. A literature search of relevant, peer-reviewed, published articles was undertaken from indexed databases (Medline & PubMed, Scopus, Embase, CINAHL Plus, Web of Science and Google Scholar) for this study. The following attributes of Responsible Research were identified for possible intervention: the fact that research was conducted on human tissues from body donors and details regarding ethical handling thereof may be explicitly mentioned in method section; expression of gratitude towards body donors by authors may be included in acknowledgement section; editor's and publisher's note in support of adoption of attributes of Responsible Research may be included in published research. Adherence to best practices in terms of ethical guidelines requires anatomists to embrace a responsible approach in research from an inclusive perspective. Accordingly, practice of acknowledging the body donors may be nurtured and augmented to include the anonymised dead (human tissues from unclaimed bodies and unknown source) provided the research protocol received clearance from authorities concerned with ethical scrutiny. Moreover, adoption of the practice in review articles will enhance the boundaries of Responsible Research in anatomical science. Thus, few recommendations are proposed as epilogue for effectual implementation of the notion floated in present study.

The Sun Also Rises: Tracing the evolution of humanistic values in anatomy pedagogy and research, including cadaveric acquisition practices

Anatomy has always been at the intersection of the socio-cultural and political landscape, where new ideas constantly replace older wisdom. From ancient Egyptians through the Greeks, and then the Romans, finally culminating into the European Renaissance-all the significant eras of human civilisation have left their insignia and distinct marks on the evolution of anatomical practices. Despite its utility as a tool for anatomy pedagogy and research that has proven its worth over millennia, cadaveric dissection has particularly been subject to political and social vicissitudes. A major debate about anatomical dissection lay with the ethical considerations, or its lack thereof, while acquiring corpses for demonstration in the dissection halls. From antiquity, anatomical dissection-often synonymous with medical studies-had typically been carried out on the dead bodies of executed criminals with certain laws, such as the Murder Act of 1752, facilitating such uses. Gradually, the uses of unclaimed bodies, resourced primarily from the impoverished sections of society, were also introduced. However, these body acquisition protocols often missed the crucial element of humanism and ethical considerations, while knowledge augmentation was taken as sufficient reasoning. Unfortunately, a gross disregard towards humanistic values promulgated heinous and illegal practices in acquiring corpses, including grave robbery and even murders like in the case of Burke and Hare murders of 1828. Follow-up legislation, such as the Anatomy Act of 1832, and comparable laws in other European nations were passed to curb the vile. What distils from such a historical discourse on humane values in anatomy dissection, or medical science in general, is that the growth and integration of humanism in anatomy have never been linear, but there were intermittent and, yet, significant disruptions in its timeline. For example, there were serious human rights violations in anatomical practices during the Third Reich in Germany that perpetrated the holocaust. The medical community has kept evolving and introducing new moral values and principles while using such egregious events as lessons, ultimately resulting in the Declaration of Helsinki in 1964. This article revisits the heterogeneous journey of integrating humanistic values in anatomy practice. Such humanistic traits that, like medical science, have also developed over centuries through the inputs of physicians, researchers, and philosophers-from Greece to modernity with an important stopgap at the Renaissance-are a fascinating lore that deserves to be re-envisioned through the lens of contemporary values and ethos. In parallel to human medicine, humanistic values continue to influence veterinary medicine, a welcome development, as our society condemns animal cruelty in any form. There are lessons to be learned from this historical journey of how humanism shaped many of the concepts that anatomists use now. Finally, and most importantly, it might prevent the medical community from repeating the same mistakes by cautioning against the traps that are there, and in a convoluted world where morality as such is eroding from our social fabric, will always be there. Such historical account acts as a righteous, ethical, and contextual compass to guide the existing and upcoming anatomists in discerning between light and dark, right and wrong, and roads-to be or not to be-taken.

Willingness toward post-mortem body donation to science at a Mexican university: an exploratory survey

BACKGROUND

Voluntary post-mortem donation to science (PDS) is the most appropriate source for body dissection in medical education and training, and highly useful for biomedical research. In Mexico, unclaimed bodies are no longer a legal source, but PDS is legally possible, although scarcely facilitated, and mostly ignored by the general population. Therefore, we aimed to evaluate the attitude and willingness for PDS and to identify a sociodemographic profile of people with willingness toward PDS.

METHODS

A validated on-line survey was distributed by the convenience method via the social networks of a Catholicism-inspired, private university in northern Mexico. Frequency analyses of all variables and coded free comments were complemented with association studies.

RESULTS

Although the responder cohort (n = 143) was too small and biased to be representative of the university community (n = 13,500), willingness to post-mortem organ donation was 90.7% and to PDS 70.7%. In this cohort, PDS willingness had the strongest association with mature age (> 40 years old; P, 0.0008). Among young adults, willingness to PDS was the lowest among volunteers from technical and business schools and the highest among those from the social sciences (P, 0.009). Respondents from the social sciences were also the most consistent between attitude and behavior with respect to organ donation. A free comment option revealed respondents were interested in the unusual taboo topic.

CONCLUSIONS

A small, but sufficiently large proportion expressed willingness toward PDS. In our university cohort, which was biased in higher education and altruism, mature age and social interest were associated with PDS willingness.

New Challenges for Anatomists in the Era of Omics

Anatomic studies have traditionally relied on macroscopic, microscopic, and histological techniques to investigate the structure of tissues and organs. Anatomic studies are essential in many fields, including medicine, biology, and veterinary science. Advances in technology, such as imaging techniques and molecular biology, continue to provide new insights into the anatomy of living organisms. Therefore, anatomy remains an active and important area in the scientific field. The consolidation in recent years of some omics technologies such as genomics, transcriptomics, proteomics, and metabolomics allows for a more complete and detailed understanding of the structure and function of cells, tissues, and organs. These have been joined more recently by "omics" such as radiomics, pathomics, and connectomics, supported by computer-assisted technologies such as neural networks, 3D bioprinting, and artificial intelligence. All these new tools, although some are still in the early stages of development, have the potential to strongly contribute to the macroscopic and microscopic characterization in medicine. For anatomists, it is time to hitch a ride and get on board omics technologies to sail to new frontiers and to explore novel scenarios in anatomy.

Profiting from public dissection: A new era of unethical practices

Historically, adverse events have reflected poorly on both the practice of dissection and the perception of the discipline of anatomy. The recent public dissection of a body donor is a regression to an unethical historical practice and was strongly denounced by anatomists around the world. The individual whose donated body was sourced from a 'for-profit" company in the United States had not given consent for a public dissection. This violates the ethics surrounding consent and body donation and potentially places the future of body donor programs in jeopardy as it compromises community frameworks around epistemic trust. Recent guiding frameworks by international anatomical associations on the ethical use of bodies have cemented the way in which body donor programs should operate. This viewpoint reflects on past and current events pertaining to public dissections and questions how these indignities may influence the public's interaction with human bodies. The authors argue that public dissection should be prohibited as it is against social mores. Social pressure should be applied to individuals or companies who wish to profit from unethical anatomical practice and legislation prohibiting public dissection should be introduced in those countries where it does not yet exist.

Applicability and usefulness of the Declaration of Helsinki for forensic research with human cadavers and remains

Bodies of deceased persons and human remains and their specimens (i.e., organs, bones, tissues, or biological samples) are essential in forensic research but ad hoc worldwide-recognized ethical standards for their use are still lacking. Such standards are needed both to avoid possible unethical practices and to sustain research in the forensic field. Pending consensus within the forensic science community regarding this topic, with this article we aim to stimulate a debate as to the applicability and usefulness of the Declaration of Helsinki in the field of forensic research involving human cadavers and remains. Considering the fundamental differences compared to clinical research involving human beings and the different moral obligations involved, we focus on the risks, burdens, and benefits of research, ethics committee approval, and informed consent requirements. The Declaration of Helsinki framework allows forensic researchers to focus on substantial ethical principles promoting the consistency, integrity, and quality of research. Consensus regarding ethical standards and the adoption of national and supranational laws that clearly regulate the use of human cadavers and remains, including those from autopsies, continues to be of primary importance for the forensic science community.

The pathological anatomical collection of the Natural History Museum Vienna

The pathological anatomical collection Vienna (Pathologisch-Anatomische Sammlung Wien; PASW) is a living and still growing research collection. It was established as early as 1796 as part of the Medical University of Vienna, acquired the status of an independent federal museum in 1971, and was assigned to the Natural History Museum Vienna in 2012. It houses a wide range of human wet and dry specimens and further objects, such as moulages, medical devices, microbiological and histological specimens, and a photo archive (approximately 50,000 objects), which, as a meaningful source, may contribute to disclosing not only aspects of the medical history and the development of corresponding museums in Vienna, but is also considered a collection of cultural and current scientific relevance, quite comparable to today's biobanks. Most of the tissue amassment represents wet organic specimens and human skeletons or skeletal elements representing, e.g., congenital and metabolic disorders, infectious diseases, injuries, neoplasms, or musculoskeletal diseases, basically collected as descriptive anatomical teaching aids. This article reviews the current medical issues on which research has been and is being conducted by including PASW specimens (hereby using the ICD-10 code), and the extent to and ethical conditions under which this important heritage could be used as a reference collection for clinical and bioanthropological (paleopathological and palaeoepidemiological) studies; finally, this article reflects on the value and future research prospects, taking into account different positions and the ongoing discussions in pathological anatomical human tissue collections.

Altruism in death: Attitudes to body and organ donation in Australian students

Health education, research, and training rely on the altruistic act of body donation for the supply of cadavers. Organ transplantation and research rely on donated organs. Supply of both is limited, with further restrictions in Australia due to requirements for a next-of-kin agreement to donation, irrespective of the deceased's pre-death consent. Research suggests health workers are less likely to support the donation of their own bodies and/or organs, despite recognizing the public good of donation, and that exposure to gross anatomy teaching may negatively affect support for donation. Attitudes to body and organ donation were examined in Australian students studying anatomy. Support for self-body donation (26.5%) was much lower than support for self-organ donation (82.5%). Ten percent of participants would not support the election of a family member or member of the public to donate their body, and just over 4% would not support the election of a family member to donate their organs, with one-to-two percent not supporting this election by a member of the public. Exposure to gross anatomy teaching was associated with an increased likelihood of consideration of issues about body and organ donation, whether for self, family, or the public, and registration as an organ donor. Exposure decreased participants' willingness to donate their own body, with those who practiced a religion least likely to support body donation. Gross anatomy courses provide an opportunity to inform future healthcare workers about altruistic donation, albeit with a recognition that religious or cultural beliefs may affect willingness to donate.

Assessing the Ethical Concerns of Medical Students in the Gross Anatomy Lab

OBJECTIVES

Cadaver dissection has become the gold-standard for anatomical education in US medical schools. Ethical issues regarding cadavers may not be as obvious as in living patients, which can lead to their potential neglect in medical school curricula. In this study, we assessed the different ethical concerns (ECs) of medical students regarding cadavers in the gross anatomy lab (GAL), gathered student information, including self-reported academic performance (AP) in the GAL, and determined the best predictors for a student's EC.

METHODS

All second-year medical students at the University of Toledo were invited to complete an anonymous, online-survey. Participants were presented with 10 hypothetical but realistic lab scenarios and asked to rate their EC for each on a 5-point Likert scale. Gender, age, and scores received in the GAL course were also collected. A multiple linear regression model was used to find the best predictors of the total EC score.

RESULTS

A total of 112 (63%) responses to the online-survey were recorded. The highest EC was for Q7: Taking pictures of the cadaver. The lowest EC was for Q10: The dissection of cadavers itself is an EC. Gender was the best predictor of total EC, followed by age. Female total EC was significantly higher than that for males (35.8 ± 5.5 vs 33.1 ± 7.9). Female scores for Q1 and Q2 were significantly higher than those for males. Total EC for students in the age group 25 to 34 was significantly higher than those in the age group 18 to 24 (35.9 ± 6.1 vs 33.9 ± 7.2). No significant difference was found for individual scenarios. AP was not significantly related to the total score or the scores of the individual scenarios.

CONCLUSION

The significant differences in ECs of medical students found in our study indicate that not all students have the same outlook towards the GAL specifically and ECs generally.

Evolving strategies in whirlwind mode: The changing face of anatomy education during Covid-19 pandemic

The Covid-19 pandemic stipulated adoption of unfamiliar strategies for delivering anatomy education in online mode. The factors which determine education strategies are variable across geographical regions. It was perceived that an overview of education strategies around the globe would be useful for anatomists. Hence this narrative review was undertaken to collate observations from different geographical regions pertaining to education strategies adopted during the pandemic. Data relevant to the topic of study were extracted from 12 articles that were selected from an initial pool of 317 articles based on search criteria set for the review. Subtle differences in core education strategies implied that baseline response from anatomists was similar across regions. It was evident that online digital tools were key elements of education strategies adopted by educators for delivering online anatomy classes across the globe. Interestingly, a considerable gap in terms of number and variety of online tools used for anatomy education (those requiring commercial purchase) was noted between economically developed and developing regions. This may have an impact on learning outcome for students and may even lead to variations in anatomical knowledge by regions. It was observed that offline human dissection sessions were incorporated into online practical classes in one region as positive cases showed a declining trend. This positive development is worth emulating elsewhere based on cautious assessment of prevailing situation. From a broad perspective timely introduction of education strategies ensured delivery of anatomy education during the pandemic and gave an evolved outlook to the fabric of anatomy education.

The place of ethics in practice of anatomical sciences: have we left our dark past behind and looking towards a bright future?

INTRODUCTION

Anatomical sciences involve handling of human tissues and, therefore, application of principles of bioethics is central to anatomical practice. For a considerable period of time, anatomy was practiced without ethical norms as concept of ethics developed during second half of twentieth century. Hence, possible glimpse into contrast in ethical standards between anatomy in the past and present was deemed as an intriguing research theme.

METHODS

A literature search was undertaken from indexed databases (Medline and Pubmed, Scopus, Embase, CINAHL Plus, Web of Science and Google Scholar). Relevant data were extracted from 37 articles that were selected from an initial pool of 752 articles based on search criteria set for the study.

RESULTS

Prevalent anatomical practices in the past such as dissection of executed criminals, acts of vivisection, illegal procurement of human remains, use of human tissues obtained as part of war crimes and dissection of human fetuses as well as their archival were analyzed through prism of established ethical norms in present day. The observations from past were presented vis-à-vis ethical practices undertaken in present times such as use of donated bodies and/or body parts procured through legal means for dissection, adherence to ethical norms during dissection, archival of human tissues mandating stringent regulation and dignified disposal of human remains. Existing loop holes were identified and future prospects regarding ethical standards in anatomy were highlighted based on rational judgment of existing trends.

CONCLUSION

The article concludes with defense on future prospects of ethics in anatomy based on documented arguments.

The value of in-person undergraduate dissection in anatomical education in the time of Covid-19

While several innovative pedagogical practices have been developed and implemented in anatomy education since the onset of the coronavirus disease 2019 (Covid-19) pandemic, considering the value of in-person undergraduate dissection remains crucial. In this commentary, a human dissection course at the University of Toronto is used as an example to highlight the value of dissection for undergraduate learners in non-professional programs. In-person dissection allows for real life, anatomical variation, and supports the advancement of students' conceptual knowledge of the human body and visual-spatial abilities. Direct involvement with dissection during undergraduate training also provides students with an opportunity to practice and refine non-technical skills, such as communication and collaboration, while simultaneously promoting the development of students' professional identity formation. Further, dissection is a practical, hands-on experience that can provide students with insight into potential career aspirations related to anatomy and the health professions. It is suggested that as institutions veer from traditional pedagogical practices and evaluate how to best move forward post-pandemic, it is imperative that the value of undergraduate dissection is considered among new innovations in the field of anatomy.

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.

Bodies and bureaucracy: The demise of the body snatchers in 19th century Britain

As European anatomical teaching developed in the middle ages, anatomists found themselves balanced between the educational and judicial systems. Dissection was associated with the final stages of legal prosecutions and the supply of bodies was severely limited. Driven by increasing student demand for dissection, anatomists found themselves pushed to explore alternative routes for body supply. This led to association with the developing profession of grave robber, body snatchers, and even murderers. Keen to protect themselves from increasing vulnerability to legal prosecution, the eminent anatomists of the United Kingdom pushed for government legislation to provide a supply of cadaveric material for education. This article looks at the development of the Anatomy legislation in the United Kingdom in 1832. By highlighting three events in the early 1800s, it demonstrates that the development of the legislation was for addressing the concerns of the anatomists rather than any ethical concerns about the cadaveric supply. The poorest in society were used to develop the medical understanding of the more wealthy before, during, and after the introduction of the legislation. The first event made the anatomists criminal liable for body supply while the latter two events linked anatomists with murderers. The increasing demand for legislation to provide a supply of cadaveric material released the anatomists from the financial burden of dealing with grave robbers while still allowing dissection tables to be supplied with the poorest in society.

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.

Lacunae regarding dearth of dissection-based teaching during COVID-19 pandemic: how to cope with it?

Introduction

In view of the ongoing COVID-19 pandemic, anatomy education programs were amended so as to shift to primarily online mode from physical classes. In the whole process, main concern area that has emerged is regarding dearth of physical human dissection sessions. There is enough evidence available in literature to suggest that dissection room is an ideal place to cultivate and inculcate discipline independent skills or humanistic skills among the students. These include attributes in relation to ethical practice, professionalism, communication skills, empathy and compassion. Imbibing these skills are an essential element of medical education curriculum as it is desirable that students exhibit these traits when they begin medical practice. Hence deficiency in terms of exposure to physical dissection sessions can adversely affect training of medical students on a long term.

Methods

A literature search of relevant, peer-reviewed, published articles was undertaken from indexed databases (Medline and PubMed, Scopus, Embase, CINAHL Plus, Web of Science and Google Scholar) for this study.

Results

To counter the pertinent issue in online anatomy teaching program, a few measures have been suggested in this paper based on identification of actual deficit areas in terms of learning and analysis thereof. Live streaming of real time dissection, awareness sessions on human dissection, online interactive learning sessions and reflective thoughts-based exercise can contribute to building discipline independent skills in present scenario.

Conclusion

Incorporation and implementation of these interventions within the realm of online anatomy education programs during COVID-19 pandemic can possibly contribute towards desirable learning outcomes.

Assessment of Ethical Compliance of Handling and Usage of the Human Body in Anatomical Facilities of Ethiopian Medical Schools

Background

Human anatomy has historically been a cornerstone in medical education and is special in that it uses human remains kept in various anatomical facilities like a morgue, gross anatomy laboratory, or museums for instruction and research. While serving knowledge advancement facilitating clinical practice and research, human cadaver handling, and usage at all levels, such as cadaver sourcing, transportation, storage, preservation, dissection, and final disposal deserves in return the utmost respect. In Ethiopia, even though there is not enough information on when, where, and by whom the first cadaver dissection was conducted, dissection is being conducted in many of its medical schools. Despite ethical necessity surrounding human body usage in every anatomical setting, there is still ethical and legal uncertainty due to several challenging barriers which is severe in developing nations including Ethiopia. The aim of this study is, therefore, to assess ethical practices of handling and usage of the human body to promote, in the near future, formulation and implementation of acceptable, respectful, and ethical guidelines for the anatomy dissection laboratories and related settings in Ethiopia.

Methods

A multicentered cross-sectional study was used at selected anatomy facilities of eight Ethiopian medical schools. The collected data through structured questionnaires and checklists were cleaned, preset and entered in to SPSS version 20 for analysis. Internal consistency and reliability were measured by using Cronbach’s alpha.

Results

The study result showed vivid human body ethical breaches that ranged from lack of power by anatomy unit to oversee the process during sourcing, transportation, embalming, caring, and dissection of cadavers in the anatomy laboratories to student’s mistreatment of cadavers.

Conclusion

In addition to lack of compliance due to lack of standard ethical guidelines or policies regarding human body usage, the compliance-based professional development is also nonexistent. The ethical way of body sourcing is through body donation; however, in Ethiopia, anatomy teaching exclusively depends on unclaimed bodies. Using a body for dissection that is solely sourced unethically may generate a negative emotional sense of life for anatomy instructors, technical assistants, morticians, and medical students. We inspire better provision of moral and ethical exercise with the good practice concerning the human body through recognizing the humanity and uniqueness of the deceased person. The results of this study serve as a serious condemnation of practices in Ethiopian anatomy facilities and we urge the Anatomical Society of Ethiopia to play its part in changing the present practices related to ethical and legal uncertainty of the human body usage.

In death there is life: perceptions of the university community regarding body donation for educational purposes in the United Arab Emirates

Human body dissection is the traditional instructional method for anatomy education worldwide, providing a kinaesthetic learning experience that is often challenging to achieve with other teaching techniques. However, due to lack of body donation programs in Middle Eastern medical schools, dead bodies are imported from abroad. Since literature suggests that the body shortage is influenced by reluctance to donate one's body, this study aimed to determine the perceptions of faculty, staff, and students regarding body donation for educational purposes at a new Dubai-based medical school. An online dually translated questionnaire was administered to the target population (322), of which 150 participants representative of faculty, staff, and students, responded. Although 111 (74.0 %) of participants considered body donation to be appropriate for educational and research purposes, only 44 (29.3 %) of participants expressed willingness to donate their bodies. Reluctance to donate 106 (70.7 %) appeared to be mostly influenced by religion, psychological barrier, and familial reasons. The emergence of four themes (i.e., resource, barrier, humanitarian, and awareness) and the identification of a potential donor group within the group that was willing to donate provided insight into the level of awareness within the university community. Furthermore, such findings may assist to establish future body donation programs and strategize recruitment approaches, especially when there is an ensuing dearth of anatomical donations.

Physicians' viewpoints on faculty anatomists and dissection of human bodies in the undergraduate medical studies

BACKGROUND

Studies abound regarding the views of faculty anatomists and medical students on the importance of anatomy and the dissection of human bodies, but very little is known about the views of practicing physicians.

METHODS

A survey was distributed among physicians and surgeons practicing in Spain in order to find out their views on the practice and consequences of human dissection by undergraduate students of medicine. The most relevant definition to qualify faculty anatomists of medical schools was also requested. Responses were repeatedly clustered into characteristic subgroups for analysis.

RESULTS

In total, 536 physicians and surgeons belonging to 36 different specialties in seven Spanish hospitals responded to the survey. The results highlighted two main facts. Firstly, faculty anatomists were perceived as teachers, above any other professional identity (namely: physician, biologist or scientist); nonetheless, the ascription of identities varied between specialties (p=0.009); and it also depended on whether the respondents had dissected in their undergraduate degree (p=0.03) and on the respondent's gender (p=0.03). Secondly, physicians and surgeons confirmed that dissecting human cadavers serves the undergraduate student not only for acquiring anatomical knowledge, but also essential skills and attitudes, including professionalism.

CONCLUSIONS

The results strongly suggest that dissection practice should be reinforced and enriched in undergraduate medical school. As this is important in itself, the results of the study could also help with the development of strategies to alleviate the current shortage of adequately trained anatomists for medical degrees.

Covid-19: Emerging Considerations for Body Sourcing and Handling. A Perspective View from Nigeria

The current Coronavirus disease (Covid-19) pandemic has spread to about 220 countries of the world and has resulted in a significant number of deaths globally. Infections are still on the rise, and the impact on the global death rate could be devastating. There are fears over the likely impact of a large number of deaths on body sourcing and handling of cadavers for teaching and research. Historically, epidemics come with several challenges and have often led to some level of negligence of ethical practices and health and safety regulations associated with body sourcing and handling. The authors highlighted some emerging problems in this article, focusing on Africa and Nigeria in particular. These problems include a higher risk of coronavirus exposure for body handlers, shortage of cadavers for teaching and learning, a lack of standard regulations leading to unethical body sourcing and handling, and a lack of monitoring and collaboration needed for a well-coordinated Covid-19 pandemic response strategy. If these issues are ignored, the previous gains made in anatomical ethical practices may be destroyed. Some useful recommendations for policymaking geared toward prevention or curtailing these emerging issues have been instilled in this article.

Proposing a Framework Guide for the Integration of Educational Technologies and Innovations into the Teaching of Anatomy and Medical Sciences: The ASIC Framework

Educational technologies are becoming important and integral to medical education and practice more than ever before. The scope and appreciation for digital medicine is also widening. No thanks to the covid-19 induced restrictions including physical distancing and lockdown measures, which has changed the mode of educational delivery in many climes. Technology became a major avenue for sustaining medical education and practice. However, what this has also revealed is the heterogeneity in the deployment of technologies and educational innovations based on factors that are linked but not limited to human and system factors. There is currently no generally accepted framework to guide the use of medical education technologies and innovations in the teaching of human anatomy to medical and allied health students. The current framework attempts to provide a framework that could work for various medical education systems, centred on four key considerations: adaptation, standardization, integration, and compliance. In this article, the ASIC framework is presented, illustrated, and succinctly discussed.

Medical Students' Feedback of Applying the Virtual Dissection Table (Anatomage) in Learning Anatomy: A Cross-sectional Descriptive Study

OBJECTIVE

Conventional cadaver dissection is the main learning tool for studying human anatomy. Other tools have been developed to add another dimension of depth to anatomy teaching, such as Anatomage. 3D Anatomage is a touch interactive anatomy virtual dissection table used in anatomy education. The aim of this study was to address students' opinions on applying the virtual dissection table (3D Anatomage) as an additional tool to cadaver dissection in learning anatomy.

METHODS

An electronic questionnaire consisted of 6 questions that included items regarding the effect of using 3D Anatomage on students' deep understanding of anatomy topics, the locations and relationships of the different internal body structures and the application of anatomical knowledge. The survey was completed by 78 medical students.

RESULTS

The results of this study showed that the majority of students preferred using 3D Anatomage as an additional tool to cadaver dissection for learning anatomy since it enhances active learning, and approximately 89% of students agreed that 3D Anatomage helped them to better understand the relationships between internal structures and visualizing the body system. Additionally, approximately 72% of the students indicated that the imaging facility in 3D Anatomage was useful for enabling their understanding of anatomy as it is envisioned through medical imaging.

CONCLUSION

In conclusion, using the 3D Anatomage virtual dissection table is effective in anatomy education, and its use is recommended as an anatomy learning resource in addition to cadavers.

Cultivation of humanistic values in medical education through anatomy pedagogy and gratitude ceremony for body donors

BACKGROUND

One of the most important objectives of modern medical education is to empower medical students to become humanistic clinicians. Human anatomy plays a crucial role in this mission by using cadavers to cause reflections on death, dying, illness, and the role of medical practitioners in humanistic care. The objective of this study was to introduce, describe, and evaluate the impact of a ceremony in honor of the body donors on ethical and humanistic attitudes of medical students.

METHODS

We used a phenomenological research approach to explore and understand the lived experiences of the anatomy teachers as they teach anatomy in the context of humanism and ethics. A separate survey of third-year medical students was carried out to understand their perceptions of changes in themselves, respect for donors and donor families, and their relationship with patients. Data were collected in two phases: a desktop review of teaching materials followed by in-depth interviews of the main anatomy teachers followed by a self-administered, 5-item Likert scaled questionnaire given to students.

RESULTS

In the present article, we describe the rituals conducted in honor of body donors at our School of Medicine. We also describe the lived experiences of anatomy teachers as they work on improving humanistic education quality through the introduction of the concept of "silent mentor" which refers to a cadaver that quietly allows medical students to learn from it. In turn, a ceremony in honor of body donors who have altruistically donated their bodies so that learning anatomy through dissection would be possible is also introduced. A survey of the impact of the ceremony in honor of body donors on medical students revealed positive responses in terms of promoting studying anatomy (3.96 Vs 3.95) as well as reflections on own death (4.44 Vs 4.35), the life of body donors (4.07 Vs 4.04), and how to humanely view future patients and their significant others (4.32 Vs 4.24) relative to those that did not attend the ceremony (5-item Likert scale). The majority of the students that attended the ceremony also indicated that it had a positive impact on their future doctor-patient relationship, thinking about the possibility of donating their body for teaching as well as about medical ethics. Most of them also think that attending the ceremony helped reduce their anxiety, fear, and disgust of seeing corpses or dissecting and 90% insisted that memorial ceremonies should continue being conducted at Zhongshan Medical School.

CONCLUSION

The combination of the anatomy component of the basic medical curriculum and gratitude ceremonies as well as activities to promote body bequeathal programs might help to accomplish the goal of cultivating high-quality medical students and professionals for the future. The long-term benefits would be a medical graduate who exudes empathy, relates well with patients and their significant others, leading to a productive doctor-patient relationship.