Maintaining the anonymity of cadavers in medical education: Historic relic or educational and ethical necessity?

Personalization above anonymization? A role for considering the humanity and spirituality of the dead in anatomical education

Clinical anatomy education is meant to prepare students for caring for the living, often by working with the dead. By their nature many clinical anatomy education programs privilege topographical form  over the donor's humanity. This inbalance between the living and the dead generates tensions between the tangible and the spiritual insofar as semblances of the humanity of donors endure even in depictions and derivatives. This article argues that considering the relevance of spirituality, and what endures of a donor's humanity after death, would enhance contemporary anatomy education and the ethical treatment of human body donors (and derivatives). In developing this argument, we (the authors) address the historical connection between spirituality and anatomy, including the anatomical locations of the soul. This serves as a basis for examining the role of the mimetic-or imitative-potential of deceased human donors as representations of the living. We deliberate on the ways in which the depersonalization and anonymization of those donating challenge the mimetic purpose of human body donors and the extent to which such practices are misaligned with the health care shift  from a biomedical to a biopsychosocial model. Weighing up the risks and opportunities of anonymization versus personalization of human body donors, we propose curricula that could serve to enhance the personalization of human donors to support students learning topographical form. In doing so, we argue that the personalization of human donors and depictions could prevent the ill effects of digital representations going "viral," and enhance opportunities for donors to help the general public learn more about the human form.

American Association for Anatomy recommendations for the management of legacy anatomical collections

Collections of human remains in scientific and private institutions have a long tradition, though throughout history there has often been variable regard for the respect and dignity that these tissues demand. Recent public scandals around the use of human remains, coupled with an increasing community awareness around accountability in such instances, forces scholars to confront the ethical and moral concerns associated with these collections. This includes specific focus on the acquisition, storage, use, and disposition of these remains, which were often collected with no consent and with little knowledge, or concern, about the individual or their respective culture and practices surrounding death and postmortem treatment. As a response, the American Association for Anatomy convened a Legacy Anatomical Collections Task Force to consider these issues and to develop recommendations to assist those working with these tissues in education, research, and museum collections. This has culminated with the development of Recommendations for the Management of Legacy Anatomical Collections. The recommendations provide both an ethical foundation and practical considerations for the use, storage, and disposition of legacy collections of human tissues, and deliver guidance for establishing appropriate management and oversight, investigating provenance, and engaging with communities of care. While these Recommendations are considered a living document which will change over time as ethical principles concerning human tissue evolve, they currently represent 'best practice' recommendations that can guide researchers, teachers, and museum associates as they consider the future of legacy anatomical collections in their care.

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.

Dyad pedagogy in practical anatomy: A description of the implementation and student perceptions of an adaptive approach to cadaveric teaching

Prior to the challenges imposed by the Covid-19 pandemic, anatomy practical sessions at Trinity College Dublin involved eight to 10 students per donor station, rotating between digital learning, anatomical models/osteology, and dissection activities for three hours weekly. To maintain cadaveric participation in the anatomy laboratory while adhering to distancing guidelines, a transition to dyad pedagogy was implemented. This mode of delivery allowed two students per donor station to spend one hour per week in the anatomy laboratory with all digital learning elements transferred to the virtual learning platform Blackboard as pre- and post-practical session learning activities. Dyad pedagogy has been explored in clinical settings and simulation procedural-based training but is yet to be fully verified in anatomy education. To determine the effectiveness of hybrid practical sessions and reduced donor to student ratios, the opinions of first year medical students were examined using an online questionnaire with a 51% response rate. Although students recognized the merits of more time in the anatomy laboratory, including opportunities for self-directed study and exposure to anatomical variation, they felt that having two students per station enabled sufficient hands-on time with the donor body and fostered learning opportunities that would not be possible with larger groups. Strong preferences for quality time with the donor body supported by online resources suggests this modality should be a key consideration in course design for anatomy curricula and emphasizes the importance of gauging students' preferences to optimize satisfaction and learning output when pivoting to blended learning strategies in anatomy education.

10 tips on working with human body donors in medical training and research

Human body donors selflessly decided to make the ultimate gift to donate their bodies to education. Being on the receiving end, the health sciences education community owes it to the donors to ensure that they are being treated with utmost respect by promoting and developing high ethical standards and maximizing the benefits from this gift. Working with human body donors for research purposes has increased over the years, while regulations associated with these processes did not change. This article draws upon current literature and author’s experiences to offer practical tips for health educators and everyone working with body donors to achieve these goals. We offer 10 practical tips that help in starting the conversation about the best ways to work with body donors to maximize their contribution to health sciences education.

The creation of a body donation program at Federal University of Juiz de Fora in Brazil: academic importance, challenges and donor profile

Dissection and human specimens study remain the gold standard method for teaching anatomy. Due to the increasing health science courses in Brazil, the traditional way of obtaining bodies for scientific purposes, the unclaimed ones, became insufficient. In addition, this source is no longer ethically appropriate according to anatomists. In order to maintain the teaching quality, the Federal University of Juiz de Fora (UFJF) in Brazil, inspired by successful initiatives around the world, created a body donation program; Sempre Vivo. Besides the bureaucratic difficulty faced during its regulation, the implementation of a body donation program requires special attention regarding the religiosity, culture and uniqueness of the city's inhabitants. Informing people can demystify the process, avoid prejudice and increase the number of donors. In this way, an outreach project was designed to publicize Sempre Vivo and raise public awareness. In the first six years, Sempre Vivo reached the mark of 64 registered donors and seven bodies received. The donor’s profile corresponds to female (70.3%), 57 years of age, retired (50.8%), spiritist (53.1%) and with 12 years or more of formal education (90.6%). Considering that the UFJF has not received unclaimed bodies for ten years, the program was considered satisfactory up to this level and, in the future, it may be the exclusive source of anatomical specimens. The description of the creation and the publicizing of Sempre Vivo, the overcome challenges, as well as the donors’ profile, may encourage and facilitate the foundation of similar programs in Brazil and abroad.

Teaching Professionalism to Medical Students Using Dissection-Based Anatomy Education: a Practical Guide

Professionalism is a core competency for all healthcare professionals and is a subject of great interest within the academic community due to its vital importance in delivering the highest quality patient care. Despite this, professionalism remains difficult to define, teach and assess. The potential use of anatomy education in teaching professionalism has been increasingly highlighted within the literature, but still remains an underutilised tool in medical education. Therefore, this practical guide offers evidence-based practical points for successfully incorporating professionalism within a dissection-based anatomy course delivered to undergraduate medical students.

Attitudes of Anatomy Students toward Commemorations for Body Donors: A Multicultural Perspective

Many medical schools practice commemorative ceremonies to honor body donors. Attitudes of medical education stakeholders toward these ceremonies have not yet been fully investigated. The aim of this study was to explore anatomy students' attitudes toward commemorations at a multicultural institution which has not introduced these ceremonies yet. A survey was carried out on different groups of anatomy students that were exposed and not yet exposed to human remains. The survey was used to record basic demographic data from the respondents, ask if they would support the establishment of an anatomy commemoration and in which format. A total of 756 anatomy students participated in the survey (response rate 69.8%). The majority (76.3%) were in favor of introducing a commemoration for donors. The associations of students' gender, attitude toward body donation, and level of exposure to human remains with attitudes toward commemoration for donors were identified (P < 0.05), whereas ethnicity and religion seemed to have no influence on attitudes (P > 0.05). Most students believed that anatomy staff and students should organize the commemoration. There was a preference for the commemoration to be secular with revealed identities of donors, and not recorded for social media. The support for the establishment of commemorations transcended cultural and religious differences and confirmed students' respectful attitude toward donors. Anatomy commemorations seem to have potential not only to engage students with one another, and donor families, but also to pave the way for students to become life-long ethical and empathetic learners and practitioners.

Physician Associate Students' Experience of Anatomy Dissection

The role of physician assistant/associate (PA) has expanded from its inception in the United States over 50 years ago, to European countries including Ireland. While there is an increasing body of evidence exploring the role and training of PAs in clinical settings, there is a scarcity of research exploring PA students' perspectives in relation to their experience of anatomy dissection, or how these experiences may contribute to the development of their core professional identity. Students in the first two cohorts of PA Program at the Royal College of Surgeons in Ireland program were invited to interviews which solicited them to reflect and report on their own experiences of anatomical dissection during their course. Participants' responses were analyzed using a thematic inductive approach; common themes and patterns were organized into a hierarchical structure, which generated the final framework of themes. Ten participants took part in the study; only one had previous personal experience of dissection, while two further participants had some familiarity with prosected specimens. The first theme concerned the participants' expectation of anatomical dissection, with sub-themes of preconceptions, smell, and emotions. The second theme involves discussion of coping strategies that the participants used, including talking, viewing the cadaver as their first patient, and naming (or not naming) the cadaver. The third theme includes how the participants' talked about respect and compassion in the dissection room, development of team working skills, and awareness of bereavement and organ donation. A number of recommendations were also made for the experience and orientation of future students in such a program.

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

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

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

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

Ethical Perspectives on Body Donation Following Physician-Assisted Death

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

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.

Cadaver as a first teacher: A module to learn the ethics and values of cadaveric dissection

Objectives

The undergraduate medical students must be made aware of the ethical and humanistic values of cadaveric dissection. This study therefore designed, implemented, and evaluated the impact of the module 'Cadaver as a Teacher' (CrAFT) that examines the ethical values of cadaveric dissection.

Methods

This prospective, multimethod study involved 447 first-year undergraduate medical students who had participated in all three sessions of the CrAFT module. Activities included interactive lectures, individual assignments, and a poster-making competition. Students offered a silent tribute and wrote words of gratitude down on a tribute wall. They also expressed their thoughts in the form of essays, poems, and collages. These reflections were qualitatively analysed to generate themes. At the end of the module, an online quiz was conducted to assess the knowledge gained by the students. Their scores were correspondingly recorded and calculated.

Results

The major themes identified were: cadaver as a teacher, acknowledgement and thanksgiving, bonding, and empathy. Out of all the test takers, 316 students (94.32%) scored more than a five out of ten. The students strongly felt that the module effectively sensitised them towards the ethical and humanitarian aspects of handling cadavers.

Conclusions

The implementation of an educational module about cadavers is a novel approach towards sensitising medical students. The students believed that sensitising them early on would have helped them establish a practice grounded in professionalism, human values, and empathy.

Uncovering Hidden Curricula: Use of Dark Humor in Anatomy Labs and its Implications for Basic Sciences Education

Humor is subjective within most settings, but within the anatomy laboratory, it is likely to be significantly more contentious. While humor may be considered a component of the hidden curriculum of medical education, it has yet to be studied specifically from a basic sciences perspective. This study sought to understand if, when, how, and why humor may be used in anatomy labs and the implications this may have in basic sciences education. A survey consisting of demographic and qualitative items was designed to sample widely from academics, students, and health professionals with anatomy laboratory experience. A total of 185 respondents, representing 9 countries participated following purposive sampling and snowball recruitment. Findings of significance were 72% of respondents who had experienced dark humor within the anatomy lab. Themes identified from free-text pertained to the use of internal and external barometers to ascertain the appropriateness of humorous remarks and the use of humor as a mechanism for diffusing stress. Polarity in responses concerning the acceptability of dark humor and rude mnemonics was also observed. This study highlighted that while dark humor may be a perceived tension release, many individuals make use of very specific internalized gauges to determine when and what humor may be appropriate. The data emphasized the need for not only future humanistic-focused anatomy but also basic sciences, education research, to better understand and have ideal educational experiences for all. Finally, this study provided further evidence of the impact of the hidden curriculum associated with the use of humor within educational and professional settings.

The Use of Anatomical Dissection Videos in Medical Education

Dissection videos are commonly utilized in gross anatomy courses; however, the actual usage of such videos, as well as the academic impact of student use of these videos, is largely unknown. Understanding how dissection videos impact learning is important in making curricular decisions. In this study, 22 dissection videos were created to review structures identified in laboratory sessions throughout the Organ Systems 1 (OS1), 2 (OS2), and 3 (OS3) courses. Dissection videos were provided to 201 first-year medical students, and viewing data were recorded. Demographic data for age and gender identity were also collected from students. Overall, there was a significant decrease in total views (P = 0.001), the number of students who pressed play (P < 0.001), and the number of students who viewed ≥ 90% of the total length of videos (P < 0.001) from OS1 to OS3. The total adjusted time spent viewing videos was not significantly different between individual OS courses. There were some instances where significant differences existed in examination performance between those who did and did not view videos, and by time spent viewing videos. There were no significant differences in time spent viewing videos by gender. Together these data suggest that students may utilize dissection videos more at the beginning of a dissection course, although they remain an important resource throughout the year for a subset of students.

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.

Not Just a Specimen: A Qualitative Study of Emotion, Morality, and Professionalism in One Medical School Gross Anatomy Laboratory

Medical schools are increasingly integrating professionalism training into their gross anatomy courses, teaching ethical behavior and humanistic attitudes through the dissection experience. However, many schools continue to take a traditional, technical approach to anatomical education while teaching professionalism in separate courses. This interview-based study explored how students viewed the body donor and the professional lessons they learned through dissection at one such medical school. All students oscillated involuntarily between seeing the cadaver as a specimen for learning and seeing the cadaver as a person, with some students intentionally cultivating one of these ways of seeing over the other. These views shaped students' emotional and moral responses to the experiences of dissection. The "specimen" view facilitated a technical, detached approach to dissection, while the "person" view made students engage emotionally. Further, students who intentionally cultivated a "specimen" view generally felt less moral distress about dissection than students who intentionally cultivated a "person" view. The concept of respect gave students permission to perform dissections, but "person-minded" students developed more complex rules around what constituted respectful behavior. Both groups of students connected the gross anatomy experience to their professional development, but in different ways. "Specimen-minded" students intentionally objectified the body to learn the emotional control physicians need, while "person-minded" students humanized the body donor to promote the emotional engagement required of physicians. These findings support efforts to integrate professionalism teaching into gross anatomy courses, particularly content, addressing the balance between professional detachment and concern.

Effects of an Educational Film About Body Donors on Students' Empathy and Anxiety Levels in Gross Anatomy

While most German anatomy institutes provide only limited information about body donors and their lives, students have expressed a desire to learn more about these individuals, especially about their motivations to donate their bodies for the sake of medical education. In order to gratify this wish, as well as to further humanize body donors, an educational film was compiled, and a study designed to capture the film's effects on medical students. This is the first study using standardized, validated psychological tools to evaluate the impact of an educational film about body donors on students' empathy and psychological stress levels. The study followed a longitudinal, controlled, and cluster randomized design, including 77 (48 females/29 males) participants who watched the video either before, midway, or after the dissection course. Questionnaires were completed at four points in time applying the Jefferson Scale for Empathy (JSPE-S) and the Interpersonal Reactivity Index (IRI) to measure empathy. Psychological stress levels were recorded by the Brief Symptom Inventory (BSI). Overall, students recommended the film to be shown to all students (median 6.0; maximum on the six-point Likert scale). Viewing the film revealed no significant changes between study groups or over time in JSPE-S sum scores. All groups demonstrated a significant reduction of BSI values before the dissection course actually started and increased values during the course, but both developments appeared not to be associated with the intervention. Overall, the educational film did not correlate with any negative effects on students' empathy and psychological stress levels, and it was strongly approved of by students, as it provided more humanizing personal information about body donors without violating their anonymity.

Profile and Motivations of Registered Whole-Body Donors in Turkey: Istanbul University Experience

Little is known regarding the profiles of whole body donors in Muslim majority countries where donation is scarce. Therefore, this study aims to profile registered donors in Turkey by means of a survey. The explored data could be used to improve ongoing campaign efforts and ethical practices such as commemoration services. Registered donors of the donation programs at the two faculties of medicine of Istanbul University were compared with the national population and a cluster analysis was performed to reveal any concealed sub-groups. Data from 188 respondents were analyzed. The majority of registered donors were married (42%), male (65.4%), aged over 50 years (76%), held a tertiary education degree (49.7%), and were irreligious (58.5%). Cluster analysis revealed two groups with significantly different educational levels, marital statuses, and religious choices. Regarding whether their bodies could be used for education or research, the majority (64.5%) of the respondents left the decision to the anatomy department. Similarly, 73.8% approved indefinite use of their organs, body parts and/or skeletons. The respondents were also willing to share their medical history (94.2%) and personal information (81.6%) if needed. Motivational themes for body donation including usefulness, impermanence, religion, awareness, and kinship were devised after a thematic analysis. Among the respondents, 56.5% were registered organ donors and 63.3% were frequent blood donors. The results of this study provide data that may help revising informed consent forms, developing and implementing thanksgiving ceremonies, and selecting additional targets for supporting body donation campaign activities such as organ and blood donation units.

A Bioethos for Bodies: Respecting a Priceless Resource

The value that willed body donors provide to medical education is priceless. Their precious gift helps to teach anatomy, spatial relationships between morphological structures, anatomical variation, and professionalism to medical students in a way that plastic models, podcasts, and lectures cannot. They are also an important resource for medical research and a wide variety of postgraduate training opportunities. While many body donation programs throughout the world are nonprofit organizations, there are body donation companies in the United States that sell donors for-profit. These "body brokers" have accumulated large profits from this business. It is incongruous that others would profit from such a priceless, freely donated gift. To prevent this incongruity, it is proposed that the international anatomical community develop a normative culture (a bioethos) for body donation programs. This would involve the conscious and systematic development of ethical principles for the day-to-day policies and practices of institutions that collect and use human bodies. With the development of this bioethos, a cultural shift in how donors are treated would occur and, over time, this would become the normal practice. These principles would become fundamental and foundational for the procurement and use of priceless human tissues.

Three-dimensional Printing in Anatomy Education: Assessing Potential Ethical Dimensions

New technological developments have frequently had major consequences for anatomy education, and have raised ethical queries for anatomy educators. The advent of three-dimensional (3D) printing of human material is showing considerable promise as an educational tool that fits alongside cadaveric dissection, plastination, computer simulation, and anatomical models and images. At first glance its ethical implications appear minimal, and yet the more extensive ethical implications around clinical bioprinting suggest that a cautious approach to 3D printing in the dissecting room is in order. Following an overview of early groundbreaking studies into 3D printing of prosections, organs, and archived fetal material, it has become clear that their origin, using donated bodies or 3D files available on the Internet, has ethical overtones. The dynamic presented by digital technology raises questions about the nature of the consent provided by the body donor, reasons for 3D printing, the extent to which it will be commercialized, and its comparative advantages over other available teaching resources. In exploring questions like these, the place of 3D printing within a hierarchical sequence of value is outlined. Discussion centers on the significance of local usage of prints, the challenges created by regarding 3D prints as disposable property, the importance of retaining the human side to anatomy, and the unacceptability of obtaining 3D-printed material from unclaimed bodies. It is concluded that the scientific tenor of 3D processes represents a move away from the human person, so that efforts are required to prevent them accentuating depersonalization and commodification.

Transformation and Closure for Anatomical Donor Families that Meet Medical Students

The University of Oklahoma College of Medicine has conducted an annual Anatomical Donor Luncheon where families of the anatomical donors met anatomy dissection groups of medical students. The luncheon presented an opportunity for donor family members to share the life story of their loved one with the medical students prior to the start of the anatomy course. This study was designed to understand the impact of the Anatomical Donor Luncheon on families of the donors. Seven families in two different focus groups were included to explore the reactions and attitudes of the donor families to meeting the medical students. Conversations were digitally recorded and transcribed. Qualitative analysis of textual data were coded by three investigators using the Constant Comparative Method. To provide evidence of validity, a form of member checking was utilized. For further triangulation, an analyst not involved in conducting the focus groups or analyzing the data, re-coded all data. This analyst used categories and themes identified by the original analysts, ensuring validity of the themes and any negative cases (data not supporting or contradictory of the established categories and themes). One meta-theme and three sub-themes were identified. The meta-theme was Donor Family Participants Experience Transformation and Closure, and sub-themes were Motivators for Participation, Optimal Venue Factors, and Optimal Medical Student-Anatomical Donor Family Interactions. Study findings indicated the Anatomical Donor Luncheon facilitated closure on the death of their loved one, and transformed their apprehension about the luncheon and body donation into an attitude of gratitude and appreciation.

Of Discomfort and Disagreement: Unclaimed Bodies in Anatomy Laboratories at United States Medical Schools

Use of unclaimed bodies for anatomy teaching in undergraduate medical education continues, but is ethically controversial. The purposes of this study were to estimate the proportion of United States (US) medical schools using unclaimed bodies in first-year anatomy laboratories, to determine whether schools inform students of this use, and to explore anatomy course leaders' attitudes toward unclaimed body use. Anatomy course leaders from 146 US medical schools that had independent preclinical programs including anatomy were surveyed. Survey results were analyzed with descriptive statistics and statistical tests of association. Free text responses were analyzed using a thematic editing style of qualitative content analysis. Of 89 responses (response rate, 61.0%), 11 schools (12.4%) reported possible use of unclaimed bodies. Course leaders from these schools reported greater comfort with using unclaimed bodies compared to leaders from other schools (P < 0.01). Although most course leaders (49/76, or 64.5%) believed it was important or very important to inform students about use of unclaimed bodies, respondents from schools where unclaimed bodies could be used were more neutral (P < 0.01). Qualitative findings revealed deep disagreement and contradictory views about how unclaimed body use relates to ethical principles of respect for persons and justice. Continued use of unclaimed bodies, varying levels of comfort with their use, and disagreement about the practices' underlying morality suggest a need for greater ethical reflection about the permissibility of unclaimed body use in clinical anatomy and for educational interventions that teach students about its history, ethics, and contemporary practice.

Sharing personal information about anatomical body donors: What first-year medical students want to know and how it affects emotional responses to dissection

Among educators who teach in the human anatomy laboratory, there has been lively debate about sharing information about anatomical donors. One consideration in this debate is concern about the emotional effect of personalizing donors on the students. The purpose of this study was to evaluate student responses to being exposed to donor information (DI). Three cohorts of first-year medical students (n = 284) were surveyed at four time points throughout the year. Surveys queried students about positive and negative responses to working in the laboratory, wanting to know specific DI, and if knowing this DI would/did affect their responses to working with donors. Analyses examined the relationships between desire to know DI and indices of the following: positive response index (PRI), negative response index (NRI), avoid-approach index (AAI), and compassion-respect index. Across all surveys, a majority of respondents wanted to know some form of DI. At all time points, a majority of respondents felt that knowing all types of DI would increase their positive responses to working with donors. A greater PRI and AAI tended to be associated with wanting to know more personal DI (e.g., names and personal histories). A greater NRI tended to be associated with anticipating that learning personal DI would increase their negative responses before entering the laboratory, which did not persist after dissection began. These data suggest that for a majority of students, knowing personal DI increases their positive response and does not elicit negative responses to dissection or working with anatomical donors. Clin. Anat. 32:1019-1032, 2019. © 2019 Wiley Periodicals, Inc.

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.

Cutting Deep: The Transformative Power of Art in the Anatomy Lab

On Tuesday evenings at New York University School of Medicine (NYUSoM), the anatomy lab is transformed into an art studio. Medical students gather with a spirit of creative enterprise and a unique goal: to turn anatomy into art. They are participants in Art & Anatomy, an innovative drawing course within the Master Scholars Program in Humanistic Medicine (MSPHM)-a component of NYUSoM, which offers elective courses across a range of interdisciplinary topics in medical humanities. Art & Anatomy has had approximately four hundred fifty participants since its inception in 2009. The educational intention of the course is to use drawing as an active mode of learning that enhances visual-perceptual ability and three-dimensional (3D) spatial understanding of the body's interior; however, the course also opens a creative space for participants to process the emotional complexities of cadaver dissection and the anatomy lab experience. The anatomy lab can be the training ground for clinical detachment, but many U.S. medical schools are beginning to attend more closely to the emotional aspects of dissection. The authors maintain that the inherently expressive nature of drawing makes the Art & Anatomy course a novel and effective approach to this endeavor. Select student artwork and a curriculum overview are provided.

Anonymous body or first patient? A status report and needs assessment regarding the personalization of donors in dissection courses in German, Austrian, and Swiss Medical Schools

Many Anglo-American universities have undertaken a paradigm shift in how the dissection of human material is approached, such that students are encouraged to learn about the lives of body donors, and to respectfully "personalize" them as human beings, rather than treating the specimens as anonymous cadavers. For the purposes of this study, this provision of limited personal information regarding the life of a body donor will be referred to as "personalization" of body donors. At this time, it is unknown whether this paradigm shift in the personalization of body donors can be translated into the German-speaking world. A shift from donor anonymity to donor personalization could strengthen students' perception of the donor as a "first patient," and thereby reinforce their ability to empathize with their future patients. Therefore, this study aimed to collect data about the current status of donation practices at German-speaking anatomy departments (n = 44) and to describe the opinions of anatomy departments, students (n = 366), and donors (n = 227) about possible donor personalization in medical education. Anatomy departments in Germany, Austria, and Switzerland were invited to participate in an online questionnaire. One-tenth of registered donors at Ulm University were randomly selected and received a questionnaire (20 items, yes-no questions) by mail. Students at the University of Ulm were also surveyed at the end of the dissection course (31 items, six-point Likert-scale). The majority of students were interested in receiving additional information about their donors (78.1%). A majority of donors also supported the anonymous disclosure of information about their medical history (92.5%). However, this information is only available in about 28% of the departments surveyed and is communicated to the students only irregularly. Overall, 78% of anatomy departments were not in favor of undertaking donor personalization. The results appear to reflect traditional attitudes among anatomy departments. However, since students clearly preferred receiving additional donor information, and most donors expressed a willingness to provide this information, one could argue that a change in attitudes is necessary. To do so, official recommendations for a limited, anonymous personalization of donated cadaveric specimens might be necessary. Anat Sci Educ 11: 282-293. © 2017 American Association of Anatomists.

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.

Medical student use of Facebook to support preparation for anatomy assessments

The use of Facebook to support students is an emerging area of educational research. This study explored how a Facebook Page could support Year 2 medical (MBChB) students in preparation for summative anatomy assessments and alleviate test anxiety. Overall, Facebook analytics revealed that in total 49 (19.8% of entire cohort) students posted a comment in preparation for either the first (33 students) or second (34) summative anatomy assessments. 18 students commented in preparation for both. In total, 155 comments were posted, with 83 for the first and 72 for the second. Of the 83 comments, 45 related to checking anatomical information, 30 were requiring assessment information and 8 wanted general course information. For the second assessment this was 52, 14 and 6, respectively. Student perceptions on usage, and impact on learning and assessment preparation were obtained via a five-point Likert-style questionnaire, with 119 students confirming they accessed the Page. Generally, students believed the Page was an effective way to support their learning, and provided information which supported their preparation with increases in perceived confidence and reductions in anxiety. There was no difference between gender, except for males who appeared to be significantly less likely to ask a question as they may be perceived to lack knowledge (P < 0.05). This study suggests that Facebook can play an important role in supporting students in preparation for anatomy assessments. Anat Sci Educ 10: 205-214. © 2016 American Association of Anatomists.