The Donor Letter Project: Learning Professionalism and Fostering Empathy in an Anatomy Curriculum

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.

Art in medicine: in the classroom, exam room, and Reading room

In this article, the authors discuss the development and current curriculum of the Art in Medicine course at the University of Colorado School of Medicine (CUSOM), developed in collaboration with the Centre for Bioethics and Humanities, and the Denver Art Museum. Examples of art museum-based techniques implemented with medical students are discussed with objectives, methods, and pedagogy highlighted. Translational skillsets for medical professionals, including empathy, tolerance of ambiguity, perspective taking, bias, and communication are emphasised through practice in engagement in visual arts with facilitation by medical faculty and art museum educators. Following the discussion of classroom based activities, two of the co-authors, physician-educators from the CUSOM Departments of Medicine and Radiology, discuss the direct applications and importance of these skillsets in the context of the exam room and the reading room respectively.

A thematic analysis of students' discussions on death and body donation in international online focus groups

Historically, Anatomy education is an in-person discipline involving exposure to human body donors that facilitates personal and professional growth through, in part, the initiation of reflection on the topic of death. However, during the COVID-19 pandemic the decreased exposure to cadaveric anatomy for many health professions students may have influenced the depth of their individual reflections on this topic. Accordingly, this study aimed to investigate the effect of an alternate approach-focus group discussions between peers with varying degrees of exposure to cadaveric material-that may offer one strategy to stimulate deep reflection on the topic of death. A programmatic intervention was introduced, wherein students (n = 221) from 13 international universities discussed differences in their anatomy courses during small focus group sessions as part of an online exchange program. An inductive semantic thematic analysis was conducted on responses to an open-ended text-response question on how the activity influenced students' reflections about death. Resulting themes were organized into categories that described the content and topics of the students' discussions as they grappled with this sensitive topic. The students reportedly engaged in deep reflection and expressed an increased sense of connectedness with their peers, despite their disparate exposure levels to cadaveric anatomy and being physically distanced. This demonstrates that focus groups with students experiencing different laboratory contexts can be used to help all students reflect on the topic of death and that interchanges between dissecting and non-dissecting students can initiate thoughts about death and body donation among non-dissecting students.

The Anatomy Course During COVID-19: The Impact of Cadaver-Based Learning on the Initiation of Reflection on Death

BACKGROUND

During the COVID-19 pandemic, in-person cadaveric dissection laboratories for teaching anatomy were omitted by many schools around the world. While knowledge domains can be easily evaluated via remote exams, non-traditional discipline-independent skills such as those encouraged through reflection on the topic of death are often overlooked. This study investigated how different anatomy course formats played a role in initiating students' reflections on death during the COVID-19 pandemic.

METHOD

In fall 2020, 217 medical, dental, premedical, and health sciences students from 13 international universities discussed differences in their anatomy courses online. Formats of anatomy courses ranged from dissection-based, prosection-based, hybrid (combination of dissection and prosection) to no laboratory exposure at all. Students' responses to the question, "Did/does your anatomy course initiate your thinking about life's passing?" were collected, and they self-reported themes that were present in their reflections on death using a multiple-choice prompt. Statistical analyses to detect differences between students with and without exposure to cadavers were performed using the chi-squared test.

RESULTS

When comparing students who had exposure to human anatomical specimens to those who had no exposure, the majority of students with exposure thought that the course did initiate thoughts about life's passing, compared to students without exposure (P < 0.05). Reflection themes were consistent across groups.

DISCUSSION

These findings indicate that anatomy dissection courses are important for the initiation of students' feelings about the topic of death. Omission of cadaveric dissection- or prosection-based laboratories will decrease the likelihood that students initiate reflection on this topic and gain important transferable skills.

Teaching professionalism in cadaver dissection: medical students' perspective

This study was designed to facilitate freshman medical students’ adaptation to the dissection room and familiarize them with the related ethical codes. Single-group post-test design research was conducted at Tehran University of Medical Sciences in 2018 - 2019. The program began with a brief explanation of the necessity of the subject, and after a documentary film was shown, the principles of professional and ethical behaviors in the dissection room were discussed by a panel of experts. In the end, a valid and reliable evaluation questionnaire (Cronbach's alpha coefficient = 0.89) was distributed among the students. A total of 129 questionnaires were completed and returned. Overall, 94.4% of the students believed that the program provided an excellent opportunity to reflect on professional behaviors during practical anatomy sessions. In addition, 92.8% of the students believed that they would use the ethical points mentioned in the program in the future. Content analysis of the open questions produced three main categories: "motivating learning", "application of theory in practice" and "changing the attitude toward responsibility". The results indicate that adequate preparation for cadaver dissection sessions and learning about professional behavior codes in the first exposure can help medical students to better understand the principles of professional behaviors.

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.

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.

Relationship between emotional intelligence and professionalism among second-year dental students

INTRODUCTION

Emotional intelligence (EI) refers to a person's ability to evaluate and manage their personal emotions and the ability to respond appropriately to the emotions of others. Limited evidence exists regarding whether EI is related to professionalism.

PURPOSE

The purpose of this study was to evaluate for relationships between EI and professionalism among second-year dental students.

METHODS

Using a quantitative cross-sectional research design, the study instrument consisted of 3 parts: (1) The Emotional Quotient Self-Assessment Checklist (EQSAC), including 30 questions comprising 6 domains that measured EI; (2) The Patient Management and Professionalism Scale (PMPS), including 10 questions comprising 5 domains that measured professionalism; and (3) Demographic questions.

RESULTS

The response rate was 99.2% (n = 117) of second-year dental students. Most EI and professionalism scores were in the moderate range. Female participants had higher domain scores for agreeableness and conscientiousness compared with male participants. Male participants had higher domain scores for emotional stability than female participants. The EI domains were found to be significant predictors of total and domain professionalism levels.

CONCLUSION

Understanding methods to improve EI levels may assist dental students in their development of professionalism.

Nurturing professionalism in medical schools. A systematic scoping review of training curricula between 1990-2019

Introduction: Professionalism is an evolving, socioculturally informed multidimensional construct that influences doctor-patient relationships, patient satisfaction and care outcomes. However, despite its clinical significance there is little consistency in how professionalism is nurtured amongst medical students. To address this gap a systemic scoping review of nurturing professionalism in medical schools, is proposed.Methods: Levac's framework and the PRISMA-P 2015 checklist underpinned a 6-stage systematic review protocol. Concurrent use of Braun and Clarke's approach to thematic analysis and directed content analysis was used to identify the key elements in nurturing professionalism.Results: 13921 abstracts were identified from six databases, 854 full-text articles reviewed, and 162 full-text included articles were included. The 4 themes identified through thematic analysis are consistent with findings of the directed content analysis. These were the definition of professionalism, the approaches, content, barriers and enablers to teaching professionalism.Conclusion: Informed by a viable definition of professionalism and clear milestones nurturing professionalism nurturing professionalism begins with culturally appropriate training in clinical competence, humanistic qualities and reflective capacity. This process requires effective evaluations of professional identity formation, and the impact of the learning environment underlining the need for longitudinal assessments of the training process.