Virtual thanks giving to a cadaver by medical students exposed to learning anatomy before and amidst COVID-19 pandemic.

PURPOSE: Due to COVID-19 pandemic, Thanks giving ceremony to cadaver was different this year in two ways: the students were partially exposed to cadaveric dissections (for 7 months) and later learned Anatomy via online classes due to lockdown (for 5 months) and secondly it was not feasible to gather for the ceremony so virtual platform was preferred. The purpose of this study was to discern the gratitude for cadaver and to recognize the importance of cadaveric dissection from the reflection of students who experienced hybrid anatomy learning amidst COVID-19. METHODS: The study was conducted on 48 first year medical students who were admitted to the college in August 2019 and were willing to participate. An online invitation was sent to students to participate in virtual thanks giving to cadaver ceremony on the last day of their anatomy class (August 2020). RESULTS: Though the students partially studied gross anatomy with the aid of dissections on the cadaver; however, they expressed respect and gratitude to the silent mentor in the form of a card, poem, drawing or paragraph and shared it via google classroom platform. The students wished if they could continue their anatomy course in dissection hall as paused due to COVID-19 pandemic. CONCLUSIONS: Reflection of these students may mark impact on future anatomy students who may or may not get the chance for dissections. The thanks-giving gesture will also help to bind medical science and humanity especially during the crisis of pandemic.

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.

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.

The Law, Ethics and Body Donation: A Tale of Two Bequeathal Programs.

Historically, legislature has been utilized to facilitate appropriate use of cadavers in the anatomical sciences. However, cadaver acquisition and use have also been guided by ethically appropriate and morally acceptable principles. Various global and regional frameworks of "ethical practice" guide body donation, including the use of unclaimed bodies by institutions. These frameworks are responsive to, and reciprocal with the various ethical, moral and legal factors that influence the development of body donation programs. This reciprocity supports the notion that anatomists and anatomical societies have a responsibility to advocate for legal reform when required. In this study, two body bequest programs from geopolitically and socially disparate countries are used as cases to contrast existing legal and governance frameworks for body donation and to examine whether anatomists can direct the acquisition of ethically donated cadavers. The study includes an Australian donor program that has exclusively accepted bequests since its inception, and a South African program that has recently transitioned to a bequest system. Elements such as consent by next-of-kin and Inspector of Anatomy, use of unclaimed bodies and ethics committee approval amongst others, are compared. It is acknowledged that legal frameworks for cadaver acquisition generally deliver broad guidance on acceptable utilization of bodies for the anatomical sciences. However, professional discretion is of importance in adapting to societal needs and values. Thus, while anatomists have been able to progress toward more ethical practice than that which is required by the law, they must continue to do so as societal values evolve.

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.

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.

Holding donated human bodies in conservation: A novel interactive safe-keeping system meeting high ethical and safety standards.

"Mortui vivos docent". Learning from donated bodies is widely considered a corner stone in pre-clinical education, advanced clinical training, and scientific progress in medicine. Making such use of dead human bodies must, of course, accord with high ethical standards and legal constraints. Piety and respect towards donors require using their remains (i) for valuable purposes, (ii) with what we call 'practical decency', (iii) in an efficient way, and (iv) with the utmost safety for all parties involved. With regard to these goals, practical aspects of preservation, safekeeping procedures (for up to several years), and complete documentation become of great importance, but have so far only been realized unsatisfactorily. Here, we describe the new Safe-Keeping System-Münster (SKS-Münster) that has been developed and implemented in the Anatomy Department of the University of Münster. Integrated components of the system include a paternoster transport system, a removal station with ventilation and an air barrier, RFID transponder technology, and an easy to use software package allowing the system together to provide all required functions in an unprecedented way.

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

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

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.

Attitudes and Responses of Medical Students and Professional Anatomists to Dissecting Different Regions of the Body.

Although there have been many studies assessing emotional responses of medical students to the dissecting room experience, little is known about whether dissecting particular regions of the human body cause more concern than others. Furthermore, no studies have been conducted on the concerns of professional anatomists. In this study, we assessed the hypothesis that medical students are more concerned about the dissection of the face, the perineum and the extremities of the limbs. We also hypothesized that there are gender differences. For the reactions of a group of professional anatomists from the United States and Europe we hypothesized that they were less concerned than the medical students and showed no differences across the regions of the body. The hypotheses were tested by means of questionnaires distributed to medical students at Cardiff University and at the Descartes Paris University who had recently completed their anatomy courses and to anatomists working at universities in Europe and the USA. Ethical approval for the study was obtained from the ethical committees at the Cardiff School of Biosciences and at Paris and all data was obtained by consent of the respondents and remained confidential. The findings were complex, although the level of concern was low overall. Some regional differences were discerned, particularly concerning the face, the perineum, the hand and the female chest. Anatomists were less concerned than the students and female students and female anatomists showed more concern than their male counterparts. Few differences were discerned however between student respondents who had positive and neutral attitudes to gender "politics" and those who espoused negative views. We recommend that, at the start of an anatomy dissection course, time is spent dealing with sensitive issues (including equality and diversity issues), emotional responses, and matters pertaining to mortality. However, we argue that this should not involve hiding regions of the body, nor overreacting to the natural anxiety of students, since doing either of these things could enhance negative reactions and stifle the progress of the student from being a layperson to a competent healthcare professional. Clin. Anat. 32:253-267, 2019. © 2018 Wiley Periodicals, Inc.

Ethical considerations in the use of Pernkopf's Atlas of Anatomy: A surgical case study.

The use of Eduard Pernkopf's anatomic atlas presents ethical challenges for modern surgery concerning the use of data resulting from abusive scientific work. In the 1980s and 1990s, historic investigations revealed that Pernkopf was an active National Socialist (Nazi) functionary at the University of Vienna and that among the bodies depicted in the atlas were those of Nazi victims. Since then, discussions persist concerning the ethicality of the continued use of the atlas, because some surgeons still rely on information from this anatomic resource for procedural planning. The ethical implications relevant to the use of this atlas in the care of surgical patients have not been discussed in detail. Based on a recapitulation of the main arguments from the historic controversy surrounding the use of Pernkopf's atlas, this study presents an actual patient case to illustrate some of the ethical considerations relevant to the decision of whether to use the atlas in surgery. This investigation aims to provide a historic and ethical framework for questions concerning the use of the Pernkopf atlas in the management of anatomically complex and difficult surgical cases, with special attention to implications for medical ethics drawn from Jewish law.

Making the Ethical Transition in South Africa: Acquiring Human Bodies for Training in Anatomy.

While dissection remains the method of choice for teaching human anatomy, ethical requirements for obtaining cadavers has made the process of acquiring human bodies more strenuous for institutions. In Africa and at the School of Anatomical Sciences in South Africa, dependence on unclaimed bodies has been prevalent. The aim of the present study was to determine whether more rigorous application of ethical consent has altered the provenance of the cadavers in the School of Anatomical Sciences, University of the Witwatersrand. The numbers of bequeathed/donated/unclaimed cadavers received over the period 2013-2017, as well as their sex and population affinity were analyzed. The majority (96.8%) of the cadavers dissected over the period were from bequests/donations. Marginally more females than males were available. In addition, the population affinity of the cadavers had changed from a majority of South African African (unclaimed) bodies to a majority of South African White (bequest/donated) bodies. The study shows that even with ethical constraints it is possible to transition from the use of mainly unclaimed bodies to the acquisition of bequeathed/donor bodies. However, there may be challenges in relation to anatomical collections in the School as few of the bequest/donated cadavers remain in the School to be added to the collections. These changes also affect the demographics of the Schools' collections.

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.

Publications relating to the reactions of medical students to human cadavers and ethics / Publicaciones relacionadas con las reacciones de los estudiantes médicos hacia cadáveres humanos y ética / Publicações relacionadas com as reações dos estudantes de medicina à cadáveres humanos e ética

Objectives: Faculty of Medicine students are practicing on a human cadaver in the course of education especially in Anatomy lessons. There are some physical, emotional, and ethical problems that students have experienced with participation in these lessons. In some publications we have reviewed issues regarding these, we aimed to reveal whether ethical issues are being addressed. Methods: We conducted literature searches by writing the clues "Publications relating to the Faculty of Medicine student's reactions to cadavers lessons and ethics" on search engines on the internet. By examining the articles obtained, we investigated whether students are experiencing problems, especially on ethics. Results: 28 articles (90.3%) were original research, 2 (6.4%) were reviews and 1 (3.2%) was a book. Only 6 out of these studies (19.3%) have addressed ethical issues. In our research, quite a few publications (19.3%) have been found that dealt with ethical problems in cadaver lessons. Human body dissection during an anatomy course for the first-year medical students raises questions about invasion of privacy, cadaver sources, dying, and death. Conclusion: Detailed reviews of the situations that causes ethical problems in the studies to be done in this direction are thought to be beneficial to the medical faculties students education.

Objetivos: Los estudiantes de la Facultad de Medicina practican con cadáveres humanos para la educación, especialmente en lecciones de Anatomía. Existen varios problemas emocionales, físicos y éticos que experimentan los estudiantes al participar en estas lecciones. Después de revisar publicaciones que tratan este tema, nuestro objetivo es evaluar si se abordan los temas éticos. Métodos: Realizamos búsquedas en la literatura mediante motores en internet usando las palabras clave: "Publicaciones relacionadas con las reacciones de estudiantes de Facultad de Medicina a lecciones que usan cadáveres y ética". Al examinar los artículos que se obtuvieron, investigamos si los estudiantes experimentaban problemas, especialmente de ética. Resultados: 28 artículos (90,3%) eran investigaciones originales, 2 (6,4%) eran revisiones y 1 (3,2%) fue un libro. Solamente 6 de estos estudios (19,3 %) abordaban temas éticos en relación con lecciones usando cadáveres. La disección del cuerpo humano en cursos de anatomía de estudiantes de medicina de primer año produce cuestionamientos sobre invasión de privacidad, origen de los cadáveres, el morir y la muerte. Conclusión: La revisión detallada de las situaciones que causan problemas éticos en los estudios a realizar en esta dirección se cree que son beneficiosos para la educación de los estudiantes en las facultades de medicina.

Objetivos: Estudantes de medicina estão praticando ensinamentos em cadáveres humano no curso de graduação, especialmente nas aulas de anatomia. Existem algumas questões físicas, emocionais e éticos que os estudantes têm experimentado ao participar em essas aulas. Em algumas publicações, que nós analisamos estas questões, tivemos como objetivo revelar se questões éticas estavam sendo abordadas. Métodos: Nós conduzimos pesquisas de literatura, buscando em endereços eletrônico de busca por "Publicações relativas à reações de estudantes de medicina a experimentos com cadáveres e ética". Examinando os artigos obtidos, investigamos se os alunos estão enfrentando problemas, especialmente com relação a ética. Resultados: 28 artigos (90,3%) eram pesquisas originais, 2 (6,4%) foram resenhas e 1 (3,2%) um livro. Somente 6 destes estudos (19,3%) abordaram questões éticas. Em nossa pesquisa, foram encontradas várias publicações (19,3%) que tratam de problemas éticos nas lições de cadáver. Dissecação do corpo humano durante um curso de anatomia para estudantes de medicina do primeiro ano levanta questões sobre invasão de privacidade, fontes de cadáver, morrer e morte. Conclusão: Revisões detalhadas das situações que provoca problemas éticos nos estudos são considerados benéficos para o ensino de medicina

Instrumental.

Incorporating classmates' unique one-word reflections on human anatomy and the experience of engaging with the bodies of our anatomical donors, this series captures a diverse spectrum of human emotions surrounding anatomical dissection. Grappling with the humanity of our varied reactions, we related ourselves-ethically and clinically, individually and collectively-to our first "patients" and their critical role in our education and growth as physicians.

Does Confucianism allow for body donation?

Confucianism has been widely perceived as a major moral and cultural obstacle to the donation of bodies for anatomical purposes. The rationale for this is the Confucian stress on xiao (filial piety), whereby individuals' bodies are to be intact at death. In the view of many, the result is a prohibition on the donation of bodies to anatomy departments for the purpose of dissection. The role of dissection throughout the development of anatomy within a Confucian context is traced, and in contemporary China the establishment of donation programs and the appearance of memorial monuments is noted. In reassessing Confucian attitudes, the stress laid on a particular interpretation of filial piety is questioned, and an attempt is made to balance this with the Confucian emphasis on a moral duty to those outside one's immediate family. The authors argue that the fundamental Confucian norm ren (humaneness or benevolence) allows for body donation as people have a moral duty to help others. Moreover, the other central Confucian value, li (rites), offers important insights on how body donation should be performed as a communal activity, particularly the necessity of developing ethically and culturally appropriate rituals for body donation. In seeking to learn from this from a Western perspective, it is contended that in all societies the voluntary donation of bodies is a deeply human activity that is to reflect the characteristics of the community within which it takes place. This is in large part because it has educational and personal repercussions for students. Anat Sci Educ 11: 525-531. © 2018 American Association of Anatomists.