Using cultural historical activity theory to understand how post-graduate residents perform discharge planning at a medical center in Taiwan.

BACKGROUND: Despite the importance of discharge planning in physicians' education, currently in most countries, no identical training is provided. Difficulties in promoting physician discharge planning education in Taiwan are still noted. This study aims to find the physicians' role of discharge planning training in educating post graduate year residents (PGY) in Taiwan. MATERIALS AND METHODS: We took advantage of government and hospital policies that promote the discharge planning program to teach and implement it, beginning with PGY residents by incorporating it into their training program. We recruited 30 PGY residents who were attending their three-month general internal medicine training from 2018 to 2019. They were interviewed at the end of the program using cultural-historical activity theory (CHAT). Qualitative research methods were used to further understand how discharge planning and care was implemented. RESULTS: Trainees initially believed that they did not have any role in discharge planning. Using the cycle of expansive learning, we found that the role of physicians in discharge planning was unclear. There were still some inconsistencies in the teaching and implementation of the discharge planning program for PGY residents that needed to be resolved, but this study also let participants learn through practice to improve their identification of discharge planning. CONCLUSIONS: This study analyzed the impact of a discharge planning program for PGY physicians in Taiwan. It showed that the program affected physicians' practice and medical education, although some contradictions remain.

Exploring factors influencing dental students' negative emotions during a gross anatomy laboratory in Taiwan.

Background/purpose: Negative emotions of medical students during a gross anatomy laboratory are documented in the field of medical education, but those of dental students are relatively less reported in the literature. The purpose of the present study was to explore negative emotions of dental students during the gross anatomy laboratory and possible influential factors. Materials and methods: Basic demographic variables, gross anatomy learning attitudes, and/or life attitudes were collected at five time points among year 2 dental students (n = 49) at a medical university in northern Taiwan. Multi-hierarchical regression analyses were executed to explore possible factors that led to negative emotions. Results: Students who were older, had more-positive attitudes towards life, and had more-positive attitudes towards the anatomy laboratory tended to have weaker negative emotions when they first faced the cadavers. Having a tendency to care about and help people and having a grateful attitude also significantly predicted weaker negative emotions at the middle and end of the semester, respectively. Conclusion: Negative emotions of younger dental students who first encounter a cadaver should be of concern. Striving to improve students' positive attitudes toward life, positive attitudes toward the gross anatomy laboratory, willingness to care about and help people, and an overall grateful attitude may help reduce negative emotions during the gross anatomy laboratory. At an institutional level, integrating educational activities that reduce negative emotions toward cadavers by dental students is highly recommended.

Overview of dental radiology education for medical radiology students in Taiwan.

Background/purpose: In Taiwan, the formal education for cultivating medical radiation technologists began in 1965. However, there are very few dental radiology curricula in Taiwan's medical radiology schools. We investigated mainly the appearance of dental radiology education for medical radiology students in Taiwan. Materials and methods: We used documentary analysis, a survey of dental radiology education, and secondary data analysis in this study to find the appearance of Taiwan's dental radiology education for medical radiology students. Results: There were currently ten medical radiology schools. Among them, five offered independent curricula in their subject schedules and another five had dental radiology education included in their general medical radiology curricula. Of the 53 dental radiology teaching hospitals, 21 (39.62%) were medical centers and 25 (47.17%) were regional hospitals, and these large hospitals were concentrated in the northern region of Taiwan. These large dental radiology teaching hospitals offered more training hours of dental radiology internship for medical radiology students and had a higher availability for the medical radiology students. Conclusion: In Taiwan, the current status of dental radiology curricula in the medical radiology schools is indeed seriously insufficient. A dental radiology education system should be established in the future, including the innovative dental radiology curricula developed for medical radiology students and more dental radiology curricula designed for dental students. This in turn can create new career options for medical radiology students and new practice directions for medical radiation technologists, and then expand their potential involvement in dental radiology.

Exploring the impacts of a coffin-lying experience on life and death attitudes of medical and nursing students: preliminary findings.

BACKGROUND: Physicians and nurses often exhibit strong negative emotional and behavioral reactions when patients they care for die, and death education helps them cope with these difficulties. When implementing death education, the literature shows that experiential activities are more effective than lecturing, and progressive exposure is the best way to reduce death anxieties. This study examined the effects of coffin-lying, an activity sometimes seen in Asian cultures, on life and death attitudes of medical and nursing students. METHODS: During a period from 2020 to 2021, 134 medical and nursing students from a medical university in northern Taiwan voluntarily participated in this study. Among them, 53 were in the experimental group, who participated in a coffin-lying activity for nearly 3 hours, and the other 81 were in the control group. All participants filled out questionnaires 1 week before the activity (T1), 1 week after the activity (T2), and 6 ~ 11 weeks after the activity (T3). Three waves of data were analyzed by a repeated-measure multivariate analysis of variance (MANOVA). RESULTS: The effects of "love and care" and "feeling of existence" were only manifested at T2, however, the scores of "fear of death" and "death avoidance" between the experimental and control groups significantly differed at T2 and T3. In addition, there were no significant differences between the experimental and control groups in "neutral acceptance", "approach acceptance", or "escape acceptance". CONCLUSIONS: The coffin-lying activity based on desensitization was effective in improving "fear of death" and "death avoidance", and the effects were sustained to 6 ~ 11 weeks. Coffin-lying is not only a well-designed activity that quickly reduces negative tendencies toward death, but it is also worth adopting by medical and nursing schools to make death education more comprehensive.

Overview of education system for oral hygienists in Taiwan.

Background/purpose: Currently, Taiwan has a very complete education system of oral hygiene, but there is still no licensing system for oral hygienists. This study explored mainly the profile of education system for oral hygienists in Taiwan from 2017 to 2021. Materials and methods: This study used the documentary analysis and secondary data analysis to survey mainly the development of oral hygiene education system in Taiwan, and the changes of oral hygiene students and graduates from 2017 to 2021. Results: In Taiwan, currently, there are 8 oral hygiene schools which offer associate, bachelor, and master degrees in oral hygiene. The oral hygiene enrollment quotas determined by the Ministry of Education increased from 343 quotas in 9 programs in 2017 to 500 quotas in 13 programs in 2021, while new oral hygiene students who completed registration increased from 282 students in 2017 to 353 students in 2021. The registration rate of the five-year training program of junior college was significantly higher than the other programs. The number of oral hygiene students with official student status increased from 604 students in 2017 to 1349 students in 2021. The total increase was 745 students from 2017 to 2021 with a total increase rate of 123.34%. Conclusion: In Taiwan, although the manpower of oral hygienists is important for public oral health, they usually work as dental assistants or change their careers. It is imperative to continue to promote the certification system for oral hygienists to improve the professionalism of this occupation.

Overview of dental radiation technologists in Taiwan.

Background/purpose: In Taiwan, there is no independent licensing system for dental radiation technologists. A licensed medical radiation technologist who engages in dental radiology is the so-called dental radiation technologist. This study explored mainly the profile of dental radiation technologists in Taiwan. Materials and methods: This study used the methods of documentary analysis, dental radiation manpower survey, and the secondary data analysis to find the profile of dental radiation technologists in Taiwan. Results: There were currently 59 dental radiology departments and 101 dental radiation technologists (29 males and 72 females) in 57 hospitals and their branches. Of the 101 dental radiation technologists, 56 worked in the medical centers, 28 in the regional hospitals, and 17 in the district hospitals. More than half of the dental radiation technologists were concentrated in the medical centers (55.45%, 56/101) or the northern region of Taiwan (57.43%, 58/101), especially in the northern medical centers (30.69%, 31/101). Conclusion: In Taiwan, the manpower of dental radiation technologists is insufficient, and dental radiation technologists usually work in the dental departments of the hospitals. A large number of clinic dentists lack dental radiation technologists to assist in dental radiology works and the clinic dentists have to perform the dental radiology works by themselves. Therefore, a dental radiology education system should be established to design innovative dental radiology courses for radiological technology students. This in turn can provide a new practice direction for medical radiation technologists and expand their potential participation in the field of dental radiology.

Using drawing and situated learning to teach transitional care to post-graduate residents.

BACKGROUND: The "draw-and-talk" technique has become popular in medical training, as it can help healthcare practitioners develop empathic understanding of patients and contribute to personal transformation. We adopted this method to make the teaching of transitional care planning more relevant to post-graduate residents undergoing their internal medicine training at a medical center in Taiwan. METHODS: Before the conventional lecture on discharge planning, trainees were invited to draw their "home" and "life as older adults" and share their drawings with others. Subsequently, they were guided to consider whether their home would be livable if they either had a disability or were old. The drawings and narratives were analyzed thematically, and feedback on the session was collected. RESULTS: Trainees were initially of the opinion that they did not have any role in discharge planning. However, the emphasis on the self-experience of drawing and the thematic use of "home" and "elderly life" led to reflective discussions about post-discharge care. The session provoked constructive self-reflection and meta-cognitive awareness and encouraged residents to actively participate in transition care plans. Response to the draw-and-talk session was overwhelmingly favorable. CONCLUSIONS: Post-graduate residents in Taiwan conventionally do not have much interest or autonomy regarding their patients' lives outside the hospital. The use of drawing and reflection is a simple and inexpensive method to contextualize discharge planning in participants' real lives, engage them in actively visualizing the healthcare needs of older adults and patients with disability, and initiate thinking about the impact of discharge preparations, follow-up care, and barriers to care at home. Draw-and-talk might be helpful in improving residents' knowledge and empathy toward patients preparing for discharge, which is crucial for the quality of transitional care.

The training effectiveness of dental trainees in postgraduate year training program for dentists.

BACKGROUND/PURPOSE: Taiwan's two-year postgraduate year training program for dentists (PGYD) has been implemented since 2010. However, there was no relevant study for confirming the training effectiveness of PGYD trainees. This study evaluated whether different training institution attributes and different training modes for PGYD trainees could result in differences in the achievement of PGYD training purposes. MATERIALS AND METHODS: We adopted the questionnaire survey to collect the views of PGYD trainees on the training effectiveness of PGYD and further evaluated whether different training institution attributes and different training modes for PGYD trainees could result in differences in the achievement of PGYD training purposes. RESULTS: For the "patient-centered" learning environment and the management ability to be a responsible dental clinic owner, the views of PGYD trainees in dental clinics and district hospitals were more positive than those in medical centers. For the clinical professional ability and the management ability to be a responsible dental clinic owner, the views of PGYD trainees in joint group were more positive than those in single hospital. CONCLUSION: We conclude that both hospitals and dental clinics can achieve PGYD training purposes. The smaller training institutions (dental clinics or district hospitals) are better training institution attributes and the joint group is the better training mode to achieve PGYD training purposes. The joint groups with medical centers combining many dental clinics, especially those in remote areas, may be an excellent training mode, because this training mode has the high potential to subsequently balance the distribution of dentists in Taiwan.

How technology-enhanced experiential e-learning can facilitate the development of person-centred communication skills online for health-care students: a qualitative study.

BACKGROUND: The COVID-19 pandemic brought a new challenge to medical education-health-care students had fewer opportunities to interact with and treat real patients in clinical settings. Interpersonal communication skills are often developed through human interaction and communication in person, and few studies have proposed feasible digital solutions to develop learners' communication skills. Consequently, understanding how medical teachers facilitate and implement online training programmes, with feasible instruments, to enhance students' learning effectiveness when in-person training is not possible is critical. METHODS: By using a convenience sampling method, we recruited 26 health-care students from seven medical schools in Taiwan. Through semistructured interviews and the thematic analysis technique, we analysed the latent learning factors from the experience of implementing the technology-enhanced experiential e-learning tool 'mPath'. RESULTS: Three themes were generated: A) transferring theory into practice, B) increasing authenticity with analytical features, and C) maintaining autonomy with nondirective learning. The features accessibility, flexibility, intractability, and visualisation with the characteristics of remote accessibility and flexibility, repetition and retrospect, feedback requesting, and visualised analytical reports were considered to enhance learning outcomes. CONCLUSION: This study indicated how online training using technology could develop the participants' person-centred communication skills and what features influenced the learning outcomes of social distancing. mPath may be a feasible online learning approach and has provided inspiration for developing health-care students' communication skills when in-person training is not possible.

Impacts of a gross anatomy laboratory course on medical students' emotional reactions in Taiwan: the role of high-level emotions.

BACKGROUND: Gross anatomy laboratory course at medical school is usually an important learning subject for medical students; however, seeing a cadaver often makes them feel uncomfortable. According to the broaden-and-build theory, positive emotions broaden our inventory of thoughts and actions, and build physical, mental, and social resources. Research on positive psychology found that through direct thanks and positive reframing, people who feel gratitude show fewer depressive symptoms. The present study tried to reduce students' negative emotions towards cadavers by sequential activities, such as family interviews and an initiation ceremony, which induced gratitude and other positive emotions. METHODS: The Emotional Reactions Towards Cadavers Scale (ERTCS) was used to evaluate medical students' emotional reactions after they see a cadaver. Third year medical students (n = 105) at Taipei Medical University in northern Taiwan completed ERTCS on three occasions within a single semester during academic year 2016. Repeated-measures ANOVA and hierarchical regression analyses were then conducted to identify any changes in the emotional reactions of these students. RESULTS: The ERTCS showed satisfactory internal consistency and a three-factor structure, i.e., negative emotions, high-level emotions, and excited emotions. High-level emotions were the highest, and negative emotions were the lowest among the three in our sample. Three-wave data showed that participants' high-level emotions increased, negative emotions decreased, and the former simultaneously predicted the latter after controlling for the influence of gender, religious beliefs, experience of the death of a family member or friend, and burnout level. CONCLUSIONS: While past research usually focused on coping strategies to reduce medical students' negative emotions, our study supported the broaden-and-build theory, which emphasizes positive emotions, and demonstrated that elevating medical students' gratitude to 'silent mentors' is an effective way. It is suggested that combining dissection courses with medical humanities can help students successfully handle negative emotions during a gross anatomy laboratory course.

The impact of the COVID-19 pandemic on the dentist manpower in Taiwan.

BACKGROUND/PURPOSE: The dentists are the high-risk group of infectious respiratory diseases during dental treatment. This study investigated the changes of the numbers of overall practicing dentists, dental clinics, and hospital dentists in Taiwan during the COVID-19 pandemic. MATERIALS AND METHODS: We collected the data of the numbers of overall practicing dentists, dental clinics, and hospital dentists in each city and county of Taiwan in October 2019, April 2020, and October 2020 for evaluating the impact of the COVID-19 pandemic on the dentist manpower in Taiwan. RESULTS: After the COVID-19 outbreak, the total increased numbers of practicing dentists, dental clinics, and hospital dentists in Taiwan were 408, 14, and -16 from October 2019 to October 2020, respectively. In addition, their increased rates of the corresponding items were 2.76%, 0.21%, and -0.72%, respectively. The increased rate of practicing dentists from October 2019 to April 2020 was significantly higher than that of dental clinics (P < 0.001) and that of hospital dentists (P < 0.001). Moreover, the increased rate of practicing dentists from October 2019 to October 2020 was significantly higher than that of dental clinics (P < 0.01). CONCLUSION: During the COVID-19 pandemic, the increased number of practicing dentists is not different from that in the past, but the increased numbers and rates of dental clinics and hospital dentists are lower than those in the past. This indicates that the willingness of dentists to open new dental clinics or work in hospitals reduces due to the impact of the COVID-19 pandemic.

Distribution of students admitted to dental schools of general universities in Taiwan in 2020.

BACKGROUND/PURPOSE: In Taiwan, the average income of a dentist increases after the implementation of national health insurance in 1995. Thus, the domestic departments of dentistry become a popular choice of university departments for high school graduates. The purposes of this study were to evaluate the distribution of students admitted to dental schools of general universities in each city or county in 2020 and to further compare the differences in regional distributions of dental freshmen accepted by three admission ways in 2020. MATERIALS AND METHODS: This study collected the number of dental freshmen of general universities in each city or county in 2020 for further evaluating the differences in regional distributions of dental freshmen accepted by three admission ways in 2020. RESULTS: The distribution of dental freshmen in 2020 did have a big urban-rural gap. These dental freshmen were more concentrated in municipalities than in non-municipalities in Taiwan. The execution of three admission ways did play a role in balancing the urban-rural gap in the distribution of dental freshmen. CONCLUSION: The urban-rural gap of the distribution of dental freshmen was not larger than that of dentists. The increased guaranteed enrollment quota of dental freshmen for the high school graduates in the offshore islands do cause unequal opportunities of admission to dental schools. If these extra-enrolled dentists do not return to their hometowns to practice, this may worsen the surplus of dentists and may fail to improve the uneven distribution of dentists in Taiwan.

Regional distributions of overall dentists and institutional dentists in Taiwan in 2019.

BACKGROUND/PURPOSE: Taiwan is facing a huge urban-rural gap in the human resources of dentists between cities and counties. Although the postgraduate year training program for dentists (PGYD) was implemented in Taiwan in 2010, the uneven distribution of dentists is still a serious problem. The purpose of this study was to evaluate the distributions of overall dentists and dental training institutions and their dentists (so-called institutional dentists) in each city and county in 2019 to further analyze the regional distributions of overall dentists and institutional dentists in Taiwan. MATERIALS AND METHODS: This study collected the numbers of dentists, dental training institutions, and institutional dentists in each city and county in 2019 for evaluating the regional distributions of dentists and institutional dentists in Taiwan. RESULTS: The numbers of dentists and institutional dentists in municipalities were significantly higher than those in non-municipalities in Taiwan, respectively. The coefficient of variation was greatest for dentists in the single-system institutions (1.72) and program-management institutions (1.87). The coefficients of correlation between the dentist index and institutional dentist index were R2 = 0.9805 (P < 0.001) for municipalities, R2 = 0.4523 (P < 0.01) for non-municipalities, and R2 = 0.7691 (P < 0.001) for nationwide. CONCLUSION: The dentist manpower and dental training institutions are concentrated in municipalities of Taiwan. The quantitative and qualitative improvement of collaborating institutions in the PGYD system may have an influence on the distribution of new-entry dentists and contribute to establishment of an effective regional dental health care service.

The changes of the number and regional distribution of dentists and dental institutions 9 years after the implementation of postgraduate year training program for dentists in Taiwan.

BACKGROUND/PURPOSE: In Taiwan, there are three major dentist occupation problems: a surplus of dentists, an uneven regional distribution of dentists, and a concentration of dentists in the metropolitan areas. The purpose of this study was to evaluate the distributions of the population and dentists in each city or county in 2001, 2010 and 2019 to further analyze the changes of regional distributions of dentists 9 years after the implementation of postgraduate year training program for dentists (PGYD) in 2010 in Taiwan. MATERIALS AND METHODS: This study collected the data of population, the number of dentists in each city or county in 2001, 2010 and 2019, and the numbers of dentists and dental institutions from 2001 to 2019 for evaluating the changes of regional distributions of dentists 9 years after the PGYD implementation in Taiwan. RESULTS: Nine years after the PGYD implementation, the uneven distribution of dentists persisted. The number of dentists still increased and dentists were more concentrated in municipalities than in non-municipalities in Taiwan. Moreover, the number of dental institutions increased slowly, but dental institutions tended to become larger. CONCLUSION: Because the PGYD system is not mandatory, dentists choose their practice locations as driven by the market factors. The increase in the average number of dentists in dental institutions is also driven by the market factors. The market-driven movement of dentists to the people-concentrated municipalities finally persist the imbalance of dentist distribution in Taiwan. This situation also enables the development of large-scale dental institutions in municipalities in Taiwan.

The status of hospital dentistry in Taiwan in October 2019.

BACKGROUND/PURPOSE: Dental care has been officially incorporated into the hospital accreditation system in Taiwan since 2015. The geographical distribution of dentist manpower still remains in an unbalanced status as shown by the dentist-to-population ratio. This study tried to assess the dental manpower issue in terms of the status of hospital dentistry, and hence provided two organizational-level suggestions with their policy implications. MATERIALS AND METHODS: This study utilized the secondary data analysis to evaluate the dental manpower in dental departments of medical centers, regional hospitals, and district hospitals in different regions of Taiwan in October 2019. RESULTS: Our results found that the dental manpower including the numbers of general dentists and dental specialists was highest in medical centers, followed by regional hospitals and district hospitals. Moreover, the dental resources and manpower were mostly concentrated in the northern region of Taiwan, followed by the central and southern regions of Taiwan, the eastern region of Taiwan, and offshore islands. CONCLUSION: The hospital dentistry in Taiwan develops toward large-scale and specialization. Both hospital general dentists and dental specialists are concentrated in the medical centers, especially the medical centers in the northern region of Taiwan, indicating the problem of oversupply in the northern Taiwan and unbalanced distribution of dentists among the regions in Taiwan. Therefore, the responsibilities of the hospitals in metropolitan areas are to develop the elderly and disabled dentistry and to assist with oral health promotion and oral disease prevention in remote areas to reduce the urban-rural gap in dental resources in Taiwan.

Does postgraduate year training program for dentists worsen the imbalance of geographical distribution of dentists in Taiwan?

BACKGROUND/PURPOSE: Taiwan implemented the non-compulsory postgraduate year training program for dentists (PGYD) in 2010. Previous studies found that training institutions for dentists are mostly distributed in metropolitan areas. This study explored whether the PGYD system might worsen the imbalance of geographical distribution of dentists in Taiwan. MATERIALS AND METHODS: This study collected the data of population, the number of practicing dentists from 2010 to 2018, and the number of practicing dentists in the training institutions in 2018 to draw the Lorenz curve and to calculate the Gini coefficient for evaluating whether the PGYD system might worsen the imbalance of geographical distribution of dentists in Taiwan. RESULTS: Our results showed that the uneven geographical distribution of overall practicing dentists did not deteriorate after the implementation of the PGYD system. However, the uneven geographical distribution of practicing dentists in training institutions was more serious than the uneven geographical distribution of overall practicing dentists. CONCLUSION: Because the PGYD system is not mandatory, dentists engage in training program and select training institutions as driven by the market factors. After completion of the PGYD training, dentists choose the practice location as driven by the market factors again and this in turn redistributes the dentists to different regions of Taiwan. In addition, major dentist policies may also result in the movement of dentists to various regions of Taiwan. Thus, the market-driven redistribution of dentists to different regions of Taiwan finally reduces the imbalance of geographical distribution of dentists in Taiwan caused by the PGYD system.

Correlation between early clinical exposure environment, attitudes toward basic medicine, and medical students' basic science learning performance.

BACKGROUND: Early clinical exposure (ECE) is viewed as a way to provide contexts of basic science and highlight its relevance to medical practice. However, very few studies have specifically looked into how the ECE experience contributes to students' academic performance. The purpose of this study was to investigate whether ECE experiences (external cause) or students' learning attitudes (internal cause) more closely correlated with medical students' academic performance. METHODS: Subjects who participated in the study comprised 109 s-year students at Taipei Medical University. Fifty of the 109 study participants were enrolled in an elective ECE program. The dependent variable in this study was the test score of a systems-based basic sciences (SBBS) course. Independent variables of the study included students' attitudes and test anxiety towards the SBBS course, engagement/length of time spent in ECE, and the ECE learning environment. Data of students' engagement in ECE, levels of their motivational beliefs and test anxiety, differences in the ECE learning environment, and the SBBS final test scores of these 109 respondents were collected for hierarchical multiple regression (HMR) analyses. RESULTS: Results of the HMR analyses revealed that students' test anxiety towards basic science and also the learning environment of the ECE had significant positive predictive power on their SBBS test scores. CONCULSION: This study discovers that medical students' academic performance in basic science correlates not only with their anxiety to testing, but even more so with the clinical environment they are exposed to. Hence we suggest including further investigations about different learning environments on ECE experiences in future studies.

Effects of a "silent mentor" initiation ceremony and dissection on medical students' humanity and learning.

OBJECTIVES: Many medical schools in Taiwan have adopted a dignified "silent mentor" initiation ceremony to strengthen student's medical humanity and increase their learning attitudes. This ceremony consists of introductions of the body donor's conduct and deeds, wreath-laying, and a tea party. However, few empirical studies have examined the influences of the ceremony and dissection on medical humanity. This study explored if the initiation ceremony and the course can help students care more about others, develop more positive attitudes toward death, improve learning effectiveness in the course, and decrease negative emotions the first time they see a cadaver. METHODS: The Attitudes Towards Death and Love and Care subscales of the life attitude inventory, Learning Effectiveness of Gross Anatomy Laboratory Scale (LEGALS), and Emotional Reactions Towards Cadavers Scale were adopted to examine differences before (T1) and after (T2) medical students attended an initiation ceremony at a university in northern Taiwan. Whether these effects lasted to the end of the semester (T3) was also tested. RESULTS: After the ceremony, students' attitudes towards death increased, negative emotions towards cadavers decreased, but love and care and the LEGALS did not significantly change. Data from T3 showed a similar pattern, but high-level emotions (e.g., being respected, cherished, and grateful) and the LEGALS were significantly higher than those at T1. DISCUSSION: The initiation ceremony, which showed a body donor's deeds and attitudes toward life and death when they were alive, could help medical students gain more mature attitudes towards death and decreased negative emotions. Learning between T2 and T3 might have caused significant changes in high-level emotions and the LEGALS at T3. Arranging reflective writing with guided discussion by a teacher before and after the ceremony is highly recommended.