That's not what you expect to do as a doctor, you know, you don't expect your patients to die." Death as a learning experience for undergraduate medical students.

BACKGROUND: Experiencing the death of a patient can be one of the most challenging aspects of clinical medicine for medical students. Exploring what students' learn from this difficult experience may contribute to our understanding of how medical students become doctors, and provide insights into the role a medical school may play in this development. This research examined medical students' responses of being involved personally in the death of a patient. METHOD: Ten undergraduate medical students were followed through their three years of clinical medical education. A total of 53 individual semi-structured interviews were conducted. Grounded theory analysis was used to analyze the data. RESULTS: Students illustrated a variety of experiences from the death of a patient. Three main themes from the analysis were derived: (i) Students' reactions to death and their means of coping. Experiencing the death of a patient led to students feeling emotionally diminished, a decrease in empathy to cope with the emotional pain and seeking encouragement through the comfort of colleagues; (ii) Changing perceptions about the role of the doctor, the practice of medicine, and personal identity. This involved a change in students' perceptions from an heroic curing view of the doctor's role to a role of caring, shaped their view of death as a part of life rather than something traumatic, and resulted in them perceiving a change in identity including dampening their emotions; (iii) Professional environment, roles and responsibilities. Students began to experience the professional environment of the hospital by witnessing the ordinariness of death, understanding their role in formalizing the death of a patient, and beginning to feel responsible for patients. CONCLUSIONS: Along with an integrative approach to facilitate students learning about death, we propose staff development targeting a working knowledge of the hidden curriculum. Knowledge of the hidden curriculum, along with the role staff play in exercising this influence, is vital in order to facilitate translating the distressing experiences students face into worthwhile learning experiences. Finally, we argue that student learning about death needs to include learning about the social organization and working life of clinical settings, an area currently omitted from many medical education curricula.

A belief in the soul may contribute to the stress experienced in the dissecting room.

The aim of this research was to explore whether medical students believe in a soul and how this may affect their dissecting experience. Three questionnaires were delivered electronically to the 2011 cohort of second-year medical students over a 2-year period. At the University of Otago, students enter medicine via three categories: Health Sciences First Year (following 1 year of university); postgraduate (following a Bachelors or higher degree); and 'other' category entry (Allied Health Professional or 3 years after a Bachelors degree). The entry category, age, ethnicity and gender of the students were collected; 51.6% of the students believed in the concept of a soul. On a scale of 1-5, students ranked the importance of religion/spirituality as 2.69. Those who believed in a soul were more likely to have a religious/spiritual component to their life and be males or 'other' category entrants. However, there were many students who believed in the soul who did not have a religious/spiritual association, suggesting that this belief extends beyond religion. Those who believed in a soul had significantly higher anticipatory stress and experienced higher levels of stress during dissection. A higher proportion of students in the 'other' category entrants believed in the concept of the soul and also had significantly higher levels of stress during dissection. Our data suggest that a belief in a soul may affect students' experiences in dissecting. Incorporating the teaching of humanities with anatomy may help medical students as they assimilate both the biomedical and philosophical aspects of dissection.

Medical students' understanding of the concept of a soul.

The concept of a soul has been discussed throughout religious, philosophical, and scientific circles, yet no definitive description exists. Recent interviews with medical students during the production of a documentary film identified that many believed in the concept of a soul. This study explores students' understanding of the concept of a soul. The 2011 cohort of second-year medical students at the University of Otago in Dunedin, New Zealand were invited to participate in an online survey with a free text response asking students to describe their understanding of the soul. The descriptions of the soul included the soul as a "spirit" or "life force" and some described the soul as giving a person their "values" and "personality." Students discussed the location of a soul with most stating that the soul was not attached to the body, but others mentioned the heart or the brain as the seat of the soul. A common theme related to the mortality of the soul emerged, with most believing that the soul left the body at death. Some students' concept of a soul was related to their religious beliefs, while others who did not believe in the concept of a soul described it as a "myth" used to bring comfort at the time of death. Medical students have varied opinions on the concept and importance of the soul. It is important to recognize the diversity of views when exploring the process of death and spirituality with medical students.

Medical students' responses to the dissection of the heart and brain: A dialogue on the seat of the soul.

The search for the soul has been documented since the fifth Century BCE when philosophers and physicians began to explore the role of human consciousness and emotion. Traditionally in western civilization, there have been two distinct followings with some believing that the brain was the seat of the soul and others believing that this role belonged to the heart. The aim of this study was to assess the attitudes of medical students towards the heart and brain during their anatomy laboratory dissections to evaluate if any extra meaning is given to these organs and where they perceived the origin of the soul. Medical students (n = 16) at the University of Otago were interviewed in regards to their thoughts about body dissection and particularly their views towards the brain and the heart. Semi-structured interviews were conducted following the dissection of these two organs, and then transcribed and analyzed. There were mixed opinions among students with some experiencing difficulty dissecting the brain because this organ had special meaning to them; they perceived it as the organ that "made a person who they were." Others commented on their emotional reactions when removing the heart, which they viewed as the "seat of emotion." Some students experienced emotional and physical reactions to these two dissections and Anatomy faculty need to be aware that students may struggle because they viewed these organs as special. A dialogue emerged amongst some medical students on the seat of the soul which gave extra meaning to the dissection.

Seasonal changes in morphology and steroid receptor expression in the prostate of the brushtail possum (Trichosurus vulpecula): an animal model for the study of prostate growth?

The prostate of the brushtail possum undergoes growth and regression during the year. The present study investigated the morphological changes and expression of androgen and oestrogen receptors during the breeding and non-breeding seasons. Prostate tissue was collected from adult possums at 2-monthly intervals. The periurethral and outer glandular areas were separated and the volume of stromal, epithelial and luminal tissues measured in each area. Immunohistochemistry was used to investigate cell proliferation with proliferating cell nuclear antigen (PCNA) and to localise androgen receptor (AR) and oestrogen receptors α and ß (ERα, ERß). Seasonal changes in expression of the three receptors were investigated using quantitative PCR and western blot analysis. During the breeding season the volume of stromal tissue in the periurethral area and the luminal volume in the glandular area significantly increased. The change in periurethral volume was associated with increased PCNA-immunopositive cells. While the localisation of AR to the stromal and epithelial cells did not change, there was a significant increase in receptor expression before the main breeding season. ERα and ERß expression and localisation did not alter during the year. Similarities in receptor expression and localisation suggest that the possum may be a suitable animal model for the study of human prostate growth.