Morphologie - Demir - Investigation of Medical Faculty Students' Views On Cadaver and Cadaver Teaching in Anatomy.
Morphologie - Demir - Investigation of Medical Faculty Students' Views On Cadaver and Cadaver Teaching in Anatomy.
Morphologie - Demir - Investigation of Medical Faculty Students' Views On Cadaver and Cadaver Teaching in Anatomy.
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ORIGINAL ARTICLE
a
Department of Anatomy, Faculty of Medicine, Ankara Medipol University, Ankara, Turkey
b
Department of Anatomy, School of Medicine, Institute of Health Sciences, Istanbul Medipol University,
Istanbul, Turkey
KEYWORDS Summary
Anatomy education; Purpose. — Cadaver education in anatomy is one of the cornerstones of medical school educa-
Cadaver; tion. The primary purpose of this study is to determine the importance of cadaver education
Medical students from the students’ point of view by examining the effect of cadaver education on learning the
anatomy course. In this study, the perspectives of second-term medical students who received
or did not receive anatomy education with cadavers, on cadavers and on anatomy education
with cadavers were investigated.
Methods. — The study was carried out with a total of 116 (66 females and 50 males) second-
term medical faculty students. Participants were divided into 2 groups; the first group (n = 56)
consisted of students who learned anatomy with cadavers, while the second group (n = 60)
included students who had never seen a cadaver and learned anatomy through atlas and models.
Results. — As a result, it was determined that the students in both groups thought that there
should be cadavers in anatomy education and education with cadavers would accelerate and
facilitate the learning process of anatomy. It was also determined that, the students who
received anatomy education with cadaver were psychologically affected by the cadaver com-
pared to those who did not, and they thought that the cadaver was less effective in gaining a
physician identity (P < 0.05).
∗ Corresponding author: Hacibayram mahallesi, Talatpaşa Bulvari, Ankara Medipol Üniversitesi, No.2, 06050 Altindağ, Ankara, Turkey.
E-mail address: [email protected] (H.M. Altintas).
https://doi.org/10.1016/j.morpho.2022.03.004
1286-0115/© 2022 Elsevier Masson SAS. All rights reserved.
B. Tugtag Demir, H.M. Altintas and B. Bilecenoglu
Conclusion. — When the results of the study are evaluated, it is revealed that the anatomy
course is difficult, but the education given on the cadaver significantly facilitates learning and
makes it more attractive.
© 2022 Elsevier Masson SAS. All rights reserved.
48
Morphologie 107 (2023) 47—54
After explaining the purpose of the study to the students, Thirty point four percent of the students who received
it was stated that it was not necessary to write the names anatomy education with cadavers stated that education with
of the students who filled out the questionnaire in order to cadavers has a role in gaining a physician identity, while
increase the reliability of the feedback. During the adminis- 26.8% stated that they were undecided. Sixty-five percent of
tration of the questionnaires, it was ensured that no faculty the group who that did not receive cadaver training, stated
members from the anatomy department were present in the that anatomy education with definitely play a role in gaining
environment. identity as a physician (P < 0.05).
Fifty-five point four percent of the students who received
Analysis of data anatomy education with cadavers stated that they did not
agree with the question ‘‘I think that my personal dissection
will contribute to my choice of specialization’’, and 14.3%
The data were analyzed and interpreted using the SPSS
stated that they were undecided. The group that did not
(Statistical PackageforSocialSciences) 21.0 package pro-
receive anatomy education with cadavers, stated that they
gram. Evaluations were made according to percentage and
strongly agree with this question at a rate of 53.3% (P < 0.05).
frequency distribution. A validity and reliability analysis
There was no statistical significance in the questions
was performed for the questionnaire, and the chi-square
of ‘I think the formations on cadavers are seen bet-
test was applied for intergroup significance. Differences
ter than models in anatomy applications’, ‘think trainings
between groups were interpreted at the 0.05 significance
on cadavers affect/may affect my psychology’, ‘Anatomy
level.
preference is a priority for me for Medical Specializa-
tion or PhD education’ and ‘I can donate my body as a
Results cadaver’ (P > 0.05).
The question ‘‘I think that touching and/or dissecting a
The research was carried out with 66 females and 50 males cadaver for the first time is/will not be different from touch-
second year medical faculty students. While the mean age ing any living thing’’, was answered by 48.2% of the students
of the group who got anatomy education with cadavers who received anatomy education with cadavers as ‘I agree’,
was 20.05 ± 99, the mean age of the group who did not and by 32.1% of them as ‘I absolutely agree’. Twenty-six
get anatomy education with cadavers was determined as point seven percent of the students who did not receive
20.15 ± 93. anatomy education stated that they did not agree, and 15%
Seventy-seven point six percent (n = 90) of the students stated that they absolutely did not agree (P < 0.05).
stated that they preferred medical school because they While 44.6% (n = 25) of the students who received
wanted it, and 22.4% (n = 26) stated that they preferred it anatomy education with cadaver answered that they agree
because their families wanted it. While 39.3% (n = 22) of with the statement ‘‘I would like to do the dissection
the group trained with cadavers stated that they person- myself’’, 32.1% (n = 18) stated that they strongly agree.
ally participated in the dissection practice, 60.7% (n = 34) 30% (n = 18) of the students in the group who did not
stated that they did not participate in the dissection prac- receive anatomy education with cadaver agreed with the
tice. 60% of the students who studied anatomy with cadavers same statement and 41.7% (n = 25) stated that they strongly
stated that there should be a maximum of 5 students around agreed (P < 0.05).
a table. While 26% (n = 43.3) of the students who received
The validity and reliability analysis of the questionnaire, anatomy education with cadaver agreed with the idea that
which was prepared to measure the knowledge and thoughts cadavers should not be provided with money and should be
of the second-year medical students about anatomy educa- based on volunteerism, 30% (n = 18) stated that they strongly
tion on cadaver, was conducted and the cronbachalpha value agreed to this idea. 14 (25%) of this group, stated that they
of the 13-question questionnaire applied to both groups was were undecided on this subject, and 23 (n = 41.1) agreed
found to be 0.71. The cronbachalpha value of 5 questions (P < 0.05).
applied only to the group who received anatomy education The group that received anatomy education with cadav-
with cadaver was determined as 0.62. Since the reliability ers was asked if they were afraid when they saw the cadaver
results are between 0.60 ≤ ␣ < 0.80, it can be said that the for the first time. Around 57.1% (n = 32) of the group stated
questionnaire is reliable. that they were afraid, 33.9% (n = 19) stated that they were
No statistical significance was found between gender and very afraid, 8.9% (n = 5) stated that they were undecided. It
survey questions (P > 0.05). Despite the lack of significance, was determined that the students, whose statistical differ-
it can be said that female students generally feel more sorry ence was significant, experienced fear when they saw the
for the cadaver and think that they should be treated more cadaver for the first time (P < 0.05) (Fig. 1). In addition,
respectfully. unlike the other group, this group was also asked whether
The answers given by the students to the survey ques- training on a cadaver dissected a few hours before the lesson
tions are summarized in Table 1. In both groups, the and on a cadaver that was dissected long before the lesson
students thought that ‘Cadaver is absolutely necessary in made a difference in learning; 60% of the students stated
anatomy education’, ‘Every practice lesson should be done that a cadaver dissected a few hours before the lesson was
on cadaver’, ‘Cadaver should be respected in anatomy appli- more effective in terms of learning (Table 2).
cations’ and ‘Dissection practices contribute/will contribute The answer of the question ‘How do you learn/think you
to learning’. It was determined that the students generally will learn anatomy best?’ was ‘with lesson’ in 39.3%, ‘with
answered these questions as ‘agree’ or ‘strongly agree’ and cadaver’ in 37.5%, ‘with model’ in 21.4% and ‘with atlas’ in
the results showed statistical significance (P < 0.05). 1.8% of the students who received anatomy education with
49
B. Tugtag Demir, H.M. Altintas and B. Bilecenoglu
1. I think that cadavers should Yes n 2a,b 1a,b 5b 23b 25a .00*
be absolutely included in % 3.6% 1.8% 8.9% 41.1% 44.6%
anatomy education. No n 0a,b 1a,b 0b 13b 46a
% 0.0% 1.7% 0.0% 21.7% 76.7%
2. I think that every practice Yes n 1a,b,c 3c 24b 19a,b,c 9a,c .00*
lesson should be done on a % 1.8% 5.4% 42.9% 33.9% 16.1%
cadaver. No n 3a,b,c 10c 8b 21a,b,c 18a,c
% 5.0% 16.7% 13.3% 35.0% 30.0%
3. I think that the cadaver Yes n — 0a 0a 21a 35a .03*
should be respected in anatomy % — 0.0% 0.0% 37.5% 62.5%
applications. No n — 1a 2a 10a 47a
% — 1.7% 3.3% 16.7% 78.3%
4. I think that dissection Yes n 3a,b 2a,b 6a,b 27b 18a .00*
practices contribute/will % 5.4% 3.6% 10.7% 48.2% 32.1%
contribute to learning. No n 0a,b 0a,b 5a,b 12b 43a
% 0.0% 0.0% 8.3% 20.0% 71.7%
5. I think that the formations Yes n 2a 6a 9a 21a 18a .16
are seen better in cadavers than % 3.6% 10.7% 16.1% 37.5% 32.1%
models in anatomy applications. No n 0a 3a 19a 22a 16a
% 0.0% 5.0% 31.7% 36.7% 26.7%
6. I think education on cadavers Yes n 10a 9a 15a 16a 6a .12
affect/may affect my % 17.9% 16.1% 26.8% 28.6% 10.7%
psychology No n 15a 22a 10a 11a 2a
% 25.0% 36.7% 16.7% 18.3% 3.3%
7. I think that education with Yes n 12a 6a 15a 17a 6b .00*
cadavers has a role in my % 21.4% 10.7% 26.8% 30.4% 10.7%
gaining a physician identity. No n 1a 0a 3a 17a 39b
% 1.7% 0.0% 5.0% 28.3% 65.0%
8. I think that my own Yes n 31a 11b 8b,c 3c,d 3d .00*
dissection will contribute to my % 55.4% 19.6% 14.3% 5.4% 5.4%
choice of specialization. No n 0a 4b 11b,c 13c,d 32d
% 0.0% 6.7% 18.3% 21.7% 53.3%
9. Anatomy is the primary Yes n 14a 10a 9a 12a 11a .31
choice for me for specialization % 25.0% 17.9% 16.1% 21.4% 19.6%
or PhD education in Medicine. No n 12a 13a 18a 7a 10a
% 20.0% 21.7% 30.0% 11.7% 16.7%
10. I would like to do the Yes n 2a 1a 10a 25b 18b .04*
dissection myself. % 3.6% 1.8% 17.9% 44.6% 32.1%
No n 3a 1a 13a 18b 25b
% 5.0% 1.7% 21.7% 30.0% 41.7%
11. I can donate my body as a Yes n 15a 10a 10a 11a 10a .25
cadaver % 26.8% 17.9% 17.9% 19.6% 17.9%
No n 16a 12a 19a 5a 8a
% 26.7% 20.0% 31.7% 8.3% 13.3%
12. I think that touching and/or Yes n 3a,b 2b 6b 27a,c 18c .00*
dissecting a cadaver for the first % 5.4% 3.6% 10.7% 48.2% 32.1%
time is/will not be different No n 9a,b 16b 17b 13a,c 5c
than touching any living thing. % 15.0% 26.7% 28.3% 21.7% 8.3%
13. Obtaining cadavers should Yes n 0a 7a 14a 23b 12a .03*
definitely not be done with % 0.0% 12.5% 25.0% 41.1% 21.4%
money, it should be tried to be No n 2a 3a 11a 26b 18a
obtained from volunteers. % 3.3% 5.0% 18.3% 43.3% 30.0%
Test: Chi-square.
* P < 0.05 indicates that there is significance between different letters.
50
Morphologie 107 (2023) 47—54
Figure 1 Fear situations of the group who received anatomy education with cadavers when they saw the cadaver for the first
time.
Table 2 Opinions of the group who received Anatomy Education with Cadaver about Cadaver.
cadaver. In the group who did not receive anatomy educa- wanted to perform abdominal or head-neck dissection
tion with cadavers, 35% of the students were answered as (Table 3).
‘the lessons’, 28.3% as ‘the models’ and 11.7% as ‘the atlas’
(Fig. 2).
The question ‘‘Which region do you want to dissect Discussion
the most?’’ was answered as ‘the peripheral nerves and
medulla spinalis’ with a rate of 30.4%, and ‘the brain/central
When the results of the presented study are evaluated, it has
nervous system’ with a rate of 35% in the group that
been revealed that education with cadavers is more bene-
received anatomy education with cadavers. In the group that
ficial than atlas, books and models, but at the same time;
received anatomy education without cadaver, 36.6% of the
medical students think that, the cadaver should be given
students answered as ‘heart/thorax’ and 23.3% answered
the respect as given to human beings and that working on
as ‘head and neck’ to the same question. None of the
cadavers will have benefits beyond learning human anatomy.
students who received anatomy education with cadavers
51
B. Tugtag Demir, H.M. Altintas and B. Bilecenoglu
Figure 2 Distribution of the answers given to the question ‘how do you learn anatomy best’ in the research groups.
Table 3 Distribution of answers to the question ‘Which region of a cadaver would you like to dissect or participate in
dissection?’.
It is known that women’s empathy skills are more devel- question, while 47 of them stated that they strongly agreed
oped [11]. In related studies, it was stated that female and argued that cadavers should be respected in both groups
students felt more sorry for the cadaver and would be (P < 0.05). Males may have experienced such feelings less
more disturbed if unethical behaviors were made against the than females, since they feel less anxiety, fear and sadness
cadaver [11,12]. Similarly, in our study, although the results than females, or because they feel more ready to encounter
were not statistically significant, it was determined that a cadaver in the first stage. As a result, 41.1% of the total of
female students felt more sorry for the cadaver and thought the students who received anatomy education with cadav-
that they should be treated more respectfully. In addition, ers stated that they agree, and 44.6% of them stated that
when the answers given to the question about respecting they strongly agree that the first encounter with a cadaver
the cadaver were evaluated, 21 of the group that received was frightening.
anatomy education with cadaver stated that they agreed, One of the important issues to be considered is the stu-
and 35 of them strongly agreed. Ten of the group that did not dents’ thoughts, concerns and prejudices about dissection.
receive anatomy training with cadaver agreed with the same The students’ first encounter with a cadaver, the negative
52
Morphologie 107 (2023) 47—54
jokes made by unconscious students against the cadaver thought that anatomy education using cadavers is neces-
during dissection, the experiences they gained during their sary, although they did not perform dissection. Snelling et al.
time in the dissection room, the instruments in the dissec- reported that 91% of students think that cadaver dissection
tion laboratory and the smell may affect the psychology of is a necessary procedure for anatomy education, and this
the students. Over time, the student may develop emotional rate even increased to 95% at the end of the 12 weeks of
symptoms such as anxiety, disgust, and fear. Other factors dissection education [21]. Likewise, in our study, 80.2% of
such as gender, previous experience of death may also affect the students who received anatomy education with cadavers
the emergence of these symptoms [13,14]. stated that cadavers should definitely be in anatomy educa-
To face a cadaver for the first time is actually to face a tion (P < 0.05). Sixty point eight percent of the students in
dead body for the first time. This situation causes trauma at the same group stated that dissection on a cadaver would
a rate of 5% for students who have not had such an experi- be more beneficial in each practice (P < 0.05). In accordance
ence before. In order to avoid this situation, well-equipped with the literature, in our study, it was concluded that
instructors should prepare students for death anxiety and anatomy education with cadaver is an indispensable part
provide them the necessary support during dissection. In of medical education and dissection contributes to learning
this way, the negative consequences of death anxiety that anatomy.
may occur in students can be prevented easily [12]. In It has been shown in many studies that even medical stu-
our study, it was also examined whether cadaver education dents and healthcare professionals do not prefer to donate
would affect the psychology of the student. The group, who their own bodies to be used as cadavers [22—24]. Mwachaka
did not receive anatomy education with cadavers, answered et al. reported that the majority of the students did not want
this question as ‘I agree’ with the rate of 28.6%, while to donate their bodies as cadavers after their first encounter
26.8% stated that they were undecided. On the other hand, with a cadaver, and this perception of the students about
the group that received anatomy education with cadavers donating their bodies did not change after repeated encoun-
answered this question as ‘I don’t agree’ with a rate of 25% ters with a cadaver [25]. According to our results, it has
and as ‘I agree’ with a rate of 36.7% (P > 0.05). been found that the perceptions of students about donating
Anatomy education with cadavers supports the increase their bodies are in line with the literature, and although
of medical professionalism of students and also provides they think that anatomy education with cadavers is very
positive contributions to their professional careers [14,15]. important, both students who receive cadaver training and
Aziz et al. They stated that anatomy education with cadav- those who do not, avoid donating their bodies as cadavers.
ers is a prerequisite for learning medicine and dissection In the study of Izunya et al. the majority of students (47%)
studies bring students closer to their profession [16]. Other whose ideas were examined about replacing cadaver dissec-
similar studies have stated that working on cadavers is tion with artificial models in the near future preferred such
effective in creating the awareness of being a physician a change, while 41% stated that cadaveric education should
[12,17]. In our study, 30.1% of the group that received continue [26]. However, researchers such Parker et al. and
anatomy education with cadavers thought that (I agree) Mclachian et al. have reported that; dissection enables stu-
education with cadavers has a role in gaining the iden- dents to understand the 3D view of human anatomy, which is
tity of a physician, while 65% of the group that did not not fully possible with artificial models [22,27]. In addition,
receive anatomy education with cadavers thought this way Azis et al. previously stated that terminating or reducing
(I totally agree). As a result, the students stated that they cadaver dissection would impair the student’s ability to
felt like a real doctor and they learned anatomy better; apply the scientific method during diagnosis [28]. Although
while dissecting. In a similar study, it was stated that more students prefer cadaver dissection as the best method of
than 90% participants expressed the opinion that dissec- learning anatomy, replacing cadaver dissection with plastic
tion courses play an important role in the formation of models may cause clinically negative results. In addition, as
a sense of belonging to the profession, and that anatomy stated in our study, the cadaver should not be considered
education strongly makes one feel like being a medical as a course material only. Based on the changes in students’
student [16—18]. thoughts about death, we believe that it personally con-
Do we need dissection in an integrated problem-based tributed to health professionals.
medical learning course? Azer et al. conducted a research
on the perceptions of first and second year medical stu-
dents. They reported that 44% of the first-year medical Conclusion
students saw cadaver dissection as the most useful method
in anatomy education. Despite their low scores on the impor- It is essential for students to understand the human body
tance of dissection, the second-year medical students stated in order to be a well-equipped physician with a holistic
that they continued to believe in the importance of cadaver approach. For this, practice in medical education is essen-
dissection and that dissection prepared them for surgical tial. Cadaveric dissection in anatomy, which is one of the
branches in the clinic [19,20]. Similarly; in our study, 70.4% basic courses of medical education, is one of the impor-
of the students who did not receive anatomy education tant practices of medical education. It has been determined
with cadavers thought that dissecting would contribute to that three-dimensional modeling or working on a model,
the choice of specialization, while 74.9% of the group who which is among the alternative methods to cadaver educa-
received anatomy education with cadavers reported that tion, cannot replace cadaver education and cadaver is seen
dissection would be effective in their choice of special- as the most superior learning tool in learning anatomy. It
ization (P < 0.05). In summary, it was concluded that even is expected that this study, in which cadavers are evaluated
the group who did not see a cadaver in anatomy education from the perspective of students, will serve as a mirror to our
53
B. Tugtag Demir, H.M. Altintas and B. Bilecenoglu
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