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Emotional Involvement and Attitude of First Year Medical Students towards Cadaveric Dissection: A Study from Andhra Pradesh, India |
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Veerraju NVV Adabala, JS Surya Prabha Kona, Krishna Babu Goru, Sesi AVS Devarakonda, Babji Korukonda 1. Assistant Professor, Department of Anatomy, Rangaraya Medical College- Dr. NTR University of Health Sciences, Kakinada, Andhra Pradesh, India. 2. Assistant Professor, Department of Community Medicine, Rangaraya Medical College- Dr. NTR University of Health Sciences, Kakinada, Andhra Pradesh, India. 3. Professor and Head, Department of Community Medicine, Rangaraya Medical College- Dr. NTR University of Health Sciences, Kakinada, Andhra Pradesh, India. 4. Professor and Head, Department of Anatomy, Rangaraya Medical College- Dr. NTR University of Health Sciences, Kakinada, Andhra Pradesh, India. 5. Professor, Department of Surgery, Rangaraya Medical College- Dr. NTR University of Health Sciences, Kakinada, Andhra Pradesh, India. |
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Correspondence Address : Dr. Veerraju NVV Adabala, Kakinada East Godavari, Kakinada, Andhra Pradesh, India. E-mail: adabalaveerraju23@gmail.com |
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| ABSTRACT |  | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
: Introduction: Teaching anatomy in medical colleges has been conventionally based on use of human cadaveric specimens, either whole body specimens for dissection or individual specimens. Cadavers are to be held in high esteem and regarded as the first teacher of a medical student as cadaveric dissection allows students to grasp the three dimensional anatomy and skill development. Aim: To know the physical and psychological effects experienced by students while doing cadaveric dissection and also to know the attitude of the medical students towards dissection in learning anatomy. Materials and Methods: A descriptive cross-sectional study was conducted among the 181 first year medical students in a Government Medical College, Andhra Pradesh, India, during the month of May 2021. The study was undertaken after two months of cadaveric dissection classes and the responses were the cumulative subjective effect of all the classes. Data was collected using a predesigned, prestructured and pretested questionnaire, entered in MS Excel and descriptive statistics like simple frequencies, percentages were used. Chi-square test was used to statistically analyse the data. Results: Total 181 students participated in this study (out of 250 first year medical students). Nearly, 88% of the students were older than 18 years of age. Nearly, 2/3rd of the students were females (65.7%). Out of 181 participants, 152 (84%) experienced psychological symptoms while doing dissection. Out of 152 students, who experienced psychological symptoms, 40.8% experienced excitement followed by anxiety 22.4%, fear 17.8% stress 16.4%. Among those who experienced excitement nearly 70% were females. Sweating was the most common physical symptom experienced by the participants. Among the study participants 98.3% students had sense of gratitude to people who donated their body and 96.1% had sympathy and respect for the cadaver. A 20.4% want to donate body for dissection. While assessing the attitude, 97.2% students agreed that cadaveric dissection is important in the curriculum, 97% agreed that dissection is required for understanding the structure of human body. Conclusion: Student-cadaver encounter is of paramount importance in medical education. Computer assisted and multimedia methods should be complementary but not a substitute to dissection. Introducing cadaver oath has resulted in students reflecting about organ donation and body donation, showing respect to the dead body. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Keywords : Anatomy, Cadaver, Medical education, Mental health | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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DOI and Others :
DOI: 10.7860/IJARS/2022/51822.2759
Date of Submission: Aug 12, 2021 Date of Peer Review: Sep 11, 2021 Date of Acceptance: Oct 27, 2021 Date of Publishing: Apr 01, 2021 AUTHOR DECLARATION: • Financial or Other Competing Interests: None • Was Ethics Committee Approval obtained for this study? Yes • Was informed consent obtained from the subjects involved in the study? Yes • For any images presented appropriate consent has been obtained from the subjects. No PLAGIARISM CHECKING METHODS: • Plagiarism X-checker: Aug 13, 2021 • Manual Googling: Nov 05, 2021 • iThenticate Software: Dec 18, 2021 (14%) Etymology: Author Origin |
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| INTRODUCTION |
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Anatomy, the study of human body structure is one of the most fundamental and essential subjects studied by all medical students in their medical education career. Teaching Anatomy in medical colleges is through human cadaveric whole body dissection or specimens which is conventional method. The cadaveric dissection helps students to understand anatomy in three-dimensional picture (1). Since renaissance in medical education, cadaveric dissection has been most important pillar in learning anatomy (2). Andreas Vesalius was said to have contributed most innovation to anatomy by human dissection within and outside his territory rectifying the contraventions in the works of earlier anatomists (3),(4). Vesalius’s high skill in dissection earned him the professorial title in surgery and anatomy (4). Cadaver has to be regarded as first teacher for a medical student. Cadaveric dissection is practiced in medical colleges during first year of medical education curriculum as a part of teaching anatomy. Exposure to cadaver during early stages of medical education induces some positive and negative feelings among medical students. The effects can be both physical (nausea, vomiting) and psychological (anxiety, stress, depression). Some studies observed ability of medical students to cope up with the emotional impact of such exposure. Evidences available in some studies suggest that adaptive mechanisms to cope with such exposure developed soon afterwards in those students (2),(5),(6),(7). In recent times, the worth and relevance of dissection has been under discussion at various universities due to problems involved in it like cost and time issues (8). There has been much argument surrounding the ethics and effectiveness of using human dead body as a learning tool. During the last decade, in US and the UK several universities have abandoned dissection and moved from a cadaver-oriented to a cadaver-less anatomy (8). But the benefits of orthodox Cadaveric dissection include memory enhancement, peer teaching, three dimensional and spatial orientation (9),(10). Attitude of students towards dissection determines conceptualisation in learning anatomy and professionalisation. Managing emotions and learning through team work from others helps is necessary in developing empathy (11). Bioethics education is one of the best ways to achieve professionalism which should be started in dissection hall for medical students by taking a ‘Cadaveric Oath’ (12). A cadaver oath, a pledge which the students recite on the starting day of Anatomy learning, is a unique and essential aspect of the new competency based medical education curriculum (12). The positive influences could be arousing an interest in the subject, or it could lead to specialisation in surgery and allied specialities and sometimes may induce the student to think of organ donation or body donation. This study takes into account the attitude of student in developing empathy by cadaveric oath and student’s opinion towards body donation. The present study was conducted to assess the physical and psychological effects of exposure to human cadaver dissection among first-year medical students, and also further explore their attitude and insight in that area. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Material and Methods |
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A descriptive cross-sectional study was conducted among the first year medical students in a Government Medical College, Andhra Pradesh, India from 1st May to 31st May 2021. The purpose of the study was explained and informed consent was taken from the participants. Anonymity and confidentiality were maintained throughout the study. Ethical committee clearance was obtained from Institutional Ethics Committee. (IEC/RMC/2021/634 dated 10/4/2021). Inclusion criteria: First year Bachelors of Medicine and Bachelors of Surgery (MBBS) students who were willing to participate and gave consent were included. Exclusion criteria: Students who were absent and refused to give consent were excluded. Sample size calculation: Convenient sampling method was used by taking all the first year MBBS students (250 students) in a Government Medical College. Out of 250 only 181 participated in the study. Study Procedure The study was undertaken after two months of cadaveric dissection classes and the responses were the cumulative subjective effect of all the classes. The practical session of the anatomy consisted of two hours of dissection five times in a week. Data was collected using a self-designed, self-structured questionnaire which was prepared by literature review of previous articles (11) and then peer reviewed and expert reviewed in the Department of Anatomy. Questionnaire was sent through google forms to their mail. Pilot study was done to check the validity and reliability of the questionnaire (Cronbach’s alpha value-0.8). Pilot study was done among 20 paramedical students attending dissection classes to test the comprehensibility, appropriateness and consistency of parts of the questionnaire. Subjects of pilot study were not included in the main study. Questionnaire consisted of two parts: Part 1 with questions related to personal characteristics of the students, like age, sex, place of stay, parents education and occupation etc., (14 questions). Part 2 with questions related to opinion and attitude towards cadaveric dissection during their regular dissection classes. (43 questions) [Annexure 1]. The questions related to attitude were assessed using 5-point Likert scale (13). The individual score of each question is considered five for ‘Strongly agree’ response, four for ‘Agree’, three for ‘neutral’, two for ‘disagree’ and one for ‘Strongly disagree’ in the attitude domain. Opinion related yes/no type questions were 18 in number, five open ended type questions and two closed ended questions and Likert scale questions were 18 in number. So, for total 18 questions pertaining to Likert scale the maximum overall score would be 90 and minimum score would be 18 in eighteen approaches. But for analysis ‘agrees’ and ‘strongly agrees’ was combined and ‘disagrees’ and ‘strongly disagrees’ was combined. Statistical Analysis Data was entered in MS Excel and analysed in Statistical Package for the Social Sciences (SPSS) version 20.0 and descriptive statistics like simple frequencies, percentages were used. Statistical test Chisquare test was used (p-value of <0.5 was taken as significant). | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Results |
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A total of 181 students participated in this study (out of 250 first year medical students). A 159 (87.8%) of the students were older than 18 years of age. Total 2/3rd of the students were females (119, 65.7%). Among the study participants 106 (58.6%) were from urban background, 98 (54.1%) were pink card holders. All the students were from English medium schools. A total of 74 (41%) student’s fathers were graduates whereas 86 (47.5%) mothers were undergraduates. A total of 79 (43.6%) fathers of participants were employees followed by agriculturists (33, 18.2%). Majority of the mothers were homemakers (140, 73.3%). Among the study participants 158 (87.3%) were non vegetarians (Table/Fig 1). Out of 181 participants, 152 (84%) experienced psychological problems while doing dissection. Excitement was the most commonly experienced psychological symptom during dissection. Excitement, stress and anxiety were seen more among female students more than two times compared to males (Table/Fig 2). Sweating (27.4%) was the most common physical symptom experienced by the students followed by restlessness (13.2%) and irritation of eyes (12.8%). Female students experienced more physical symptoms compared to male students which are statistically significant. Sleeplessness and vomiting were experienced by very less number of students (Table/Fig 3). Among the study participants, 98.3% students had sense of gratitude to people who donated their body and 96.1% had sympathy and respect for the cadaver. A 20.4% want to donate body for dissection. An 86.2% of the students were curious about dissection. An 81.2% liked anatomy as a subject but 16% had desire not to do dissection (Table/Fig 4). While assessing the attitude, 97.8% students agreed that cadaveric dissection is important in the curriculum, 97% agreed that dissection is required for understanding the structure of human body. Active interaction of the students with teachers make dissection interesting was said by 95.3% of the students. A 92.8% of the students found human body as intricate and complex. An 87.9% of the students agreed that hands on training on cadaver dissection is better than demonstration, whereas 42.5% said that dissection consumed a lot of time in curriculum and 15% said models or simulated lab assisted training can replace dissection (Table/Fig 5). | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Discussion |
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In our study nearly, 88% of the students were older than 18 years of age and 2/3rd were female students whereas, in Biswas R and Bandyopadhyay R, study 94.2% of the students were above 18 years and only 29.9% were girls, which was less when compared to our study (11). In Biswas R and Bandopadhyay R, study 62% students had their schooling in english medium whereas all the participants in our study were from english medium schooling (11). In Saha N et al., study 92.9% were non vegetarians when compared with our study 87.3% were non vegetarians (14). In a study by Asharani SK and Shashikantha SK, more than 70% of the subjects were excited about dissection whereas only 40.8% experienced excitement in our study (15). Fear was seen only in 17.8% of the participants which was less when compared to Asharani SK and Shashikantha SK study, where nearly 50% of the students had some fear about cadaver handling (15). Psychological symptoms like excitement, stress and anxiety among female students were encountered more than two times compared to males in our study. Almost similar finding of females being more evidently symptomatic in the dissection room as compared to males was observed in AgnihotriG and Sagoo MG study (female: male symptom ratio was 1.96:1, nearly two times) (16). Authors of that study have observed over the years that more females fainted in the dissection hall due to weakness and lack of proper appetite before entering the dissection room (16). Anxiety among female students associated with dissection has also been reported by Mitchell BS et al., previously (17). Emotional issues during cadaveric dissection should not be neglected as reported in Tschernig T et al., study (18). The students need to be prepared emotionally and mentally while entering the dissection hall for better involvement in cadaveric dissection. Nnodim JO in their study suggested that a formal course on death and dying should begin preclinically and extended further into clinical years (19). The most common physical symptom experienced by the students was sweating (27.4%) in our study. In Asharani SK and Shashikantha SK study nearly 40% of the subjects experienced one or the other symptoms like headache, nausea, giddiness etc., (15). In Saha N et al., study difficulty in consuming non vegetarian food was found to be the most common physical symptom experienced by the participants (14). Nausea (20.8%) was most common physical symptom experienced by the students in Lalit M et al., study (20). In Agnihotri G and Sagoo MG study, apprehension to handle the cadaver was seen in 46.6% participants compared to nearly 41% in our study and it was only 19% in Lalit M et al., study (16),(20). Dissection helps in appreciating anatomy in 3-D way through sense of touch unlike other teaching methods. Cadaver being the first teacher for medical students, they should have gratitude towards the cadaver for helping them to understand the anatomy of the human body by way of dissection, which cannot be compared with any of the modern-day virtual teaching methods. Cadaveric oath recitation, which is a part of new curriculum of medical students, will help the students in developing empathy towards cadaver and in the long run for improving doctor-patient relationship in medical practice. In our study 96.1% had sympathy and respect for the cadaver and 98.3% students had sense of gratitude to people who donated their body which was almost similar to study findings of Lalit M et al., study (95.6% and 98.5%, respectively) (20). In Saha N et al., study done in Tripura also similar finding was observed regarding sympathy and respect for the cadaver (14). In Lalit M et al., study and Karau PB et al., 96.3% and 98.7% of the participants agreed that cadaveric dissection remains the best method of learning anatomy whereas it was only 86.7% in our study (20),(21). In this study, 60.8% of the participants agreed that cadaver dissection for anatomical learning is ethically acceptable whereas in Saha N et al., study it was only 38.4% and in Oyeyipo IP and Falana BA study it was 90% [14,22]. In our study, 81.2% liked anatomy as a subject and regarding choosing anatomy as a career 11.6% gave positive opinion whereas in Lalit M et al., study it was 8.6% (20). Opinion of the students towards anatomy dissection in present study is compared with various study (Table/Fig 6) (11),(14),(16),(20),(21),(22). In Biswas R and Bandyopadhyay R, study, 83.2% of the study participants agreed that cadaveric dissection is important in the curriculum when compared to 97.8% students in our study (11). In Lalit M et al., study, 16% said models or simulated lab assisted training can replace dissection which was almost similar to our study finding (15%) (20). Body donation for medical education is a noble gesture by which a person can give back to the society by helping the medical students. In our study, 20.4% students wanted to donate body for dissection whereas it was 32% in Biswas R and Bandyopadhyay R, study (11). The oath taking ceremony for paying respect to the cadaver creates awareness among the medical students about the noble gesture of body donation and remembering them that those cadavers were also people who were alive once and hence deserve to be treated with empathy and respect as living people, It also encourages students for body or organ donation (23). In Popoola SO and Sakpa CL study, 92.1% agreed that participating in cadaver dissection as a group provides more opportunities to develop professional skills whereas 95.6% of the students in our study said that active interaction of the students with teachers make dissection interesting (24). Changes in the undergraduate medical education curriculum in UK were made without any research into various methods of teaching and their pros and cons (25). Limitation(s) Due to COVID-19 lockdown period, the students with only two months offline classes for anatomy dissection were included in the study. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Acknowledgement |
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The authors would like to express their gratitude to all students who enthusiastically participated in the study and also thank Dr. Vineela K, postgraduate in Community Medicine Department for her enormous help throughout the study. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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