Clinical Anatomy 27:833–834 (2014)
VIEWPOINT
What is Happening in Our Anatomical Dissection Rooms? SABINE HILDEBRANDT* Department of Medicine, Division General Pediatrics, Boston Children’s Hospital, Harvard Medical School, LO234, Boston, Massachusetts
A recent student article relates disrespectful and traumatizing events in a modern dissection room. This comment serves to remind anatomical educators’ of their duties toward the medical students. It is the anatomical educators’ duty to help students not only to become familiar with the structure of the human body but also with the emotional repertoire available when dealing with the living and the dead. And it is the educators’ duty to accompany students through the dissection course experience in a manner that keeps them safe from emotional harm. Clin. Anat. 27:833–834, 2014. VC 2014 Wiley Periodicals, Inc. Key words: anatomical dissection; ethics in anatomy; duty of the educator; trauma in medical students
In the last decade, anatomical education has focused increasingly on the value of the anatomical dissection course as an educational tool in medical professionalism and medical ethics. In fact, Clinical Anatomy has devoted an entire special issue to this topic in 2006 (Clinical Anatomy 19:5, 2006). Anatomical dissection has come a long way from the days of body snatching to the current times of memorial services for body donors and respectful attitudes within the dissection labs, from rude jokes among students of anatomy to thoughtful reflections on the gift and privilege of anatomical dissection (Bertman, 2009). Or so we thought. In February 2014, a deeply disturbing and saddening essay appeared in the online journal “Pulse: voices from the heart of medicine” (URL: http://pulsevoices. org). A medical student named Michael Terry describes here his experiences during the dissection course in a letter to his body donor, “Dear Joseph.” The essay begins with a description of the donors’ head in a plastic bag that brings to mind ancient nightmares. While the student author is certainly of the sensitive kind–the kind we all would love to see as our doctor–he relates interactions within the dissection lab, which this author would have thought impossible in a modern setting: anatomy faculty chide the student as “prudish” when trying to cover up the parts of the donor’s body which were not being dissected [while in fact it is good dissection room technique to cover as much of the body as possible to keep it moist and dissectible, apart from the fact that the covering
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is a sign of respect]. The student’s question about further information on the body donor is cut short by the faculty as “impossible” to obtain [while other medical schools are working on the deanonymization of donors or are recording donor interviews for future reference by students, Talarico, 2012; Bohl et al., 2013]. Fellow students make frequent derogatory remarks in reference to the body donor, including sexually tainted ones, and often show a general disrespect for the donor. While this behavior might be excused as a way of coping with the difficult situation in the dissection room through sarcasm as a defense mechanism, it should not have gone unnoticed and uncorrected by faculty. Posing and “playing around” with the donor’s head was not discouraged by those in charge. Why was it left to the student author to try to remind his fellow students of their duty toward the dead? Why was this course allowed to traumatize the student author to such a degree that the labs reminded him of the Nazi gas chambers–the ultimate symbol of death
*Correspondence to: S. Hildebrandt, Department of Medicine, Division General Pediatrics, Instructor in Pediatrics, Lecturer on Global Health and Social Medicine, Boston Children’s Hospital, Harvard Medical School, 333 Longwood Avenue, LO234, Boston, MA 02115. E-mail: [email protected] Received 25 February 2014; Accepted 27 February 2014 Published online 20 March 2014 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/ca.22396
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and destruction? Why was this medical student left alone in all of this? Most of the immediate responses to this essay were positive (URL: http://pulsevoices.org/archive/ stories/352-dear-joseph#comment-308). However, one comment called the student author’s sensitivity “prudish sentimentality.” This label is entirely incorrect. Daring to admit ones feelings does not make us “sentimental” but empathetic and worthy of living with other human beings. The balance between clinical detachment and empathy is the ultimate goal of ethical learning in the dissection room (Hildebrandt, 2010), and the dissection room depicted in Michael Terry’s essay is a horrific example of an imbalance toward complete clinical detachment. What can be done? As always with deeply disturbing events, it is important to understand the facts first. Where did this happen? Who was involved? Where else in this country, in this world, are similar destructive practices still in place? Once we have answers to these questions we can start analyzing the background of the occurrences: why were these particular faculty members behaving in this way, what led them to this? And when we understand their behavior,
we can start thinking about possible changes for the better, so that no other medical students have to go through similar traumatizing experiences. It is our duty as anatomical educators to help our students not only become familiar with the structure of the human body but also with the emotional repertoire available to us when dealing with the living and the dead. And it is our duty to accompany our students through the dissection course experience in a manner that keeps them safe from emotional harm. Michael Terry was failed by his faculty. We have to do better.
REFERENCES Bertman SL. 2009. One Breath Apart. Facing Dissection. Baywood Publishing Company: Cambridge. Bohl M, Holman A, Mueller DA, Gruppen LD, Hildebrandt S. 2013. The willed donor interview project: Medical student and donor expectations. Anat Sci Educ 6:90–100. Hildebrandt S. 2010. Developing empathy and clinical detachment during the dissection course in gross anatomy. Anat Sci Educ 3: 216. Talarico ET. 2012. A change in paradigm: Giving back identity to donors in the anatomy laboratory. Clin Anat 26:161–172.
VIEWPOINT
What is Happening in Our Anatomical Dissection Rooms? SABINE HILDEBRANDT* Department of Medicine, Division General Pediatrics, Boston Children’s Hospital, Harvard Medical School, LO234, Boston, Massachusetts
A recent student article relates disrespectful and traumatizing events in a modern dissection room. This comment serves to remind anatomical educators’ of their duties toward the medical students. It is the anatomical educators’ duty to help students not only to become familiar with the structure of the human body but also with the emotional repertoire available when dealing with the living and the dead. And it is the educators’ duty to accompany students through the dissection course experience in a manner that keeps them safe from emotional harm. Clin. Anat. 27:833–834, 2014. VC 2014 Wiley Periodicals, Inc. Key words: anatomical dissection; ethics in anatomy; duty of the educator; trauma in medical students
In the last decade, anatomical education has focused increasingly on the value of the anatomical dissection course as an educational tool in medical professionalism and medical ethics. In fact, Clinical Anatomy has devoted an entire special issue to this topic in 2006 (Clinical Anatomy 19:5, 2006). Anatomical dissection has come a long way from the days of body snatching to the current times of memorial services for body donors and respectful attitudes within the dissection labs, from rude jokes among students of anatomy to thoughtful reflections on the gift and privilege of anatomical dissection (Bertman, 2009). Or so we thought. In February 2014, a deeply disturbing and saddening essay appeared in the online journal “Pulse: voices from the heart of medicine” (URL: http://pulsevoices. org). A medical student named Michael Terry describes here his experiences during the dissection course in a letter to his body donor, “Dear Joseph.” The essay begins with a description of the donors’ head in a plastic bag that brings to mind ancient nightmares. While the student author is certainly of the sensitive kind–the kind we all would love to see as our doctor–he relates interactions within the dissection lab, which this author would have thought impossible in a modern setting: anatomy faculty chide the student as “prudish” when trying to cover up the parts of the donor’s body which were not being dissected [while in fact it is good dissection room technique to cover as much of the body as possible to keep it moist and dissectible, apart from the fact that the covering
C V
2014 Wiley Periodicals, Inc.
is a sign of respect]. The student’s question about further information on the body donor is cut short by the faculty as “impossible” to obtain [while other medical schools are working on the deanonymization of donors or are recording donor interviews for future reference by students, Talarico, 2012; Bohl et al., 2013]. Fellow students make frequent derogatory remarks in reference to the body donor, including sexually tainted ones, and often show a general disrespect for the donor. While this behavior might be excused as a way of coping with the difficult situation in the dissection room through sarcasm as a defense mechanism, it should not have gone unnoticed and uncorrected by faculty. Posing and “playing around” with the donor’s head was not discouraged by those in charge. Why was it left to the student author to try to remind his fellow students of their duty toward the dead? Why was this course allowed to traumatize the student author to such a degree that the labs reminded him of the Nazi gas chambers–the ultimate symbol of death
*Correspondence to: S. Hildebrandt, Department of Medicine, Division General Pediatrics, Instructor in Pediatrics, Lecturer on Global Health and Social Medicine, Boston Children’s Hospital, Harvard Medical School, 333 Longwood Avenue, LO234, Boston, MA 02115. E-mail: [email protected] Received 25 February 2014; Accepted 27 February 2014 Published online 20 March 2014 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/ca.22396
834
Hildebrandt
and destruction? Why was this medical student left alone in all of this? Most of the immediate responses to this essay were positive (URL: http://pulsevoices.org/archive/ stories/352-dear-joseph#comment-308). However, one comment called the student author’s sensitivity “prudish sentimentality.” This label is entirely incorrect. Daring to admit ones feelings does not make us “sentimental” but empathetic and worthy of living with other human beings. The balance between clinical detachment and empathy is the ultimate goal of ethical learning in the dissection room (Hildebrandt, 2010), and the dissection room depicted in Michael Terry’s essay is a horrific example of an imbalance toward complete clinical detachment. What can be done? As always with deeply disturbing events, it is important to understand the facts first. Where did this happen? Who was involved? Where else in this country, in this world, are similar destructive practices still in place? Once we have answers to these questions we can start analyzing the background of the occurrences: why were these particular faculty members behaving in this way, what led them to this? And when we understand their behavior,
we can start thinking about possible changes for the better, so that no other medical students have to go through similar traumatizing experiences. It is our duty as anatomical educators to help our students not only become familiar with the structure of the human body but also with the emotional repertoire available to us when dealing with the living and the dead. And it is our duty to accompany our students through the dissection course experience in a manner that keeps them safe from emotional harm. Michael Terry was failed by his faculty. We have to do better.
REFERENCES Bertman SL. 2009. One Breath Apart. Facing Dissection. Baywood Publishing Company: Cambridge. Bohl M, Holman A, Mueller DA, Gruppen LD, Hildebrandt S. 2013. The willed donor interview project: Medical student and donor expectations. Anat Sci Educ 6:90–100. Hildebrandt S. 2010. Developing empathy and clinical detachment during the dissection course in gross anatomy. Anat Sci Educ 3: 216. Talarico ET. 2012. A change in paradigm: Giving back identity to donors in the anatomy laboratory. Clin Anat 26:161–172.
