Vol 76, No 3 (2017)
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Published online: 2017-02-16

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Reflective journals: unmasking student perceptions of anatomical education

L. Lazarus1, R. Sookrajh, K. S. Satyapal1
Pubmed: 28248411
Folia Morphol 2017;76(3):506-518.

Abstract

Background: In medical education, reflection has been considered to be a core skill in professional competence. The anatomy laboratory is an ideal setting for faculty/ student interaction and provides invaluable opportunities for active learning and reflection on anatomical knowledge.

Materials and methods: This study was designed to record student attitudes regarding human cadaveric dissection, explore their experiences of anatomy through an analysis of their journal-reflective writings and determine whether this type of creative writing had a beneficial effect on those students who chose to complete them. A total of 75 journals from Medical and Allied Health Science students were collected and analysed.

Results: Results were categorised according to the following themes: (i) Dissecting room stressors (27.6%); (ii) Educational value of dissection (26.3%); (iii) Appreciation, Gratitude, Respect and Curiosity for the cadaver (18.9%); (iv) Positive and negative sentiments expressed in the dissecting room (25.8%); (v) Benefit of alternate teaching modalities (4.6%); (vi) Spirituality/Religious Beliefs (3.7%); (vii) Shared humanity and emotional bonds (3.69%); (viii) Acknowledgement of human anatomical variations (3.2%); (ix) Beauty and complexity of the human body (1.8%) and (x) Psychological detachment (0.9%). Students appreciated the opportunity to share their emotions and reflect on the humanistic dimension of anatomy as a subject. Student reflections illustrated clearly their thoughts and some of the difficult issues with which they wrestled.

Conclusions: The anatomy laboratory is seen as the budding clinician’s first encounter with a patient, albeit a cadaver. This was the first time that reflective journals were given to students in the discipline. Reflective journals allow students to express themselves in an open-ended and creative fashion. It also assists students to integrate anatomy and clinical medicine and assists in applying their basic anatomical knowledge in an authentic, yet safe environment

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References

  1. Abu-Hijleh MF, Hamdi NA, Moqattash ST, et al. Attitudes and reactions of Arab medical students to the dissecting room. Clin Anat. 1997; 10(4): 272–278, doi: 10.1002/(SICI)1098-2353(1997)10:4<272::AID-CA10>3.0.CO;2-H.
  2. Agnihotri G, Sagoo MG. Reactions of first year Indian medical students to the dissection hall experience. Nat J Integ Res Med. 2010; 1(4): 4–9.
  3. Amadio PC. Reaffirming the importance of dissection. Clin Anat. 1996; 9(2): 136–137, doi: 10.1002/(SICI)1098-2353(1996)9:2<136::AID-CA7>3.0.CO;2-F.
  4. Atkins S, Murphy K. Reflection: a review of the literature. J Adv Nurs. 1993; 18(8): 1188–1192.
  5. Bataineh ZM, Hijazi TA, Hijleh MF. Attitudes and reactions of Jordanian medical students to the dissecting room. Surg Radiol Anat. 2006; 28(4): 416–421.
  6. Bernard E. Knowledge, Attitude and Practice of Nigerian Preclinical Students to Cadaver Dissection. IOSR J Dental Med Sci. 2012; 2(5): 33–36.
  7. Bertman S, Marks S. The dissection experience as a laboratory for self-discovery about death and dying: Another side of clinical anatomy. Clin Anat. 1989; 2(2): 103–113.
  8. Bob MH, Popescu CA, Suciu ŞM, et al. First year medical students' attitude toward anatomical corpse dissection and its relationship with their personality. Rom J Morphol Embryol. 2015; 56(1): 321–324.
  9. Bohl M, Bosch P, Hildebrandt S. Medical students' perceptions of the body donor as a. Anat Sci Educ. 2011; 4(4): 208–213.
  10. Bornman PC, Krige JEJ. Perspectives on surgery in the new South Africa. World J Surg. 2005; 29(8): 949–952.
  11. Boyd E, Fales A. Reflective Learning. J Hum Psych. 2016; 23(2): 99–117.
  12. Cahill KC, Ettarh RR. Attitudes to anatomy dissection in an Irish medical school. Clin Anat. 2009; 22(3): 386–391.
  13. Carter C. The use of journals to promote reflection. Action Teacher Education. 1998; 19(4): 39–42.
  14. Clark DC, Zeldow PB. Vicissitudes of depressed mood during four years of medical school. JAMA. 1988; 260(17): 2521–2528.
  15. Coulehan J, Williams P, Landis D, et al. The first patient: Reflections and stories about the anatomy cadaver. Teach Learn Med. 1992; 7(1): 61–66.
  16. Crow SM, O'Donoghue D, Vannatta JB, et al. Meeting the family: promoting humanism in gross anatomy. Teach Learn Med. 2012; 24(1): 49–54.
  17. Dart BC, Boulton‐Lewis GM, Brownlee JM, et al. Change in knowledge of learning and teaching through journal writing. Res Pap Edu. 1998; 13(3): 291–318.
  18. Dinsmore CE, Daugherty S, Zeitz HJ. Student responses to the gross anatomy laboratory in a medical curriculum. Clin Anat. 2001; 14(3): 231–236.
  19. Druce M, Johnson M. Human dissection and attitudes of preclinical students to death and bereavement. Clin Anat. 2005; 7(1): 42–49.
  20. Dubhashi S, Dubhashi U, Singh A, et al. Medical students react to cadaveric dissections. Recent Res Sci Technol. 2011; 3(1): 135–138.
  21. Epp S. The value of reflective journaling in undergraduate nursing education: a literature review. Int J Nurs Stud. 2008; 45(9): 1379–1388.
  22. Escobar-Poni B, Poni ES. The role of gross anatomy in promoting professionalism: a neglected opportunity! Clin Anat. 2006; 19(5): 461–467.
  23. Evans EJ, Fitzgibbon GH. The dissecting room: Reactions of first year medical students. Clin Anat. 1992; 5(4): 311–320.
  24. Fakude LP, Bruce JC. Journaling: a quasi-experimental study of student nurses' reflective learning ability. Curationis. 2003; 26(2): 49–55.
  25. Finkelstein P, Mathers L. Post-traumatic stress among medical students in the anatomy dissection laboratory. Clin Anat. 1990; 3(3): 219–226.
  26. Fitzgerald F. Curiosity. Minn Med. 1999; 82: 10–12.
  27. Getachew D. Reaction of medical students to experiences in dissection room. Ethiop J Health Sci. 2014; 24(4): 337–342.
  28. Grant A, Kinnersley P, Metcalf E, et al. Students' views of reflective learning techniques: an efficacy study at a UK medical school. Med Educ. 2006; 40(4): 379–388.
  29. Gualdron AJ, Mendoza U, Zulima D. Colombian medical students’ attitudes towards dissection during anatomy classes and their relationship with a score on the Jefferson Scale of Physician Empathy. Rev Fac Med. 2011; 59(4): 281–307.
  30. Gustavson N. The effect of human dissection on first-year students and implications for the doctor-patient relationship. J Med Educ. 1988; 63(1): 62–64.
  31. Hafferty FW. Cadaver stories and the emotional socialization of medical students. J Health Soc Behav. 1988; 29(4): 344–356.
  32. Hammer RR, Jones TW, Hussain FT, et al. Students as resurrectionists. A multimodal humanities project in anatomy putting ethics and professionalism in historical context. Anat Sci Educ. 2010; 3(5): 244–248.
  33. Hildebrandt S. Thoughts on practical core elements of an ethical anatomical education. Clin Anat. 2016; 29(1): 37–45.
  34. Horne DJ, Tiller JW, Eizenberg N, et al. Reactions of first-year medical students to their initial encounter with a cadaver in the dissecting room. Acad Med. 1990; 65(10): 645–646.
  35. Houwink AP, Kurup AN, Kollars JP, et al. Help of third-year medical students decreases first-year medical students' negative psychological reactions on the first day of gross anatomy dissection. Clin Anat. 2004; 17(4): 328–333.
  36. Ibarreta GI, McLeod L. Thinking aloud on paper: an experience in journal writing. J Nurs Educ. 2004; 43(3): 134–137.
  37. Izunya AM, Oaikhena GA, Nwaopara AO. Attitudes to cadaver dissection in a Nigerian Medical School. Asian J Med Sci. 2010; 2(3): 89–94.
  38. Javadnia F, Hashemitabar M, Kalantarmahdavi SR, et al. How to decrease the emotional impact of cadaver dissection in medical students. Pak J Med Sci. 2006; 22(2): 200–203.
  39. Johnson JH. Importance of dissection in learning anatomy: personal dissection versus peer teaching. Clin Anat. 2002; 15(1): 38–44.
  40. Jones DG. Reassessing the importance of dissection: a critique and elaboration. Clin Anat. 1997; 10(2): 123–127, doi: 10.1002/(SICI)1098-2353(1997)10:2<123::AID-CA9>3.0.CO;2-W.
  41. Jones TW, Lachman N, Pawlina W. Honoring our donors: a survey of memorial ceremonies in United States anatomy programs. Anat Sci Educ. 2014; 7(3): 219–223.
  42. Karau PB, Wamachi A, Ndede K, et al. Perception to cadaver dissection and views on Anatomy as a subject between two pioneer cohorts in a Kenyan medical school. Anat J Afr. 2014; 3(2): 318–323.
  43. Kometsi K, Louw J. Deciding on cadaveric organ donation in Black African families. Clin Transplant. 1999; 13(6): 473–478.
  44. Kotzé SH, April V, Vorster W, et al. Perceptions of first year medical students to cadaver dissection at Stellenbosch University. Poster Presentation. 2009.
  45. Kumar V. Attitude of first year indian medical students towards cadaver dissection. Int J Anat Res. 2015; 3(3): 1255–1258.
  46. La Spina F, Sedda L, Pizzi C, et al. For the North Intaly Transplant Program. Donor families attitudes towards organ donation. Transplant Proc. 1993; 25(1): 1699–1701.
  47. Lachman N, Pawlina W. Integrating professionalism in early medical education: the theory and application of reflective practice in the anatomy curriculum. Clin Anat. 2006; 19(5): 456–460.
  48. Lam WA, McCullough LB. Influence of religious and spiritual values on the willingness of Chinese-Americans to donate organs for transplantation. Clin Transplant. 2000; 14(5): 449–456.
  49. Lempp HK. Perceptions of dissection by students in one medical school: beyond learning about anatomy. A qualitative study. Med Educ. 2005; 39(3): 318–325.
  50. Marks SC, Bertman SL, Penney JC. Human anatomy: a foundation for education about death and dying in medicine. Clin Anat. 1997; 10(2): 118–122, doi: 10.1002/(SICI)1098-2353(1997)10:2<118::AID-CA8>3.0.CO;2-R.
  51. McCarroll JE, Ursano RJ, Ventis WL, et al. Anticipation of handling the dead: effects of gender and experience. Br J Clin Psychol. 1993; 32 ( Pt 4): 466–468.
  52. Mc Garvey MA, Farrell T, Conroy RM, et al. Dissection: a positive experience. Clin Anat. 2001; 14(3): 227–230.
  53. Moore NA. To dissect or not to dissect? Anat Rec. 1998; 253(1): 8–9.
  54. Mukhtar Y, Mukhtar S, Chadwick SJ. Lost at sea: anatomy teaching at undergraduate and postgraduate levels. Med Educ. 2009; 43(11): 1078–1079.
  55. Mulu A, Tegabu D. Medical students' attitudinal changes towards cadaver dissection: a longitudinal study. Ethiop J Health Sci. 2012; 22(1): 51–58.
  56. Naz S, Nazir G, Iram S, et al. Perceptions of cadaveric dissection in anatomy teaching. J Ayub Med Coll Abbottabad. 2011; 23(3): 145–148.
  57. Ndlovu PP. ubjective frameworks of meaning of kidney transplantation among African recipients. Unpublished master’s thesis. University of Cape Town, Cape Town 1997.
  58. Newell RL. Follow the royal road: the case for dissection. Clin Anat. 1995; 8(2): 124–127. Comment in Clin Anat 1995 8: 128–133.
  59. Nnodim JO. Preclinical student reactions to dissection, death, and dying. Clin Anat. 1996; 9(3): 175–182, doi: 10.1002/(SICI)1098-2353(1996)9:3<175::AID-CA9>3.0.CO;2-F.
  60. O'Carroll RE, Whiten S, Jackson D, et al. Assessing the emotional impact of cadaver dissection on medical students. Med Educ. 2002; 36(6): 550–554.
  61. Older J. Anatomy: A must for teaching the next generation. Surgeon. 2004; 2(2): 79–90. Comment in Surgeon (2004); 2: 303-304. Author reply 304. Surgeon (2004); 2: 303; Author reply 303, Surgeon (2005) 3:56; Author reply 56.
  62. Oyeyipo LP, Falana BA. Attitude of Preclinical Students to Cadaver Dissection in a South West Nigerian Medical School. Int J Trop Med. 2012; 7(1): 1–5.
  63. Palmer A, Burns S, Bulman C. (eds.) Reflective practice in nursing. Blackwell, London 1994: 1–3.
  64. Patel B, Jadav J, Parmar A, et al. Attitude of medical students to cadaver dissection in Ahmedabad City. Int J Cur Res Rev. 2012; 4(22): 54–58.
  65. Pawlina W. Professionalism and anatomy: How do these two terms define our role? Clin Anat. 2006; 19(5): 391–392.
  66. Pearson M. Psychiatric treatment of 250 physicians. Psych Ann. 1982; 12(2): 194–206.
  67. Pearson WG, Hoagland TM. Measuring change in professionalism attitudes during the gross anatomy course. Anat Sci Educ. 2010; 3(1): 12–16.
  68. Pellegrino ED. Educating the humanist physician. An ancient ideal reconsidered. JAMA. 1974; 227(11): 1288–1294.
  69. Penney JC. Reactions of medical students to dissection. J Med Educ. 1985; 60: 58–60.
  70. Prakash PLV, Rai R, D'Costa S, et al. Cadavers as teachers in medical education: knowledge is the ultimate gift of body donors. Singapore Med J. 2007; 48(3): 186–189.
  71. Purvi M, Ksheersagar DD, Mishra D. Attitude of first year medical students towards dissection. J Cont Med A Dent. 2015; 3(1): 45–49.
  72. Riley-Doucet C, Wilson S. A three-step method of self-reflection using reflective journal writing. J Adv Nurs. 1997; 25(5): 964–968.
  73. Rizzolo LJ. Human dissection: an approach to interweaving the traditional and humanistic goals of medical education. Anat Rec. 2002; 269(6): 242–248.
  74. Saha N, Chaudhuri S, Singh MM. Attitude of first year medical students in Dissection Hall. IOSR J Dent Med Sci. 2015; 14(5): 74–78.
  75. Salmons PH. Psychiatric illness in medical students. Br J Psychiatry. 1983; 143: 505–508.
  76. Sándor I, Birkás E, Győrffy Z. The effects of dissection-room experiences and related coping strategies among Hungarian medical students. BMC Med Educ. 2015; 15: 73.
  77. Satyapal KS. The treatment of human remains. SAJBL. 2012; 5(1): 55–60.
  78. Shapiro J, Nguyen V, Mourra S, et al. The use of creative projects in a gross anatomy class. Journal for Learning through the Arts: A Research Journal on Arts Integration in Schools and Communities. 2006; 2(1): 1–32.
  79. Snelling J, Sahai A, Ellis H. Attitudes of medical and dental students to dissection. Clin Anat. 2003; 16(2): 165–172.
  80. Sobnach S, Borkum M, Millar AJW, et al. Attitudes and beliefs of South African medical students toward organ transplantation. Clin Transplant. 2012; 26(2): 192–198.
  81. Sobral DT. Medical students' reflection in learning in relation to approaches to study and academic achievement. Med Teach. 2001; 23(5): 508–513.
  82. Somanath D, Srivastava S, Rajasekar SS. Experience in anatomy Lab. An analysis in preclinical students. J Healthcare Biomed Res. 2015; 2: 117–121.
  83. Strauss A, Corbin J. Grounded Theory Methodology. In: Denzin NK, Lincoln YS (eds.). Handbook of qualitative research. Sage Publications, Thousand Oaks 1994: 217–285.
  84. Swartz WJ. Using gross anatomy to teach and assess professionalism in the first year of medical school. Clin Anat. 2006; 19(5): 437–441.
  85. Tryssenaar J. Interactive journals: an educational strategy to promote reflection. Am J Occup Ther. 1995; 49(7): 695–702.
  86. Wagoner NE, Romero-O'Connell JM. Privileged learning. Anat Sci Educ. 2009; 2(1): 47–48.
  87. Walker SE. Journal writing as a teaching technique to promote reflection. J Athl Train. 2006; 41(2): 216–221.
  88. Wear D. Cadaver talk: Medical students' accounts of their year-long experience. Death Studies. 1989; 13(4): 379–391.
  89. Weeks SE, Harris EE, Kinzey WG. Human gross anatomy: a crucial time to encourage respect and compassion in students. Clin Anat. 1995; 8(1): 69–79.
  90. Wenger DCK. Its not your parents anatomy course. Acad Phys Scientist. 2006: 1–3.
  91. Williams R, Wessel J, Gemus M, et al. Journal writing to promote reflection by physical therapy students during clinical placements. Phys Theory Prac. 2009; 18(1): 5–15.
  92. Williams RM, Wessel J. Reflective journal writing to obtain student feedback about their learning during the study of chronic musculoskeletal conditions. J Allied Health. 2004; 33(1): 17–23.
  93. Williams AD, Greenwald EE, Soricelli RL, et al. Medical students' reactions to anatomic dissection and the phenomenon of cadaver naming. Anat Sci Educ. 2014; 7(3): 169–180.
  94. Winkelmann A, Güldner FH. Cadavers as teachers: the dissecting room experience in Thailand. BMJ. 2004; 329(7480): 1455–1457.
  95. Wong FK, Kember D, Chung LY, et al. Assessing the level of student reflection from reflective journals. J Adv Nurs. 1995; 22(1): 48–57.
  96. Woodward H. Reflective Journals and Portfolios: learning through assessment. Assess Eval Higher Educ. 2006; 23(4): 415–423.
  97. Yeager VL. Learning gross anatomy: dissection and prosection. Clin Anat. 1996; 9(1): 57–59, doi: 10.1002/(SICI)1098-2353(1996)9:1<57::AID-CA12>3.0.CO;2-9.