Reflective journals: unmasking student perceptions of anatomical education
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
Keywords: reflectionjournal writinganatomymedical educationcadaveric dissection
References
- 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.
- 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.
- 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.
- Atkins S, Murphy K. Reflection: a review of the literature. J Adv Nurs. 1993; 18(8): 1188–1192.
- 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.
- Bernard E. Knowledge, Attitude and Practice of Nigerian Preclinical Students to Cadaver Dissection. IOSR J Dental Med Sci. 2012; 2(5): 33–36.
- 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.
- 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.
- Bohl M, Bosch P, Hildebrandt S. Medical students' perceptions of the body donor as a. Anat Sci Educ. 2011; 4(4): 208–213.
- Bornman PC, Krige JEJ. Perspectives on surgery in the new South Africa. World J Surg. 2005; 29(8): 949–952.
- Boyd E, Fales A. Reflective Learning. J Hum Psych. 2016; 23(2): 99–117.
- Cahill KC, Ettarh RR. Attitudes to anatomy dissection in an Irish medical school. Clin Anat. 2009; 22(3): 386–391.
- Carter C. The use of journals to promote reflection. Action Teacher Education. 1998; 19(4): 39–42.
- Clark DC, Zeldow PB. Vicissitudes of depressed mood during four years of medical school. JAMA. 1988; 260(17): 2521–2528.
- 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.
- 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.
- 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.
- Dinsmore CE, Daugherty S, Zeitz HJ. Student responses to the gross anatomy laboratory in a medical curriculum. Clin Anat. 2001; 14(3): 231–236.
- Druce M, Johnson M. Human dissection and attitudes of preclinical students to death and bereavement. Clin Anat. 2005; 7(1): 42–49.
- Dubhashi S, Dubhashi U, Singh A, et al. Medical students react to cadaveric dissections. Recent Res Sci Technol. 2011; 3(1): 135–138.
- Epp S. The value of reflective journaling in undergraduate nursing education: a literature review. Int J Nurs Stud. 2008; 45(9): 1379–1388.
- Escobar-Poni B, Poni ES. The role of gross anatomy in promoting professionalism: a neglected opportunity! Clin Anat. 2006; 19(5): 461–467.
- Evans EJ, Fitzgibbon GH. The dissecting room: Reactions of first year medical students. Clin Anat. 1992; 5(4): 311–320.
- Fakude LP, Bruce JC. Journaling: a quasi-experimental study of student nurses' reflective learning ability. Curationis. 2003; 26(2): 49–55.
- Finkelstein P, Mathers L. Post-traumatic stress among medical students in the anatomy dissection laboratory. Clin Anat. 1990; 3(3): 219–226.
- Fitzgerald F. Curiosity. Minn Med. 1999; 82: 10–12.
- Getachew D. Reaction of medical students to experiences in dissection room. Ethiop J Health Sci. 2014; 24(4): 337–342.
- 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.
- 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.
- 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.
- Hafferty FW. Cadaver stories and the emotional socialization of medical students. J Health Soc Behav. 1988; 29(4): 344–356.
- 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.
- Hildebrandt S. Thoughts on practical core elements of an ethical anatomical education. Clin Anat. 2016; 29(1): 37–45.
- 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.
- 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.
- Ibarreta GI, McLeod L. Thinking aloud on paper: an experience in journal writing. J Nurs Educ. 2004; 43(3): 134–137.
- Izunya AM, Oaikhena GA, Nwaopara AO. Attitudes to cadaver dissection in a Nigerian Medical School. Asian J Med Sci. 2010; 2(3): 89–94.
- 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.
- Johnson JH. Importance of dissection in learning anatomy: personal dissection versus peer teaching. Clin Anat. 2002; 15(1): 38–44.
- 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.
- 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.
- 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.
- Kometsi K, Louw J. Deciding on cadaveric organ donation in Black African families. Clin Transplant. 1999; 13(6): 473–478.
- Kotzé SH, April V, Vorster W, et al. Perceptions of first year medical students to cadaver dissection at Stellenbosch University. Poster Presentation. 2009.
- Kumar V. Attitude of first year indian medical students towards cadaver dissection. Int J Anat Res. 2015; 3(3): 1255–1258.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- Mc Garvey MA, Farrell T, Conroy RM, et al. Dissection: a positive experience. Clin Anat. 2001; 14(3): 227–230.
- Moore NA. To dissect or not to dissect? Anat Rec. 1998; 253(1): 8–9.
- Mukhtar Y, Mukhtar S, Chadwick SJ. Lost at sea: anatomy teaching at undergraduate and postgraduate levels. Med Educ. 2009; 43(11): 1078–1079.
- Mulu A, Tegabu D. Medical students' attitudinal changes towards cadaver dissection: a longitudinal study. Ethiop J Health Sci. 2012; 22(1): 51–58.
- 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.
- Ndlovu PP. ubjective frameworks of meaning of kidney transplantation among African recipients. Unpublished master’s thesis. University of Cape Town, Cape Town 1997.
- 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.
- 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.
- 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.
- 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.
- 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.
- Palmer A, Burns S, Bulman C. (eds.) Reflective practice in nursing. Blackwell, London 1994: 1–3.
- 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.
- Pawlina W. Professionalism and anatomy: How do these two terms define our role? Clin Anat. 2006; 19(5): 391–392.
- Pearson M. Psychiatric treatment of 250 physicians. Psych Ann. 1982; 12(2): 194–206.
- Pearson WG, Hoagland TM. Measuring change in professionalism attitudes during the gross anatomy course. Anat Sci Educ. 2010; 3(1): 12–16.
- Pellegrino ED. Educating the humanist physician. An ancient ideal reconsidered. JAMA. 1974; 227(11): 1288–1294.
- Penney JC. Reactions of medical students to dissection. J Med Educ. 1985; 60: 58–60.
- 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.
- Purvi M, Ksheersagar DD, Mishra D. Attitude of first year medical students towards dissection. J Cont Med A Dent. 2015; 3(1): 45–49.
- Riley-Doucet C, Wilson S. A three-step method of self-reflection using reflective journal writing. J Adv Nurs. 1997; 25(5): 964–968.
- Rizzolo LJ. Human dissection: an approach to interweaving the traditional and humanistic goals of medical education. Anat Rec. 2002; 269(6): 242–248.
- 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.
- Salmons PH. Psychiatric illness in medical students. Br J Psychiatry. 1983; 143: 505–508.
- 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.
- Satyapal KS. The treatment of human remains. SAJBL. 2012; 5(1): 55–60.
- 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.
- Snelling J, Sahai A, Ellis H. Attitudes of medical and dental students to dissection. Clin Anat. 2003; 16(2): 165–172.
- 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.
- Sobral DT. Medical students' reflection in learning in relation to approaches to study and academic achievement. Med Teach. 2001; 23(5): 508–513.
- Somanath D, Srivastava S, Rajasekar SS. Experience in anatomy Lab. An analysis in preclinical students. J Healthcare Biomed Res. 2015; 2: 117–121.
- Strauss A, Corbin J. Grounded Theory Methodology. In: Denzin NK, Lincoln YS (eds.). Handbook of qualitative research. Sage Publications, Thousand Oaks 1994: 217–285.
- Swartz WJ. Using gross anatomy to teach and assess professionalism in the first year of medical school. Clin Anat. 2006; 19(5): 437–441.
- Tryssenaar J. Interactive journals: an educational strategy to promote reflection. Am J Occup Ther. 1995; 49(7): 695–702.
- Wagoner NE, Romero-O'Connell JM. Privileged learning. Anat Sci Educ. 2009; 2(1): 47–48.
- Walker SE. Journal writing as a teaching technique to promote reflection. J Athl Train. 2006; 41(2): 216–221.
- Wear D. Cadaver talk: Medical students' accounts of their year-long experience. Death Studies. 1989; 13(4): 379–391.
- 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.
- Wenger DCK. Its not your parents anatomy course. Acad Phys Scientist. 2006: 1–3.
- 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.
- 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.
- 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.
- Winkelmann A, Güldner FH. Cadavers as teachers: the dissecting room experience in Thailand. BMJ. 2004; 329(7480): 1455–1457.
- 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.
- Woodward H. Reflective Journals and Portfolios: learning through assessment. Assess Eval Higher Educ. 2006; 23(4): 415–423.
- 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.