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Keywords:

  • cadaver;
  • dissection;
  • anxiety, medical education;
  • anatomy;
  • education

Abstract

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. ANALYSIS OF ANXIETY RESPONSE
  5. STUDY 1
  6. STUDY 2
  7. STUDY 3
  8. CONCLUSIONS AND IMPLICATIONS
  9. Acknowledgements
  10. LITERATURE CITED

Anxiety is an emotional reaction frequently shown by students when a human cadaver is being dissected. Nonetheless, few studies analyze the nature of the anxiety response in this situation and the ones that do exist are mainly limited to English-speaking countries. Our research has three aims: to study the characteristic anxiety reaction to dissection practices, to determine the weight exerted by internal and environmental variables on this anxiety reaction, and to design practices aimed at reducing the state of anxiety experienced by pupils in their human anatomy practices. The studies were carried out in the dissection room of the Department of Human Anatomy and Embryology II at the Faculty of Medicine of the Complutense University, Madrid, during the 3 academic years 2000–2003. The anxiety response to the first dissection of a human cadaver is mainly determined by a situation considered to be threatening, with novelty as its main characteristic. The students' anxiety response is first determined by the situation itself and reactions depend on individual differences. Repeated or gradual exposure (detailed verbal information on the situation, visits to dissecting rooms when no cadaver is present, videos showing pictures of human dissections, etc.) before carrying out the first dissection reduce the students' anxiety response. Anat Rec (Part B: New Anat) 279B:16–23, 2004. © 2004 Wiley-Liss, Inc.


INTRODUCTION

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. ANALYSIS OF ANXIETY RESPONSE
  5. STUDY 1
  6. STUDY 2
  7. STUDY 3
  8. CONCLUSIONS AND IMPLICATIONS
  9. Acknowledgements
  10. LITERATURE CITED

The importance of dissection in human anatomy and its significance in the history of medicine and in medical training have been widely addressed (Dyer and Thorndike, 2000; Aziz et al., 2002). In contrast, very little research has focused on the emotional nature of dissection for students and its possible repercussion on their future professional work.

Medical schools over the centuries adopted prevailing models of pedagogy from society. By the end of the 19th century, the approach was to teach students to approach patients as though faced with a laboratory experiment. This attitude had to be acquired from the dissection room (DR). It was thought that a student-cadaver relationship should precede and provide a model for organizing a doctor-patient relationship (Bastos and Proença, 2000). From then on, the following process became generalized: the anatomist was to devote him-/herself to teaching the organization of the human body; the student had to learn a scientific attitude in the DR characterized by a hands-off interest. Socially, the idea spread that doctors were insensitive technicians who have failed in basic emotional interactions.

One of the first studies that centered on the medical students' response to dissection focused entirely on sociodemographic aspects (Becker et al., 1961). Nonetheless, in recent years there has been an increase in the number of publications on medical students' emotional state in the face of this experience, though most of these works center on descriptive aspects of this situation (Horne et al., 1990; Evans and Fitzgibbon, 1992) and are mainly limited to North American, Australian, and English medical schools. Besides, very few works center on research into anxiety reactions to dissection or variables that influence this reaction (Harvill, 1986; Jordan et al., 1986; Tschernig et al., 2000).

The earliest descriptions of the emotional response to dissection, in the 1960s, led us to think that the reaction was suppressed or controlled without creating any problems (Lief and Fox, 1963; McGuire, 1966). However, a decade later, Fox (1979) described students as being naturally distressed by dissecting a human subject and as learning to manage that distress by repressing their emotions and developing a “scientific” attitude.

Reactions have been shown to be physical (nausea, fainting, loss of appetite, sleeplessness, or nightmares) in 23% of students and psychological (horror, 11%; anxiety, 75%) in others, although these reactions have been shown to reduce after the first few weeks of dissection (Penney, 1985). In some studies, the experience of dissection produced noticeable upsets in 5% of students, such us nightmares, intrusive visual images, insomnia, depression, and learning difficulties (Finkelstein and Mathers, 1990). In other studies, 66% of students admitted to feeling moderate apprehension during the dissection process (Druce and Johnson, 1994).

Despite the diversity of opinions, all studies noted a common axis: anxiety was the most frequent emotional reaction shown by students when dissecting a human cadaver.

Despite the diversity of opinions, all studies noted a common axis: anxiety was the most frequent emotional reaction shown by students when dissecting a human cadaver.

Shalev and Nathan (1985) argued that anxiety experienced when dealing with what Kasper (1969) called the “first patient” crystallized in the future doctor-patient relationship. Therefore, further research is required that attempt to analyze the nature of the anxiety response in this situation.

From the end of the 1950s to the present day, theories about anxiety conceived as a personality variable have changed considerably. The emphasis, at the beginning of the 1960s, on the search for internal characteristics to explain a propensity to anxiety was substituted, at the end of the same decade, by an attempt to identify the environmental or situational variables giving rise to the appearance of these reactions. At the beginning of the 1970s, a new approach to these questions gained considerable ground: the interactive approach, which was both integrating and critical, and which proposed that any specific manifestation (state) of anxiety is a consequence of the interaction between a certain disposition (trait) already existing in the individual and the characteristics of the situation in which the anxiety response occurs (Bowers, 1973; Endler and Magnusson, 1976).

But there is one question implicit to the interactive model: which of the two elements has the more weight? To answer this question, research is required to determine whether the anxiety state shown by individuals in a situation clearly defined as stressful or anxiety-producing is determined to a greater extent by the situation itself or whether the reaction is, at least partly, determined by the individual's characteristics or anxiety trait. One approach is to select a situation that is clearly defined as anxiety-producing by a significant number of the individuals facing it. DR, therefore, offered an ideal study environment.

Some fears, usually referred to as biological fears, can appear with merely a short or practically nonexisting learning process, such as that of spiders and, particularly, fear of death. When a group of chimpanzees is shown a clay model of a head of a member of their species for the first time, the primates panic and their reaction is similar to that of people faced with the dissected cadaver of a human being (Hebb, 1980).

Although death is an inescapable part of the human condition and arouses intense emotions, few studies have focused on death, including cadavers or dissection, from a psychological viewpoint (Kastenbaum and Costa, 1977) or have considered death as a phenomenon that can be used to study emotional reactions (Limonero, 1996).

Although death is an inescapable part of the human condition and arouses intense emotions, few studies have focused on death, including cadavers or dissection, from a psychological viewpoint.

Although there is little research into the anxiety reaction to death or the death process, there are even fewer studies into reactions to dissection of a dead human.

The aim of this research is to study students' anxiety response to dissection and the possible factors involved in this response. This work was made up of three studies carried out during 3 consecutive academic years, 2000–2001 to 2002–2003, with independent samples of anatomy students in each study. The objectives and the characteristics of the participants in each study are described in detail in the sections corresponding to each one.

ANALYSIS OF ANXIETY RESPONSE

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. ANALYSIS OF ANXIETY RESPONSE
  5. STUDY 1
  6. STUDY 2
  7. STUDY 3
  8. CONCLUSIONS AND IMPLICATIONS
  9. Acknowledgements
  10. LITERATURE CITED

Participants

Participants of the three studies described below were students matriculated for the first time in the subject of human anatomy taught by the Department of Human Anatomy and Embryology II of the Faculty of Medicine of the Universidad Complutense, Madrid.

Procedure

All the students attended compulsory practical classes on the dissection of human cadavers in their first year of the anatomy course. DR has 18 dissection tables and the students carried out the practical work in groups, with a maximum of 36 students per group and 6 students per cadaver. Each practical class was supervised by two teachers.

Instruments

In the three studies, the anxiety status of the student was assessed at different times, i.e., their anxiety at the exact moment they were being assessed. The instrument used was the State Anxiety Scale of State-Trait Anxiety Inventory (STAI) (Spielberger et al., 1982).

In study 2, the student's anxiety trait was also assessed, i.e., individual's propensity to present an anxiety response in different situations. The instrument used for this was the Situations and Responses Anxiety Inventory (ISRA) (Miguel-Tobal and Cano-Vindel, 1994). With this instrument, scores were obtained for eight scales. The first three assess the triple response system: Cognitive Anxiety, Physiological Anxiety, and Motor Anxiety. A fourth assesses the general average: Anxiety Trait. Finally, four more measurements relate to specific characteristics or situational areas: Test Evaluation Anxiety, Interpersonal Anxiety, Phobic Anxiety, and Anxiety of Daily Life. Data were analyzed using the SPSS version 11.5 statistical package.

STUDY 1

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. ANALYSIS OF ANXIETY RESPONSE
  5. STUDY 1
  6. STUDY 2
  7. STUDY 3
  8. CONCLUSIONS AND IMPLICATIONS
  9. Acknowledgements
  10. LITERATURE CITED

The aim of this first study was to assess the intensity of the anxiety response to the dissection of human cadavers and changes in this response produced in subsequent exposure experienced by the student during the course. The participants in this study were 92 students in the academic year 2000–2001, matriculated for the first time in human anatomy. Of these, 81 (88%) were women and 11 (12%) were men. Participants had a mean age of 19 years with a standard deviation of 2.21 (Table 1).

Table 1. Sample description and features assessment in the three studies
 StudentAgeEvaluation
Total% female% maleRangeMeanSD
Study 192881217–2919.112.2State anxiety
Study 27188.711.317–5019.945.06State anxiety; Trait anxiety
Study 323691.98.117–4419.553.09State anxiety in control group (no video) and experimental group (video)

The STAI scale was applied immediately before and after four sessions of the practical program. These corresponded to session 1, dissection of the upper limb (first practical class attended by students in DR); session 2, dissection of the lower limb (2 months after the beginning of the practical program); session 3, examination of human brain serial sections (4 months after the beginning of the practical program); session 4, dissection of cardiopulmonary blockages (final practical class attended by students in DR).

Results

After the data matrix has been treated, one-way ANOVA with repeated measures was carried out to calculate the differences between pre- and postmeasurements of each of the four sessions assessed and to study intersession differences (Table 2).

Table 2. Means, standard deviations, and one-way ANOVA (Study 1 and Study 2)
   MeanSDt-test (n = 92), tt-test, P
  • a

    P < 0.001.

  • b

    P < 0.01.

Study 1Session 1Pre126.6212.949.49<0.001a
  Post114.2810.79  
 Session 2Pre218.2111.384.51<0.001a
  Post213.5810.20  
 Session 3Pre314.469.451.580.1165
  Post313.619.74  
 Session 4Pre414.349.362.700.0082b
  Post413.119.60  
     (n = 71) 
Study 2Session 1Pre124.439.825.439<0.001a
  Post117.9711.37  
 Session 4Pre416.2510.511.5110.135
  Post414.9910.60  

There were significant differences between pre- and postsession anxiety state measurements. These differences were recorded in the first (t = 9.49; P < 0.001), in the second (t = 4.51; P < 0.001), and in the fourth session (t = 2.70; P = 0.0082), i.e., in sessions in which the student carried out procedures in the presence of a human cadaver. However, no statistically significant differences were observed between pre- and postmeasurements in the third session (t = 1.58; P = 0.116), the only session in which brain serial sections were studied without the presence of a cadaver (Table 2). The students' presession anxiety levels (Figure 1) decreased steadily over the four sessions.

thumbnail image

Figure 1. Anxiety profile in the face of dissection.

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On the other hand, the comparison of predissection anxiety levels revealed statistically significant differences between the first and second sessions (t = 5.89; P < 0.0001) and between the second and third sessions (t = 3.72; P = 0.003). However, the difference between the third and fourth sessions was not significant (t = 0.18; P = 0.8604).

Finally, when anxiety levels shown by subjects when the dissection was over were compared with levels just before the following dissection, we found statistically significant differences between the first and the second dissection session (t = −3.29; P = 0.0014). However, from the second session onward, no significant differences were observed between the postdissection anxiety levels of each session and the predissection levels for the following session, either between the second and third session (t = 0.29; P = 0.29) or between the third and fourth session (t = 1.82; P = 0.07).

Discussion

The dissection was a new situation for the students and produced a greater or lesser degree of anxiety. Nonetheless, the anxiety levels dropped significantly at the end of the first exposure session immediately after the session had finished. The students' anxiety levels, therefore, declined significantly as they tackled new exposures and new experiences. We saw how from the third dissection session onward, there were no significant differences between the anxiety levels shown by students before and after the dissection.

From the second exposure session onward, there was no significant difference between the consecutive pre- and postsession anxiety levels. Therefore, as the newness or uncertainty variable decreased, pre-/postsession anxiety levels tended to equalize.

To sum up, the anxiety response of students to the human cadaver was very intense at the start of the first session and then fell sharply when the first session finished, continuing to fall steadily until no pre-/postsession differences in anxiety states were recorded. It therefore seems that novelty or uncertainty could cause the high levels of anxiety prior to exposure.

STUDY 2

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. ANALYSIS OF ANXIETY RESPONSE
  5. STUDY 1
  6. STUDY 2
  7. STUDY 3
  8. CONCLUSIONS AND IMPLICATIONS
  9. Acknowledgements
  10. LITERATURE CITED

In the second study, we aimed to determine the relationship between the specific anxiety reaction of a first-year student over his/her dissection practices and his/her anxiety traits as a personality variable. That is, we attempted to determine to what extent the reaction was due to the situation or to the students' personality traits. For this purpose, a week before the first session, the students filled out the ISRA. They also completed the STAI state scale in the first and final practical session (session 1, dissection of the upper limb; session 4, dissection of cardiopulmonary blockages).

The participants in the second study were 71 students from the academic year 2001–2002, matriculated for the first time in human anatomy. Of these, 63 were women (88.7%) and 8 were men (11.3%). The mean age was 19 years, with a standard deviation of 5.06 (Table 1).

One-way ANOVA with repeated measures was applied to data to determine whether or not there were any differences between the anxiety response immediately before and after the first and last dissection session. Pearson's correlation matrix was used to analyze the relationship between anxiety state measurements at the different assessment times and the participants' anxiety traits.

Results and Discussion

We found (Table 2) statistically significant differences between the anxiety state before and after the first dissection session (t = 5.439; P < 0.001), although these differences were not significant in the final session (t = 1.511; P = 0135). On the other hand, the data reflected statistically significant differences between the times before the first and last exposure session (pre1 and pre4; t = 6.467; P < 0.001).

The correlations between the anxiety state and anxiety trait measurements help us to establish whether a student's anxiety reaction during dissection is determined to some extent not by the situation alone, but also by his/her personal characteristics as far as a propensity to anxiety is concerned (Table 3). The data clearly showed how the anxiety reactions shown by subjects just before the first time they were exposed to a cadaver in the DR were not significantly correlated with any of the scales evaluated by the ISRA. Therefore, the anxiety state shown by students at that moment seems to be independent of any individual traits related with their propensity to suffer anxiety reactions. Nonetheless, the correlation between state and trait of anxiety was clearly significant and positive in the fourth dissection session (Table 3). Therefore, once the students had become familiar with the situation of the dissection of a human cadaver, the anxiety reaction in this situation was more conditioned by personal characteristics. Therefore, in this fourth session, the most anxious individuals or those who showed the highest levels for the anxiety trait were those who would regard the situation as most threatening and thus showed more intense reactions than their colleagues. Indeed, the anxiety reaction of the students was initially determined by the situation itself, although later it was the individual differences that enabled a student's reaction to be predicted.

Table 3. Pearson correlations between state anxiety (state STAI) and trait anxiety (ISRA)
Student (n = 71)Pre1Post1Pre4Post4
  • a

    P < 0.01 (two-tailed).

  • b

    P < 0.05.

Cognitive0.1950.313a0.419a0.360a
Physiological0.1710.2050.451a0.337a
Motor0.1790.1950.476a0.357a
Trait0.1990.259b0.492a0.385a
Test evaluation0.1600.256b0.469a0.329a
Interpersonal0.0830.1430.313a0.179
Phobic0.2090.1520.405a0.322a
Dayly life0.1600.284b0.469a0.409a

The above data indicate that successive approaches or gradual exposure (detailed verbal information about the situation, visits to DR without the presence of the cadaver, videos, etc.) before the real dissection of a cadaver would reduce students' anxiety reaction in their first practical session. In the light of these findings, we decided to design a third study to carry out in the following academic year.

STUDY 3

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. ANALYSIS OF ANXIETY RESPONSE
  5. STUDY 1
  6. STUDY 2
  7. STUDY 3
  8. CONCLUSIONS AND IMPLICATIONS
  9. Acknowledgements
  10. LITERATURE CITED

The aim of the third study was to assess whether the students' anxiety state in their first dissection was reduced by previous viewing of a video with real pictures of dissections of a human cadaver. The participants in the third study were 236 students from the academic year 2002–2003, matriculated for the first time in human anatomy. Of these, 217 (91.9%) were women and 19 (8.1%) were men. The mean age was 19 years and the standard deviation was 3.09 (Table 1).

The participants were randomly subdivided into two groups: experimental group (EG) and control group (CG). The EG (video) comprised 109 pupils (98 women and 11 men) who attended the showing of a video in a room different from the one normally used for the practical classes.

The total duration of the video was 23 min and comprised three main sections: “The Importance of Anatomy” (as a basis for practical medicine and medical communication); “The Problem of Dissection,” and “The Dissection.” The video includes recordings made in the dissection room of our department during the human anatomy practical classes. The student's anxiety state was assessed after viewing the film and before entering the dissection room for the first time.

The CG (no video) consisted of 127 pupils (119 women and 8 men) who individually filled out the STAI scale before entering the DR without having seen the video or any previous information. One-way ANOVA was applied to data to discover whether differences existed in the anxiety response among the EG (video) and CG (no video) before the first dissection session. One-way ANOVA with repeated measures was also used to determine the response profile of each group separately.

Results

The first important result (Table 4) is that the EG showed less anxiety than the CG before entering the dissection room for the first time. Therefore, the group that had seen the video showing images of the dissection of human cadavers similar to what they expected to experience in their first visit to the dissection room experienced less anxiety than the group that had not had any previous visual experience before their first real experience of dissection. This measurement (pre1) was significantly different in the two groups (t = −2.133; f.g. = 234; P = 0.034).

Table 4. Means, standard deviations, and one-way ANOVA (study 3)
  VideoNo videot-test
nMeanSDnMeanSDtd.f.P
  • a

    P < 0.05.

All participants          
 Session 1Pre10923.8211.0812726.8310.57−2.1332340.034a
 Post110915.2610.2012713.558.601.374212.3800.142
 Session 4Pre10916.209.9112717.139.62−0.5832340.581
 Post10916.299.4212716.2310.030.442340.965
Participants without fainting group          
 Session 1Pre8023.5410.9112726.8310.57−2.1532050.032a
 Post18012.778.0712713.558.60−0.6492050.517
 Session 4Pre8014.719.3012717.139.62−1.34482.2240.182
 Post8017.889.7212716.2310.031.1642050.246

After finishing the first dissection session, there were statistically significant reductions in the students' anxiety states in both groups. The results for the EG were meanpre1 = 23.82; meanpost1 = 15.26; t = 8.37; f.g. = 108; P < 0.001. For the CG, they were meanpre1 = 26.83; meanpost1 = 13.55; t = 13.65; f.g. = 126; P < 0.001. A comparison of the anxiety levels of the two groups at this time (post1) revealed that there were no statistically significant differences between these results (t = 1.391; f.g. = 212,380; P = 0.17). However, we found it interesting that the CG showed a greater anxiety reduction than the EG, who had seen the video before entering the dissection room. The CG, which had higher initial anxiety levels (pre1), presented lower anxiety levels after the first dissection session (post1) than the EG.

We therefore decided to study the possible influence on the data of one student fainting during the dissection session. This was witnessed by the other students who were in the dissection room at the time (n = 29). This group had already been subjected to the first measurement of anxiety level (pre1), but their anxiety had not yet been assessed after the dissection (post1). These students belonged to the EG (video). Therefore, another uncontrolled variable comes into play that did not affect the other groups and that could influence anxiety levels. To establish the possible influence of this occurrence, we decided to analyze the data corresponding to the group of students that had witnessed the event and compare them with those obtained for the remaining students. For the group witnessing the fainting, the scores decreased after the first exposure (meanpre1 = 24.59; meanpost1 = 22.10), but this was not statistically significant (t = 2.15; f.g. = 28; P = 0.054). On the other hand, a comparison of the anxiety level after dissection (post1) of the group that witnessed this event (n = 29) and the other students of the same condition, EG (n = 80), revealed significant differences between the two groups (t = −3.80; f.g. = 37,109; P = 0.001). In the remaining measurements, no statistically significant differences were found between the CG and the group under experimental conditions (EG; Table 4).

In the light of these results, we decided to exclude the group that had witnessed the fainting from the analysis of anxiety states presented by the students in relation to their experimental condition, EG and CG. Therefore, in the final sample for this third study, the CG consisted of 127 participants (119 women and 8 men) and the EG of 80 participants (74 women and 6 men). The results indicate statistically significant differences between the anxiety levels of EG and CG before the first dissection. In the remaining measurements, no statistically significant differences were found between the CG and the group under experimental conditions (EG; Table 4).

Regarding the intragroup measurements for the CG (Table 5), statistically significant differences were found among all possible combinations of the four evaluated measurements of anxiety state. On the other hand, for the EG (Table 6), no statistically significant differences were found between measurements of anxiety state after the first session (post1) and the measurements prior to the fourth session (pre4; t = −1.448; f.g. = 79; P = 0.155) or between the measurements before and after holding the fourth session (pre4 and post4; t = 1.446; f.g. = 79; P = 0.156).

Table 5. Control group (no video) intragroup differences
Compared pairt-test
td.f.P
  • a

    P < 0.001.

  • b

    P < 0.05.

Pre1 and Post113.650126<0.001a
Pre1 and Pre48.373126<0.001a
Pre1 and Post410.628126<0.001a
Post1 and Pre4−3.675126<0.001a
Post1 and Post4−3.2481260.001a
Pre4 and Post413.6501260.017b
Table 6. Experimental group (video) intragroup differences
Compared pairt-test
td.f.P
  • a

    P < 0.001.

Pre1 and Post110.44879<0.001a
Pre1 and Pre45.86079<0.001a
Pre1 and Post44.14679<0.001a
Post1 and Pre4−1.448790.155
Post1 and Post4−4.82679<0.001a
Pre4 and Post41.446790.156

Discussion

It is necessary to point out that the only statistically significant difference in the anxiety level corresponded to the first time a student faced the situation of dissecting a cadaver (Table 4). In other words, the experimental group experienced clearly less anxiety before their initial exposure to real dissection than the controls. We can therefore draw the clear conclusion that exposure to video pictures showing the situation that students are subsequently to encounter in the DR reduces their anxiety reaction when facing their first dissection practice on human cadavers.

As for the differentiated profiles of each of the two groups analyzed (see Figure 2), we found that whereas for the CG there are differences among all the combinations of averages assessed, for the EG these disappear in the anxiety state measurements made after the initial session (post1), the measurement made prior to the fourth session (pre4), and among the measurements made before and after the fourth session.

thumbnail image

Figure 2. Differential profiles between control (no video) and experimental group (video).

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Comparing these results with those obtained in the initial study, we can deduce that the experimental group behaves as if their first dissection were their second exposure. The anxiety levels before the first exposure were lower than those of the control group and the reduction in this anxiety after the first real exposure was smaller than in the control group. These findings are similar to those obtained from the first study.

CONCLUSIONS AND IMPLICATIONS

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. ANALYSIS OF ANXIETY RESPONSE
  5. STUDY 1
  6. STUDY 2
  7. STUDY 3
  8. CONCLUSIONS AND IMPLICATIONS
  9. Acknowledgements
  10. LITERATURE CITED

Historically, dissection of the human cadaver has always been one of the main steps in a medical student's training, offering a unique opportunity to learn about the organization of the human body and to help develop and practice technical skills (Coulehan et al., 1995). Nonetheless, the student's confrontation with the cadaver in dissection triggers different emotional reactions, which over the last few decades have attracted the interest of several authors (Penney, 1985; Finkelstein and Mathers, 1990; Druce and Johnson, 1994), and which have been found to give rise to certain attitudes in relation to the death of future patients (Shalev and Natham, 1985) or even to affect the future doctor-patient relationship (Bastos and Proença, 2000).

Of all the emotional reactions that a student can experience when dissecting a human cadaver, anxiety is the most important and has been tackled from many different perspectives (control strategies, situational aspects, physical reactions, etc.). Anxiety is also one of the reasons given for eliminating or reducing cadaver dissection from medical education (Aziz et al., 2002). However, it is worth noting that, to date, this has only been assessed by highly generalized questions and not using standardized scientifically approved instruments, making it difficult to generalize the results and to draw comparisons between the different studies.

The general aim of our research was to study the characteristics of this anxiety reaction of anatomy students by using specific, reliable, valid, and standardized tests such as the State-Trait Anxiety Inventory Scale (Spielberger et al., 1982) and the Situations and Responses Anxiety Inventory (Miguel-Tobal and Cano-Vindel, 1994). Also, this study provides evidence about the variables involved in this reaction, focusing on the weight that the situation itself (anxiety state) can have on the anxiety reaction and/or the individual's internal characteristics (anxiety trait). Clarification of these objectives could help us formulate possible strategies to control the students' anxiety reaction when faced with a dissection, to modify the causal situation of the anxiety, or to help students to develop strategies to deal with the situation.

In summary, the consecutive nature of the three studies presented in this article permits us to draw the following conclusions. The student's anxiety response to the dissection is determined first by the characteristics of the situation. Only later, after the student has been exposed to the situation, does this begin to lose its threatening character, which is when the anxiety response begins to decrease. This is when the student's anxiety state presents positive and significant correlations with their personal characteristics related with anxiety trait. Hence, the most anxious individuals will tend to present higher anxiety levels than the less anxious individuals after several dissection sessions. Therefore, evaluation of the anxiety trait could be useful to detect students who experience anxiety reactions that remain at high levels in spite of repeated exposure to the situation that causes their anxiety. We are currently carrying out new studies to help clarify this point, selecting students for their extreme levels of anxiety trait (high or low) and assessing their punctual anxiety responses in the different practical dissection sessions of the academic year.

Owing to the importance of the characteristics of the dissection situation on the student's response the first time they are exposed to the cadaver, it is only logical to consider strategies to reduce the stressful nature of the situation. Our study confirms that showing students videos containing information about the situation that they are going to experience for the first time reduces their level of uncertainty and therefore their anxiety response to their first experiment. These data are in the same line as experiments by other authors that indicate the need for students to experience gradual exposure before they are faced with a cadaver for the first time (Marks et al., 1997; Tschernig et al., 2000).

It is useful to know the exact nature of this anxiety reaction because this helps us to control it.

It is useful to know the exact nature of the anxiety reaction because this helps us to control it.

This control can and should be carried out directly by the Anatomy teacher and can be done using simple, easy, and cheap method such as showing a video of the dissection that the student is going to perform in a similar environment. The anatomist should complement this by teaching students to have an ethical and humanistic approach to the cadaver. We consider this to be a more suitable and effective strategy than eliminating or reducing cadaver dissection in medical education. Over the last few years, there have been numerous seminars and courses in which the authors try to integrate humanistic values into an anatomy curriculum (Coulehan et al, 1995; Rizzolo, 2002; Stewart and Charon, 2002). Nevertheless, in spite of this future outlook, we must not forget that “the anatomist is interested in anatomy” as well as “nulla medicina sine anatomia” (Di Dio, 1999), and it may be as difficult to convince anatomy teachers as it is students (Marks et al., 1997) that dissection is also necessary to develop a communicative, ethical, and humanistic approach to patient care (Aziz et al. 2002). It would be interesting in future studies to assess the anatomists' attitude in the dissection room.

Acknowledgements

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. ANALYSIS OF ANXIETY RESPONSE
  5. STUDY 1
  6. STUDY 2
  7. STUDY 3
  8. CONCLUSIONS AND IMPLICATIONS
  9. Acknowledgements
  10. LITERATURE CITED

The authors thank all the students who gave up their time to participate in the study.

LITERATURE CITED

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. ANALYSIS OF ANXIETY RESPONSE
  5. STUDY 1
  6. STUDY 2
  7. STUDY 3
  8. CONCLUSIONS AND IMPLICATIONS
  9. Acknowledgements
  10. LITERATURE CITED
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