Attitudes of medical students to necropsy.

Abstract

Aim-To compare the attitudes of students towards the necropsy at different stages of their undergraduate career. Method-Students in the first, fourth and sixth academic years (n = 283) were asked to respond anonymously to a questionnaire comprised of 26 attitude statements. These statements dealt with the importance of the necropsy in medicine, rapport with the bereaved family and emotional reactions to the necropsy. Results-Of the students, 226 (80%) completed the questionnaire. Overall, the students agreed on the importance of the necropsy. The three groups differed in 10 statements on the approach to the bereaved family and emotional reactions to the necropsy. First year students showed more personal involvement and would have more difficulties in approaching the family ofthe deceased as well as in attending a necropsy. These reactions were increasingly less noticeable with fourth and sixth year students. The latter group was also more inclined to accept cremation, organ donation and necropsy of their own corpses. Conclusion-The changes in attitudes towards the necropsy throughout undergraduate study may reflect both the influence of psychological defense mechanisms and the viewing of necropsy as a relevant tool in medical practice. Necropsy should be carefully and sensitively incorporated into programmes designed to teach students about death and dying. This might reduce both their reluctance to seek permission for necropsy and their difficulty in looking after the dying patient. (7 Clin Pathol 1997;50:64-66 MethodsAll first, fourth and sixth year medical students (n = 99, 99 and 85, respectively) at the State University of Campinas, Campinas, Brazil, were asked to respond anonymously to a questionnaire comprised of 26 attitude statements on necropsy. The questions dealt with three main topics: (1) the importance ofthe necropsy in medicine; (2) rapport with the bereaved family; and (3) emotional reactions to the necropsy. The questionnaire was compiled from statements from previously published papers,' 8 as well as comments from a panel of medical students, clinicians and pathologists. Pilot versions of the questionnaire were tested twice with a group of medical students not participating in the main study.The attitudes were measured using visual analogue scales (VAS)-that is, a 100 mm line representing a continuum of attitudes ranging from "strongly disagree" at one end to "strongly agree" at the other. The VAS were measured in millimetres. Non-parametric statistics (the Kruskal-Wallis and Mann-Whitney tests) were used to evaluate differences among the groups. In order to minimise the occurrence of type II errors resulting from many tests being done smultaneously, we adopted the procedure suggested by Schweder and Spjotvoll.9 The students' age, sex, religious background, and attendance at necropsies were also recorded. ResultsTwo hundred and twenty eight students, corresponding to 75%, 91% and 75% of the first, fourth and sixth year students, respectively, completed the questionnaire (table 1). Mos...

Teaching the Anatomy of Death: A Dying Art?

“…For instance, in 2006, the front page story in Australia's national newspaper began with the following sentence: 'Teaching of basic anatomy in Australian medical schools is so inadequate that students are increasingly unable to locate important body parts…'. It went onto quote senior consultants who were 'horrified' to encounter senior year medical students 'who do not know where 8 The findings confirm the potential for emotional and psychological upset: headaches, nausea, dizziness, fear, fainting and disturbed dreams were commonly found in student groups across the globe (Houwink et al 2004;Abu-Hijelh et al 1997;Penney 1985;Botega et al 1997;Nnodim 1996;McLachlan et al 2004;Sinclair 1997). Some national groups, such as Americans and Canadians, fared worse than others, (McGarvey et al 2001), and to the point where some researchers outlined symptoms attributable to mental trauma and post-traumatic stress disorder (Finkelstein and Mathers 1990;Hafferty 1991;Nuland 1993).…”

Student responses to the gross anatomy laboratory in a medical curriculum

“…Studies of medical students at several different colleges of medicine, from Australia (Davies et al, 1968;Horne et al, 1990) to the United Kingdom (Field, 1984;Evans and Fitzgibbon, 1992), Brazil (Botega et al, 1996) to Canada (Marks et al, 1997), indicate that some novices suffer strong negative reactions to the dissection or necropsy experience, or perhaps even to the idea of human dissection. One recent article (Dickinson et al, 1997) states explicitly that "gross anatomy is an extremely stressful experience for the 1st year medical student."…”

Medical student attitudes to the autopsy and its utility in medical education: A brief qualitative study at one UK medical school

“…There is limited and conflicting evidence concerning medical student attitudes towards autopsy (Benbow, 1990b(Benbow, , 1991Conran et al, 1996;Botega et al, 1997;Ruhaya and de Villiers, 2003;Kucuker et al, 2008;Papadodima et al, 2008a, b;McNamee et al, 2009;Sergentanis et al, 2010;Anders et al, 2011). Quantitative questionnaire studies have investigated medical student views about the emotional impact of the autopsy, its use in medical education, and knowledge gained from attendance (Benbow, 1990b(Benbow, , 1991Botega et al, 1997;Ruhaya and de Villiers, 2003;Kucuker et al, 2008;McNamee et al, 2009;Sergentanis et al, 2010;Anders et al, 2011).…”

“…Quantitative questionnaire studies have investigated medical student views about the emotional impact of the autopsy, its use in medical education, and knowledge gained from attendance (Benbow, 1990b(Benbow, , 1991Botega et al, 1997;Ruhaya and de Villiers, 2003;Kucuker et al, 2008;McNamee et al, 2009;Sergentanis et al, 2010;Anders et al, 2011). Most suggest that while students generally endorse the educational value of attending autopsies, the value perceived is often narrow and conditional upon the format and circumstances of the teaching, and the attitude of the teacher (Benbow, 1990b(Benbow, , 1991Botega et al, 1997;Ruhaya and de Villiers 2003;Kucuker et al, 2008;McNamee et al, 2009;Sergentanis et al, 2010;Anders et al, 2011). Obtaining data from large numbers of students permits statistical analysis of results; however, few studies employing questionnaires provide opportunity for free comment.…”