Medical School Culture Influences How Students Think About Gross Anatomy Lab.

INTRODUCTION: Medical school culture can often guide students' emotional development during their education. At Boston University School of Medicine, there is an explicit culture to refer to the human bodies used in anatomy education as "donors," rather than "cadavers." The main reason that we use the word "donor" is to show respect to the individuals who chose to generously donate their body to science, to help future physicians learn. Inherently, the word "donor" describes someone who is capable of making a decision to give a donation, and implies this person is, or was, alive. The word "cadaver," by definition, is a human body used by medical students and scientists to study anatomy. Our objective was to investigate whether students will use the word "donor" even when by definition, they mean "cadaver," due to the culture of medical school and the desire to adhere to social norms.

METHODS: We used a validated survey instrument to compare the emotional experiences of students in a traditional dissection-based course in 2019, to those in a prosection-based course in 2020, necessitated by spatial distancing requirements during the COVID-19 pandemic. Free-text responses were collected and organized into data sets, which were analyzed by evaluators blinded to the year of study. We used a grounded theory thematic analysis, beginning with a word frequency method to generate primary codes. Subsequent codes were generated by individual raters, then in group discussion, until reaching thematic saturation.

RESULTS: Among all data sets, and between years of study, Donor was a common primary code that was subsequently analyzed. This code was used in several connotations, or subcodes. Donor1 was used when referring to a previously living person. For example, "I appreciate that the donors gave their bodies to science to help us learn." (Prosection group: 37%. Dissection group: 48%). Donor2 was used as a synonym for cadaver. For example, "spending time w/ donors was absolutely necessary in consolidating anatomy knowledge." (Prosection group: 48%. Dissection group: 39%). "Cadaver" was not a high frequency word in any data set.

DISCUSSION: The high frequency of the subcode Donor2 illustrates that when students are describing a body in the lab from which they are dissecting/learning (by definition, a cadaver), they are replacing the term "cadaver" with donor, whether actively or subconsciously. This subcode is an example of how medical school culture and social norms can shape the way that students think and/or talk about the anatomy lab. The use of the word donor, which characteristically is defined as "a person who chooses to make a donation," inherently reminds students that this body was a previously living person; when performing dissections, this reminder could prompt complex emotional responses that may require time and facilitation to process. While the primary function of using the word donor is to show respect, perhaps the secondary function is to enable students to compartmentalize conflicting thoughts and feelings about a single topic, which is a skill that will help them grow and develop as medical students.