Appendix 11a - Gross Anatomy

by Michael Greger, MD and United Progressive Alumni

[ Medical School Resources | Appendices | Discussion ]


A sense of being special has been described as one coping device to deal with the stress of medical education. One student's comment: "How many people can say, 'I got up to go to work today to pull apart a dead man's genitals.'"[148] A student describes the feeling in Doctor-to-be:

There before you is a naked human, motionless, reeking of phenol and formalin, skin wrinkled and discolored, stiff and glazed. You make the mental mistake that this should not bother you, for you are to be a doctor; and so to distract yourself, you remember that so many people can only halfheartedly dream of being in medical school, but you are here, and in that you find solace. You lose such a tiny fragment of yourself in that moment, it is wholly imperceivable, like a silent genetic mutation that causes a single cancerous cell to grow years later uncontrolled, slowly and painfully gnawing the life out of that individual.[149]

In exploring medical student attitudes, sociologists hit upon a particularly telling question. The question, "Would you yourself consider donating your body to a medical school to be used as a cadaver?" was asked of 99 medical students during their gross anatomy course. Only 11 said yes. In another study only 3% of medical students were willing to give up their bodies for dissection.[150] "Even more striking than the numbers were the tone and phrasing of the answers," the researchers report. "In response to this question, students abandoned their customary calm. Their answers became abrupt, tension-laden, and filled with emotion."[151]

"Depersonalizing our cadaver was good practice for depersonalizing our patients later."[152]

The dissection of a human cadaver is the first rite of initiation into the medical profession for virtually every medical student.

An article entitled "First Cut" in the New England Journal of Medicine sets the scene:

A sign above the doors said: 'Medical Students Only.' To pass through the doors was a small rite of passage, a grisly privilege; rows of cadavers lay bathed in cold bleaching light, a submissive, as yet unflayed, welcome to the new initiates. Whatever its obvious practical educational value, human anatomy lab carries enormous symbolic value as a sort of hazing ritual.[153]

From an article in Academic Medicine:

The first day in the dissecting room is an occasion for which few medical schools prepare students adequately, but one which may produce trauma that is seldom recognized by medical educators.

Although anxiety may be present in students during the experience, 'suppression and repression' are used to cope with these feelings; the anatomy laboratory aids the process of detachment.... The laboratory is the place where students 'prove' themselves by controlling their feelings.[154]

From When a Doctor Hates a Patient: Chapters from a Young Physician's Life:

To this grim situation from which they cannot escape, soldiers and doctors sometimes respond with a grim humor that is at once offensive and defensive. Why do they do it? A number of answers are possible.... This humor makes the joke teller appear strong, insensitive, or cruel instead of weak and vulnerable.... This humor has an anesthetic effect. It helps to mask pain, feelings, and fears with apparent numbness and insensitivity.[155]

Conclusions from a study of gross anatomy folklore passed down to each new generation of students in the book Into the Valley: Death and the Socialization of Medical Students:

The stories are often sexist; victims (usually women) are presented as objects deserving of derision and abuse.... [The author is] concerned that in the long run, the feelings of superiority and detachment such stories prompt not only may distance practitioners from their patients, but also from families and friends.[156]

Remains to be Seen

"As I know them," Henry Spiro writes, "college students start out with much empathy and genuine love - a real desire to help other people. In medical school, however, they learn to mask their feelings, or even worse, to deny them.... Dissection of a cadaver in medical school teaches primacy of the eye over the ear, for cadavers don't complain, and no one has to listen...."[157] Quoting from an article called "The Inhumanity of Medicine," "Few people would disagree that two years spent in the company of a corpse is not the most imaginative introduction to a profession that, more than any other, needs to develop the skills of talking to distressed people."[158]

Becoming Doctors, a book on the professionalization of medical students, describes a typical student comment: "We start by dissecting a dead person, then spend long months in cold medical sciences.... When you don't work with patients until the third year in medical school, it's too late - something has already died within you."[159]

From a chapter entitled "The Cadaver: Cold Companion, but Ideal Patient": "The anatomy laboratory provides for most students a profound emotional shock." Alan Gregg, the late medical educator and philosopher writes: "The result is a curious kind of callousness that need not be taken for maturity....'"

"Will the students also insulate themselves from the pain of patients, and come to see them as plumbing and chemistry...?" the authors of a Medical Education article ask.[160] "Do we really imagine that the doctor will be interested in us as people?" An article in the New Statesman offers one answer: "The surgeon who apparently permits your child or lover to die on the operating table is not seeing your child or lover, but thinking of valves and plumbing and professional advancement and lunch. And it cannot be otherwise."[161]

As a historical aside, not all bodies used to be donated. See Appendix 11b.

 
 

[148] Blackwell, B, et al. "Humanizing the Student-Cadaver Encounter." General Hospital Psychiatry (1979):315-321.

[149] Knight, JA. Doctor-to-be New York: Appleton-Century-Crofts, 1981:7.

[150] Blackwell, B, et al. "Humanizing..." General Hospital Psychiatry (1979):315-321.

[151] Hafferty, FW. Into the Valley: Death & the Socialization of Medical Students Yale University Press, 1991:122.

[152] Nation 20 January 1992:1.

[153] Gropper, C. "First Cut." New England Journal Of Medicine 338(1998):845-846.

[154] Hundert, EM. "Characteristics of the Informal Curriculum and Trainees' Ethical Choices." Academic Medicine 71(1996):624-640.

[155] Peschel, RE. When a Doctor Hates a Patient: Chapters from a Young Physician's Life Berkeley: University of California Press, 1986:115.

[156] McCarthy, P. "April Fools' in the Anatomy Lab." American Health 9(1990):16.

[157] Spiro, "What is Empathy..." Annals of Internal Medicine 116(1992):843-846.

[158] Weatherall, DJ. "The Inhumanity of Medicine." British Medical Journal 309(1994):1671-1672.

[159] Haas, Jack Becoming Doctors Greenwich Jai Press, Incorporated, 1987:17.

[160] Charlton, R, et al. "Effects of Cadaver Dissection on the Attitudes of Medical Students." Medical Education 28(1994):290-195.

[161] Bywater, M. "The Doctors We Deserve?" New Statesman 127(1998):15.

 
 
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