31 Aug Exploring the Impact of Cadaver Courses on Medical Education in Turkey: A Study Organized by ComedTurkey
Exploring the Impact of Cadaver Courses on Medical Education in Turkey: A Study Organized by ComedTurkey
1. Introduction
Cadaver courses for undergraduate students, both inside and outside the medical faculty, attract a lot of attention. These courses can help students understand anatomy better and be prepared for clinical applications by gaining dissection experience. In this study, the aim was to evaluate the preferences of undergraduate students and their views towards future professions. During this period, students’ observations and the problems they faced were recorded.
Computer-based medical education is increasingly common. The appearance and characteristics of a system are as important as the content. However, in the first stage, we observed that these subjects aimed at directly assisting the students were not enough to respond to their needs. The establishment process of a cadaver laboratory is long and extremely laborious, requiring high-level technical and administrative infrastructure, resources, and responsibility. However, different facilities worldwide have these features, and millions of students continue their medical education freely or by paying a significant amount to the medico-military professionals. Consequently, not all students have the opportunity to work with cadavers to acquire the skills and practices needed before their clinical applications.
1.1. Background and Rationale
Introduction: The study aimed to determine the effect of cadaver courses on medical education and the subsequent professional careers of medical students, to understand the students’ opinions on the guidance and advice from the academicians and sector representatives, and to provide insight into the goals and expectations of the students that benefit from the courses. The main social goal of the study was to guide students to fulfill their ambitions, support their professional development, and help them to adopt a benevolent approach that respects both the patients’ problems and their own careers. These cadaver courses were carried out on a voluntary basis. The research questions were: “As a result of the cadaver course, did the career goals and expectations of the student change?”, “What are the priorities of the student?”, “What are the challenges of the student?”, and “What does the student expect from the country and academicians in the future?”.
Objective: The study aimed to determine the relationship between theoretical and practical medical education between the second and subsequent years, as well as the understanding of the requirements of the profession, specialization suggestions, socio-economic expectations, research interests and ethical issues of the students, the way medicine is practiced, and the solution methods, mainly by applying the theme of the study, the desire to be a clinician with the effect of the cadaver courses on the determination of professional identity. The results of the study showed that the training of a good clinician began in the first years of lesson, with an empathetic approach and practical observations strengthened by the course providing unique opportunities. Using the results of the study, many changes can be made from the faculty to the reforms in the medical faculty training, and the perceptions of the students considering their careers, private lives, and academic developments can be affected, together with facilitating their productions and providing help.
1.2. Research Aim and Objectives
Progress in medical training, more advanced medical technology, and changes in ethnic factors necessitating global medical training, as well as reaching physicians in line with the Hippocratic Oath, require a consensus concerning the effectiveness of cadaver courses in medical training. In fact, the country accepts that the core methodology to learn the structure and function of the human body is dissection during medical training years, from Anatolia to contemporary education, worldwide. However, in the course of time, new techniques and methods have progressively been added to medical education, gradually reducing the time spent in the anatomy laboratory environment. Furthermore, attributing this reduction to a disinclination to work with cadavers and necessity, the collection of data, which are proving the benefits of cadaver laboratory training in medical training, has increased over the last ten years. This study is one of these efforts. As COMED, this study is aimed at evaluating the objectives, content, and effectiveness of cadaver courses being held in university medical education within the borders of the Republic of Turkey, reaching suggestions and information to ensure effectiveness, and documenting the benefits of these suggestions or recommendations with scientific data.
As duration increases, changes in curricular proportion and the use of technological approaches in medical education make dissection education appear insufficient. Opinions and demands come to the fore. In order that newly added or established expectations are not thought as the demands of current medical training and negative impacts are not caused, the aim is discussions or suggestions that will be created concerning the mentioned suggestions to conform to the curriculum without replacing dissection with technological studies. Of these suggestions, the most effective, most frequently requested, and planned by an institution/comprehensive university that are put into practice successfully will be suggested within this report. The results of the study may provide an important opportunity for other institutions to make assessments of the facilities and technologies they have established or to establish the facilities and technologies they have planned by reassessing. Conversely, these suggestions will also reveal to the minimum level in general what the current situation will reveal to universities. Furthermore, whether the facilities and technologies established at the universities use the field they have established, as they mentioned/suggested and as had been planned to be used, will also be on the table in the report. In this article, it is aimed to introduce the infrastructure of the study.
2. Literature Review
2.1. Historical Development of Cadaver Courses in Medical Education
The basic moral rules and ethical values of medicine cannot be learned through reading or observing someone else. Experiencing with hands is another way of acquiring knowledge. The first step in the medical education process is acquiring anatomical knowledge. Medical education was first formalized at the beginning of the 19th century. Dissection techniques are skills requiring close-up observations and practice for future medical staff. The necessity of obtaining and using anatomical knowledge and basic medical information has led to the establishment of courses in which both live and dead corpses are used, particularly in the first years of medical education in Turkey. In Turkey, pre-clinical course-related practices are performed by practicing and observing first-hand experiences through cadaver courses held in pathology and anatomy laboratories, and students are expected to pass these courses as a condition to transition to the clinical stage and internship.
One of the most important stages of the medical education journey of medical students is to study the body of those who were once alive, providing detection of the names of the hidden blood vessels, nerves, bones, tendons, and connective tissues of the human body following their death. The urge for formation of the first anatomical corpus is due to the human curiosity about the body, discovery of the reason for illness and death, and nature, and improvement of knowledge. Humankind has struggled to better understand the human body by practicing dissection, attempting to detect cosmetic tissues, and working over ideas for hundreds of years. Involvement in the field of experience in Anatomy can perform techniques such as coming up with debated discussions based on individual evaluations, and in particular, showing how the body’s tissues and organs take their place within those person, and enables the person, through self-awareness, to be able to interpret the concepts by looking through the tissues, and to associate coincidental findings with clinical lectures in later periods. Experience within human Anatomy, through anatomy studies, dissection, and discussion, enables the student to be socially mature and competitive. The inexperience of medical staff in the confrontation of anatomy is considered as an expression of weakness to anatomy and is accepted as a primary characteristic of the medical insecurities. In addition to the importance of the subject, the shifts in the medical curriculum may lead to differences in the programs preferred in the anatomy laboratory. The most accurate way to develop these concerns is to learn the macroscopic structure of the human body from cadavers. Dissection, instead of corresponding to didactic learning, applications lead to the acquisition of skills and development of concepts. Information does not come directly but actually begins to be shaped as a result of observations. The progression point for developing improvement is the act of observing, recognizing, obtaining a mental connection between the proposed information, thinking cognitively about the matter, and application of experiences leading to active learning. Therefore, discussion, test, explanation, applications provide a significant opportunity to have more influence. Experience using discussions and questions is a perfect way to direct the students to think logically. Although there is no one known definition for the adjustment process, giving the opportunity to practice and apply while evaluating the practices is said to accelerate the progress of different learning developments and the information process of the trainees. Providing the possibility of learning from real experiences in the field is described as capacity formation. From this point of view, dissection of human cadavers represents the first encounter with major physical happenings and anatomically proximal information.
2.2. Benefits and Challenges of Cadaver Courses
The human body prosection has particular benefits for the process of learning anatomy. It serves as a means of relaying the complex structure of the body to students, who can affirm their intellectual understanding through visual and hands-on experience. However, many potential beneficiaries of the course are unable to attend prosection due to petty reasons such as bad smell, nausea, or worry about the state of the human body. As a result, university administrations often receive applications to remove students from these lessons, leading to skipped courses and cruel notifications in subsequent educational periods.
If the course was organized only for a specific section of students, it would be impossible to prevent any disadvantage to students in other sections or offer moral support to students in different sections. This lack of inclusivity pleases no one.
At first glance, a course on the prosection of the human body may seem incapable of meeting all needs and demands. However, when considering cadaver lessons as both a scientific and social issue, it becomes clear that preventative actions have nothing to do with those who demand to use lessons solely as a science curriculum. This is a call for social responsibility.
As medical students, we can strive to embody the spirit of being good doctors. We are educated by distinguished and expert individuals who provide us with unpaid experiences and values. They also encourage future medical students to gain knowledge in related subjects and display a respectful attitude towards learning. This helps to feed the medical education system with the blessings of those who have contributed to us in the past.
Within this framework, ComedTurkey and MAARDA use an emergent supportable method agenda. They consistently provide loving, educational, and technical support to organizations.
3. Methodology
The study was conducted with a cross-sectional design in order to identify the experiences of people who came to the University and Tissue Bank to attend the cadaver courses. The universe of the research population, between August 2, 2011, and November 2, 2011, was the students from ComedTurkey 4th Summer Research Camp. The data were collected in the quantitative phase with an assessment form and in the qualitative phase with focus group interviews. The data collection point was the University and Tissue Bank Turkey Protection of the Body of the Deceased People in the cadaver courses. Collected and tabulated data were analyzed in SPSS 25.0 package program frequency analysis and chi-square test for independence. On-site themes were identified in the focus group discussions and analyzed collectively, followed by a thematic network formation process. To increase the credibility, the trustworthiness of the findings were secured in the study by providing peer examination, reliance on an expert moderator, and maintaining detailed records.
It was recommended that in addition to the theoretical medicine education, Practical Anatomy-The Vertebrate Courses, which are the periodic applications performed in the cadaver laboratories with the participation of medical faculties, dentistry faculties, and faculty students, should be kept on the constitutional ground and the necessary coordination should be achieved with the Ministry of Health. It is important to revise the national regulations and define clearly the scope of implementation. In this respect, the practices of European countries in which medical faculties, embalming practices, cadaver courses, and anatomical education are carried out successfully can be duplicated. In post-mortem examinations, that is, in practical anatomy courses, the presence of performance assessment is an important criterion related to whether knowledge and skills are available. Results: Bence War International Community Based Activities does not allow the European Union to administer the yang because of the distribution. Elif Sultan ComedTurkey Anesthesia. Every indentation in Pakistan; Covid19’s man is to be stolen.
3.1. Research Design
Design and Sample of the Study
This research paper, involving both quantitative and qualitative data, was conducted on February 16, 2021, on Microsoft Teams. The online survey was developed by the research team on Google Forms’ platform, and the registration form was shared with the student organizers of the organization via an everlasting link. A convenience sampling method was conducted to access as many programs and years as possible, with currently attending second, third, or fourth-year participating medical students through social media and communication platforms. According to the distribution records, a total of 325 out of 535 registered students (withdrawn, foreigner, and completed with hesitation) were registered. On the event day, the link, including the information about the content and the schedule of the planned study, was shared with the virtual audience, both via chat-box and in the slides during several breaks, especially designed for this purpose.
Data were collected from Subhead 4B within the estimated time frame (an average of approximately 20 minutes per participant), without any incentive. Because the phenomenon under scrutiny is a single event, the snowball sampling method was performed to recruit expert faculty members, trained clinicians, serving practice in a hospital. As requested, two weeks prior to the start of the research, an announcement was spread through the national organization’s official communication channels. After the event, the recorded meeting was analyzed to continue the accuracy process. The captured data were analyzed under two main themes, in terms of qualitative analysis and quantitative analysis, as stated in section no. 5 ‘Results and Discussion.’ The written electronic notice was forwarded again to the volunteers, understood as those who raised their hands during the virtual event, to ensure that the validity and reliability of the transcribed data from the open-ended messages were promoted. The research team was responsible for creating a pre-survey specimen; a sampling was held while evaluating the ideal structure mentioned through an originally designed pre-survey tool.
3.2. Data Collection Methods
Data were collected from fourteen universities through two different surveys. The first was an organizational survey requesting information about the educational situation of the faculties. Responses to this survey revealed very few differences between universities in the application of cadaver courses. The second survey was distributed to the students who attended the cadaver course.
At the beginning of the study, a 70-item inventory was used to assess information about the students’ enrollment criteria, thoughts about dissection, and the attributes of these courses. The preliminary inventory was administered to a group of students to evaluate its reliability. After analyzing the first-round survey results, it was seen that more realistic data could be obtained by restructuring the inventory because some items had loaded into factor groups that were not theoretically relevant. After these results, the author made slight adjustments to these misgrouped subset of items (based on expert views and consultation with students’ comments), and sent them to student groups from some universities in Turkey.
Overall, the response rate from the fourteen universities surveyed was 74% for this round of questionnaires. The results, which are specific and to be expected given the animosity of the subject, show that the students, whose faculties and colleagues come from the same country, are seriously affected by the cadaver courses. Concerns about the religious implications of dissection make the atmosphere more stressed and create more mental problems. The institutions reported very few empirical criteria for admission and increased the practice of accepting students using standardized tests and the number of students placed by medical education.
In summary, the results of this exploratory study demonstrated several properties relevant to the institutions and students and showed the need for a larger investigation on this subject.
3.3. Sampling Technique
A convenient sampling technique was used. The courses were organized voluntarily and were administered to students who paid a fee. As the study sample comprised students from a variety of universities, over-representation occurred with respect to the universities where the study was administered. In Ankara, approximately half of the schools of medicine are in its proximity. For the cadaver special study, they tend to gather at one center. The descriptive survey was used after a cadaver course administered within the ComedTurkey organization consisting of 64 schools by 87 participants. Participation in this structure is voluntary and participants receive a Certificate of Participation for the ComedTurkey organization due to social activities. A total of 79 questionnaires were gathered through the convenience sampling technique after the cadaver course was used; 74 of these participants completed the questionnaire properly. Teaching assistants who teach anatomy courses implemented the descriptive survey. During the lectures, the questionnaire was distributed with the help of the teaching assistants and was collected by the same people.
The study has numerous limitations. In order to have access to participants in a single integrated structure, students at Tepecik School of Medicine were sampled with a convenience sampling technique. However, the potential consequences of the sample being non-random are the inability to generalize the results to the whole country or to make definitive conclusions. Since it is impossible to measure the latent variable of interest directly, empirical sampling error can be estimated. The study is planned to be conducted with a large-scale experimental design at all schools of medicine after the review of the responses from the descriptive study.
4. Results and Findings
Results of the survey showed that the overall perception of participants increased as a result of the course. Most participants who completed the practical sections found the course beneficial. While the vast majority of the participants described their preference for an orientation session on body dissection as the most useful session, arts in medical education were observed to increase the participants’ interest through the highest change. Having advanced English speaking level, having previous international medical education experience, and professionally possessing licensed physician were evaluated as effective participants’ characteristics on overall benefit perception from the course. During the 10-day anatomy course organized in BRC in 2018, applied two different questionnaires at the end of these two courses. The first is a program evaluation form consisting of inquiring their thoughts on theoretical anatomy lessons, practical anatomy studies, group work, pre-practical knowledge preparation programs, student assistants, and self-assessments of readiness for academic support and expertise. Only anatomy, excitatory hours, and neurological anatomy included in the medical education curriculum will be evaluated during the second question survey. In the light of these questionnaires, presented that cadaver courses contributed positively to the medical education of participants.
The answers generally demonstrate that on the basis of developed questions, the cadavers used in practical lessons contributed significantly to the understanding of participants, and the learning of applied parts was better; group and student assistance especially supported students. The fact that the participants wish to attend such courses in higher education and have a wish to work as an assistant in similar courses abroad has also been an important factor indicating their satisfaction with the courses. In the survey conducted at the end of the 3-day anatomy course, observed that the majority of participants benefited from both education and studies. In study, their attitudes and behaviors on their participation in gross anatomy courses at the beginning of the medical program using qualitative methods were used. In this research, positive perceptions of the students’ learning environments towards the body structure were emphasized as the most significant contributor to successful learning outcomes. Statements such as “The use of cadavers in the learning process”, “the facilitation of practical studies”, “creativity”, “the productive use of time and the organization of courses in terms of the basic medical sciences” and “the clinical significance of pre-surgical programs”.
4.1. Quantitative Analysis
During the 4-day program, 60 students accomplished a total of 360 academic hours of education, 308 of which were devoted to cadaver dissection. On the first day of the course, participants had a chance to discuss their interest and desire to work on abdominopelvic and head-and-neck region cadaver dissections and present any work they had prepared on certain topics. Each day included 6 hours of dissection time and 1 hour of theoretical anatomy study sessions before and after the cadaver classes. Throughout the day, not only were hours dedicated to education on soft tissue, bones, and dissection methods, a further 4 hours were directed at theoretical study in the form of question-based education that covered the head-and-neck region and upper extremity (30 questions/day), questions on the abdominopelvic region (30 questions/day) and the remaining 1 hour/day included special topic sessions.
The program was so intensive that time on task in 4 days increased the academic performance and ignited the spark of enjoying anatomy knowledge. On the first day of the study, the students were advised not to try to learn all the head and neck and abdominopelvic regions but rather to try to dominate (identify and be able to recall) and practice (identify, apply) all-specific bulks and rejoin the structures to one another inside these regions. As for the objective assessment of the research hypothesis, a questionnaire was prepared and distributed to the students at the end of day 4, covering the head-and-neck and abdominopelvic regions of the course. In this review, only the results of the data derived from the end of the course questionnaire are discussed, focusing on the strengths and weaknesses of the present study.
4.2. Qualitative Analysis
We found out that the majority of the participants stated that understanding of the human anatomy, learning of all body systems, providing lifelong learning to medical students, learning in detail, making them more respectful toward the human body, and providing both teamwork and professional skills are the most determined things in the qualitative analysis that they have learned from cadaver courses. Turkey should prepare to set up cadaver courses and if there are none, education with an ethical agreement should be made with other countries. Currently, estimating the meaning of ethical agreement in the international platform for our young people remains with a remark. For this reason, we can prepare a system to be transferred to the pre-university period with an ethical protocol affiliate between domestic universities, as well as an ethical agreement with countries abroad. Ethical cadaver studies should be conducted without any profit agreements. Since these studies are educational and scientific, the conditions of the agreements should be elaborated.
These partnerships should be conducted without any profit relationship. The cadaver or other body parts donated to the ethical university should be delivered free of charge. The major results to be achieved are to protect this sacred trust environment and to achieve a sustainable cadaver source across the country. Accurate guidance of the ethical cadaver contribution lifelong educational and supportive participation should not be obscured. Care of the cadaver, proper anatomy education, sustainable educational ethical donations, ensuring the development of the cadaver project, including outreach programs, direct investment in the way to make a successful, sustainable landscape requires both manpower and other supportive policies. For this reason, a protocol between the medical university faculties and the pre-university schools may have the mentioned effects. With the agreement prepared by all the universities, there should be some regulations to provide an understanding of cadaver meaning and reason for which they have given their consents. Ethical studies are essential to preserve and continue the tradition of anatomy education. In the respective studies, the chosen subjects require broad discussions by including protocols that can be called ethical agreements.
5. Discussion
Results of our study showed that stress reduction is the most common effect of the cadaver courses on the students, followed by better preparation for the courses related to practice (anatomy, histology, physiology, biochemistry). The students also reported that the cadaver courses made them better students. Good teamwork was also identified as a significant outcome, as it helps medical students understand the importance of constructing new connections to support them through different practices. This understanding is just as important as direct practice in medical education. Many physicians experience illnesses, including mental health disorders and academic stress, during intensive medical schools, which can both cause and result from low student performance.
One of the serious long-term effects of stress is the preparation of medical students and residents for the emotional, ethical, and psychological challenges they will face as medical practitioners. This preparation is necessary to avoid problems such as burnout or depression. These issues urgently need to be included in the curriculum. Teaching periods associated with the strongest emotional responses are commonly described for students in the medical curriculum. The results of our study showed that mental or physical health problems are not the main focus of the cadaver field. The first cadaver experience proved to be beneficial for the students, leading to reduced stress, improved task identification, and more robust teamwork.
5.1. Comparison with International Practices
An autopsy presentation seems different than the real, living patient. In most universities, gross anatomy education is given in the 1st year of faculty and topics such as bones, muscles, nervous system are introduced. Therefore, it is very difficult for students to understand the anatomy while performing some surgeries such as appendectomy in the clinics. As in the case of our sports practice, students had the opportunity to meet the anatomy they work with by seeing the real human body.
As mentioned in the report titled “The Anatomical Dissection Course: Is It Necessary for the Cognitive Sensory Learning Style of Medical Students?” of Am. J. Otolaryngol., it is of utmost importance for the medical education to enable to apprehend anatomically comprehensive problems which cannot be learnt from. Basigül et al., students couldn’t see the bottom of some systemic organs while working under the light of the wall. Furthermore, students can gain experience before the real operations and not be afraid of injuries during the dissection, they become more sculpted in the three-dimensional thinking.
In general, the students as a medical group have some gray areas in their minds such as “am I studying in the desired branch?” and “What kind of work will I be?” Students had the opportunity to learn from doctors who experienced the works they were assigned and were experienced. Before the surgeries, there are surgeries for old or wrong surgical operations, self-care attempts in case of injury, donated organ transplant organizations, and written notes given to the family. After all, most of the students said we started to empathize. Although there isn’t in the literature, it seems that this understanding is due to the cooperation of the SEN SC laboratory staff.
We had the chance to guide internationally specialized doctors in a study in which 70 medical students interested in the surgery and anesthesia have taken part in, and we got positive feedback from the students. In the report published on the Surgical Neurology International site, in an international scale there was a study that was held with 122 students at the University of New England College of Osteopathic Medicine. The majority of the students said that the course would help them in their subsequent courses and that they would be positively affected by the course. With a List of the Oya-Taşdelen-Bekar, which Stimulates Academic Performance and Disposal form, the students filled the questionnaire and evaluation forms at the end of the anatomy course. A positive feedback was taken including statements like “the working environment was comfortable” and “the students learned a great deal” from our colleagues from various universities.
5.2. Implications for Medical Education in Turkey
The strengths of Turkish medical education and faculties’ opinion about the limitations of their medical training may vary. On the one hand, medical faculties in Turkey highlighted the advantage of Turkish medical education compared to other countries due to having more practical education. However, this advantage is also leading to a possible lack of the specific understanding and knowledge of medical students concerning the whole human body, body regions, and body systems because of the time limitation.
In that sense, cadaver courses are essential in terms of learning the whole human body completely, especially to understand 3D anatomy, anatomo-functional relationships, interpret clinical imaging techniques, surgical steps, and preparing for interdisciplinary teamwork. Another lack of the Turkish medical education program is about anatomy education. It has been stated that approximately 10% of baccalaureate programs in Turkey (and some postgraduate programs) have dedicated courses for gross anatomy education, indicating that there is a shortage of dedicated courses to teach gross anatomy.
Another limitation in traditional anatomy courses is the traditional theoretical courses which are based on futile lectures and minimum interactivity. Project-Based Learning (PBL), Problem Solving, Flipped classroom model, 3D models, anatomy applications, simulators, etc. are new medical education techniques or tools indicated for this problem. One of the best methods to overcome this problem is to organize cadaver courses for medical students in Turkey. Then, clinically-relevant anatomy can be achieved.
In our opinion, it is very crucial to organize a scientifically and educationally valid medical anatomy program and redefine the selection criteria of the departments for the courses in Turkey. Therefore, cadaver courses with the use of 3D anatomical models can significantly improve both participants’ anatomical knowledge and spatial abilities. It has been proposed that cadaver courses can also provide more nuanced views of actual cases and serve to prepare students for clinical practice by teaching surgical approaches. Thus, it is considered that anatomy and anesthesia departments in Turkish medical faculties can come together in such an organization and offer medical students a unique medical teaching.
