Constructing stories of past lives: cadaver as first patient: "clinical summary of dissection" writing assignment for medical students.

Abstract

The Clinical Summary of Dissection assignment encourages students to reflect on their experiences in the Gross Anatomy Lab. The goals we have in human dissection are 1) to help students observe the donor as a whole being and not just as the bones and organs they studied; 2) to have students make careful observations without medical equipment or diagnostic procedures; 3) to have students formulate their observations into plausible hypotheses; 4) to have students identify how lifestyle might have contributed to chronic disease as evidenced by the condition of the body; and 5) to help students appreciate the contribution made to their education by the donors and their families through body donation. The Clinical Summary of Dissection is a required student writing assignment for Foundations of Clinical Practice I, the first semester of a four-semester course that introduces students to clinical medicine at the Carver College of Medicine at the University of Iowa, in Iowa City. Each group is instructed to keep a log of observations about its cadaver, including a general description, evidence of regular exercise, appearance of structures, evidence of disease, surgery, abnormalities, anatomical variations, and the morphology of the aging process. At the end of dissection, using the data collected, each group writes a one-page summary hypothesizing about the cadaver's lifestyle, possible diagnoses of chronic and acute diseases, probable age, and probable cause of death. Students are encouraged to reflect on what the experience means to each of them. They are allowed either to work on their own or with their dissection table colleagues to complete this assignment. Grades of complete or incomplete were used to score the submissions. Since 2004, discussion of the assignment has been included in one of the Personal and Professional Development weekly small group discussions. The writing styles of the summaries generally fall into one of four categories: reporting of anatomic, surgical, or clinical observations; presenting a holistic overview of the body studied; a lifestyle-focused report based upon observational hypotheses; or personal reflections on the dissection experience. Here we provide samples of edited assignments that reflect these styles. In addition to this assignment, medical students are exposed to a number of activities that attempt to link the affective, professional, and intellectual domains of their educational experience. Before classes begin, students are introduced to the curriculum. In the laboratory they are reminded of the privilege assigned to studying the human body and that this privilege is granted by the donors upon whom they will study. A Chaplain from the University of Iowa Hospitals and Clinics leads a short talk; students are allowed time for reflection and encouraged to demonstrate their thanks by learning as much as they are able. Throughout the semester, students are reminded to take respectful care of the donors' remains. This is encouraged to protect tissue that is not being studied from increased exposure and to build awareness for properly covering patients during physical exam. … observe the donor as a whole being and not just as the bones and organs …