“First Patient”: Reflections of Pathology and the Donor‐Dissection Experience

Abstract

Introduction Students in a dissection-based anatomy courses not only gain anatomical content knowledge, but also develop a professional identity, foster communication skills, cultivate team building and cross-discipline collaboration. In as much, dissection donors are often considered the students “first patient” or “teacher” with the donors not only helping facilitate the teaching of gross anatomy, but also gross pathology and histopathology. Prior research of student experiences with donor dissection discusses the evolution of student's anxieties and stresses by the utilization of coping strategies, as well as the development of detached concern or a balance of clinical detachment and empathy. However, previous research fails to situate students’ experiences with coping in the context of a theoretical framework. Aim Use the Circumplex Coping Model (CCM) as a theoretical framework to explore students’ reflections of their experiences in a dissection-based gross anatomy that uses donor pathology as a point of reflection. Methods Undergraduate students (n=28) in a lecture-free, dissection-based gross anatomy course completed three reflections, one after the first dissection and two at the end of each unit. Reflections were guided by prompts that focused the writing on pathology encountered with their donors, the first patient. In addition, the students developed “patient reports” where students documented and discussed pathologies they encountered. Data was analyzed using thematic analysis by first coding inductively and then deductively using CCM as a framework until the final themes emerged. Results The students experience demonstrated development of empathy, collaboration, problem and emotional coping. First-day reflections highlighted their emotional regulation through dehumanization, depersonalization, and distancing self. Upon integrating pathology through reflections and patient reports, the students described how they were able to humanize the cadaver and began to feel more connected to the donor and to feel a greater appreciation seeing the effects of pathology in the body. Discussion and Conclusion While previous studies have highlighted emotional regulation, the CCM assumes someone in a stressful situation must manage: 1) solving the problem (problem coping) and 2) regulating their emotions (emotional coping). Thus, in a dissection-based gross anatomy course, the problem is managing the dissection of the donor along with the unknown and ambiguity and attempting to regulate and reconcile their emotions surrounding death, dissection, and the stresses of the learning the content. Using the eight CCM styles, the students initial “coping” as demonstrated through their first-day reflections were consistent with the “problem avoidance” coping style. Incorporating donor pathology as part of the reflection prompted allows students to reframe their problem coping into what the CCM refers to as “problem solving” (i.e., active cognitive and behavioral efforts) and positive emotional coping strategies (i.e., positive reinterpretation and reframing). Implication Situating the students’ experiences in a coping framework will allow educators to better utilize reflective practices and provide feedback to allow students to raise awareness of their own thinking and beliefs.