Silent Mentor Research Articles

A bibliometric analysis of Tzu Chi Foundation’s research publications using the web of science from 1990 to 2023

Background: The Tzu Chi Foundation, a prominent Buddhist non-profit organization, has significantly contributed to global humanitarian efforts and academic research. However, its scholarly output has not been comprehensively analyzed. Aim of the study: This bibliometric study aimed to analyze the research publications of individuals affiliated with the Tzu Chi academic community, indexed in the Web of Science (WoS) from 1991 to 2023. Material and methods: Data were extracted from the Science Citation Index Expanded edition of the WoS Core Collection. Publications with authors affiliated with Tzu Chi institutions were identified using relevant keywords. Only original articles were included. Bibliometric indicators were assessed using Bibliometrix 4.1 and VOSviewer 1.6.20. Results: A total of 9,510 original articles were published by Tzu Chi affiliates between 1991 and 2023, showing an annual growth rate of 18.7%. The most frequent subject categories were “general and internal medicine”, “pharmacology and pharmacy”, “oncology”, and “biochemistry and molecular biology”. PLoS One was the top published journal. Keyword analysis highlighted apoptosis, inflammation, and stroke as prominent research topics, with emerging areas such as immune checkpoint inhibitors and COVID-19. Conclusions: This bibliometric study provided an overview of the Tzu Chi Foundation's scholarly contributions from 1991 to 2023, showing significant growth in research output and the diversification of research topics. Future efforts should focus on expanding unique research areas such as the Silent Mentor Program, stem cell research and precision medicine, and vegetarian research to enhance Tzu Chi’s global research impact, improve patient care, and foster a compassionate and effective healthcare system.

Silent Mentor programme increases medical students' empathy levels.

Silent Mentor programme increases medical students' empathy levels.

Conduct of body donation and cadaveric dissection training during the COVID-19 pandemic: challenges, impacts and mitigation.

The new coronavirus disease 2019 (COVID-19) has had a substantial impact on the Silent Mentor Programme (SMP), a programme in which members of the public may pledge their bodies to be used for medical training and research after their death. This study aimed to explore the conduct of body donations and simulation surgery training during the COVID-19 pandemic from the viewpoints of the committee members of the SMP and the next-of-kin of body donor pledgers. This study utilised a qualitative exploration method to seek an in-depth understanding of this phenomenon. In-depth individual interviews were carried out. Thematic analysiswas used to identify patterns of themes. The COVID-19 polymerase chain reaction (RT-PCR) test is compulsory before accepting a body donation, and this resulted in the turning down of several donations. Being a donor is the final wish of pledgers and this turning down led to a negative emotional remorseful feeling in the next-of-kin of pledgers. From the perspective of students, it is feared that the conduct of the programme, particularly the home visit session being held online, has impeded teaching of humanistic values, compassion, and empathy, which is the prime philosophy of the programme. Previous to the pandemic, the programme ceremonies were well-attended, denoting the utmost respect and recognition of the mentors; however, travel restrictions due to the pandemic limiting in-person attendance resulted in ceremonies becoming less impactful. Continuous postponements of cadaveric dissection training also resulted in students missing training opportunities, hence potentially impairing their professional practice and humanistic values in the medical profession. Counselling interventions should be directed at easing the negative psychologicalimpacton the next-of-kin of pledgers. As the COVID-19 pandemic may pose a significant impediment to achieving the educational outcomes of cadaveric dissection training, efforts to make up for these gaps are essential.

When Our Medical Students Learn Anatomy, They See a Person, Not a Specimen

Founded over two decades ago in Taiwan, the Silent Mentor Program goes beyond ethics to infuse humanity into medical education.

A Single Institution Cadaveric Study on Anatomical Variation of the Sublingual Gland Duct.

The purpose of this study was to conduct a cadaveric dissection study on the anatomical variation of the sublingual (SLG) excretory ducts and dictate an improved understanding of the anatomical communication between the SLG duct and submandibular (SMG) ducts. This study is carried out by standardized dissection of anterior floor of mouth in 6 formalin-fixed adult cadavers in Silent Mentor Workshop University Malaya in August 2020. The cadavers had no trace of scars, adhesions, signs of trauma or operation. SMG duct opening was identified lateral to the lingual frenulum through a papilla in the floor of mouth behind the lower incisor tooth. A horizontal incision line was done over floor of mouth just lateral to the opening. SMG duct and SLG was traced and skeletonized. Any presence of major duct arising from the SLG and its communication with SMG duct were investigated. We found there are 3 patterns of SLG excretory duct variants; (1) One major (Bartholin's) duct which open independently at its own orifice adjacent to the orifice of the Wharton's duct of SMG. (2) One major (Bartholin's) duct which joined into the Wharton's duct of SMG. (3) Absent of a major duct arising from SLG. The overall mean diameter of SLG ducts were 1.3 ± 0.41and the mean length of SLG ducts were 18.5 ± 6.55. The overall mean diameter of SMG ducts was 2.6 ± 0.74 and the mean length of SMG ducts were 46.5 ± 6.57. Excretory ductal system of SLG showed great variations, not only between the different cadavers but also within the different sides of the same cadaver. Awareness of potential anatomical variations can aid in the accurate diagnosis and treatment of patients with salivary gland pathology as well as help surgeons reveal potential risk factor and avoid complications during surgical procedures in the floor of mouth.

An Exploration of Death Anxiety of Family Members of Silent Mentor Body Donation Program.

Background: This study assesses the level of death anxiety among the family members of the Silent Mentor Programme (SMP) and determines whether their participation in various ceremonies during the training session impacted their death anxiety. Methods: The revised Collett-Lester Fear of Death Scale (CL-FODS) was administered to the study participants before the opening ceremony and after the sending-off ceremony of the programme. Results: All the four subscales that measure fear of one's own death, fear of the process of one's own dying, fear of the death of others and fear of the process of others dying in the CL-FODS showed significant reduction after the sending-off ceremony compared with before the opening ceremony. Younger family members reported significantly higher mean total death anxiety scores compared to the older members. Conclusion: The SMP not only nurtures doctors with humanity but also helps the family members to cope with grief and loss.

The Impact of a Gross Anatomy Curriculum With Donor Family Interaction: Thematic Analysis of Student Letters to Silent Mentors.

PurposeTzu Chi University’s anatomy curriculum incorporates interaction with donors’ families and regards body donors as silent teachers and altruistic role models. In this silent mentor program (SMP), students learn about their donor’s life before dissection to better appreciate the selfless donation. This study explores the influence of the program on students’ humanistic literacy based on student letters to silent mentors, which students wrote near the end of the program and laid by the silent mentor during the coffining ceremony.MethodThe study included 125 letters from third-year medical students who took the gross anatomy curriculum in academic years 2015, 2016, and 2017. With student consent, the program collated and published the letters in the open-access SMP yearbook. Using thematic analysis, the authors manually analyzed the letters in their original Mandarin, with the names of students made anonymous to ensure the authors were blind to students’ identity throughout the study.ResultsThe analysis identified 3 themes and 11 subthemes. Theme 1, my silent mentor, included 3 subthemes: life characteristics, altruistic attitude, and expectation of offering body. Theme 2, connection to silent mentor and family, included 4 subthemes: intersubjective bonding, emotive first encounter, spiritual communication, and encouragement from silent mentor. Theme 3, reflection and transformation, included 4 subthemes: reflection on life and death, professional self-expectation, inner transformation, and feedback action.ConclusionsThe findings suggest that interactions with donors’ families increased students’ appreciation of the donation and enhanced students’ humanistic literacy. Further, the letters seem to indicate that the SMP inspired students to develop a grateful, respectful, and empathic attitude toward life and their career. Thus, by implementing similar programs, gross anatomy curricula could go beyond the acquisition of structural knowledge to the cultivation of medical students’ humanistic literacy.

Donation of body for anatomical dissection in Sri Lanka: a review

Anatomy remains central for Medical Education which forms the basis of efficient and safe medical practice. Dissection of a cadaver is deliberated as an essential and valuable tool in teaching macroscopic anatomy for medical students. Apart from gaining knowledge and skills, the anatomical dissection aids in cultivating humanistic values, behaviors, and attitudes which are essential assets for an empathetic future medical practitioner. This manuscript highlights the dynamic history of acquiring human bodies for anatomical dissection, with a particular emphasis on Sri Lanka. Knowledge on the source of cadavers, and the manner by which they have been obtained, is fundamental for medical students to realize the ethical and legal challenges associated with procurement of cadavers. This knowledge will help to further students’ understanding of the evolving mindset of society, both past and present, regarding anatomical dissection and voluntary body donation. Through the study of the history of procuring cadavers, students are better positioned to appreciate the determination, generosity, and altruism of donors who have bequeathed their bodies for the educational needs of others. This, in turn, enables the students to consider the cadaver as their teacher, first patient or at best body of a fellow human being; not only to ensure that the body is treated in an ethically acceptable manner, but also to provide an empathetic foundation in students to provide the utmost care to their patients with kindness and due respect in their future medical practice. Thus the willed body donation plays a significant role in producing not only a competent but also a compassionate medical practitioner. In this manuscript, the body donation practices of Sri Lanka are reviewed along with the Taiwanese-originated silent mentor programme.

Longitudinal Follow-Up of Death Anxiety and Psychophysical-Symptom Experience of Participants in the Silent Mentor Program.

This study assessed death anxiety (Death Anxiety Questionnaire, DAQ) and psychophysical- (psychological and physical) symptom experience following cadaveric dissection among the Silent Mentor Program (SMP) participants before thawing (T1), after the suturing, dressing and coffining session (T2), and one month post-program (T3). There was a significant decline in the total DAQ score comparing T1 and T2 (t = 7.69, p < 0.001) and T2 and T3 (t = 5.00, p < 0.001) and T1 and T3 (t = 10.80, p < 0.001). There was a significant reduction in total psychological-symptom score comparing T1 and T2 (t = 4.92, p < 0.001) and between T1 and T3 (t = 4.85, p < 0.001). However, for the physical-symptom experience, a significant increase in the physical-symptom score between T1 and T2 (t = -3.25, p = 0.001) was reported but the scores reduced significantly one month after the program (T2-T3; t = 4.12, p < 0.001). The mentoring concept of the SMP program has beneficial effects on improving attitude towards death and psychophysical-symptom experience associated with cadaver dissection.

Psychological Consequences of the Delay in the Silent Mentor Programme During the COVID-19 Pandemic: Perspectives From Family Members of Silent Mentors.

The COVID-19 pandemic has put a hold on the Silent Mentor Programme (SMP); this pause has not only caused unprecedented challenges for the delivery of medical education but has forced changes in the programme ceremony sessions. We aimed to describe the psychological impact and experiences of family members of silent mentors during the COVID-19 pandemic using qualitative interviews. Many expressed feelings of remorse and unrest about the unprecedented delay of the SMP. The delay increased negative emotions particularly among some elderly family members; however, there was no prominent negative effect on their functional health and well-being. Several participants relayed the belief that the soul cannot rest until the body receives a proper burial while some worried about the deterioration of the physical condition of the mentors. In conclusion, findings provide insights into the importance of not overlooking the mental health implications of delaying the SMP in future outbreaks or crises.

Virtual thanks giving to a cadaver by medical students exposed to learning anatomy before and amidst COVID-19 pandemic.

PurposeDue to COVID-19 pandemic, Thanks giving ceremony to cadaver was different this year in two ways: the students were partially exposed to cadaveric dissections (for 7 months) and later learned Anatomy via online classes due to lockdown (for 5 months) and secondly it was not feasible to gather for the ceremony so virtual platform was preferred. The purpose of this study was to discern the gratitude for cadaver and to recognize the importance of cadaveric dissection from the reflection of students who experienced hybrid anatomy learning amidst COVID-19.MethodsThe study was conducted on 48 first year medical students who were admitted to the college in August 2019 and were willing to participate. An online invitation was sent to students to participate in virtual thanks giving to cadaver ceremony on the last day of their anatomy class (August 2020).ResultsThough the students partially studied gross anatomy with the aid of dissections on the cadaver; however, they expressed respect and gratitude to the silent mentor in the form of a card, poem, drawing or paragraph and shared it via google classroom platform. The students wished if they could continue their anatomy course in dissection hall as paused due to COVID-19 pandemic.ConclusionsReflection of these students may mark impact on future anatomy students who may or may not get the chance for dissections. The thanks-giving gesture will also help to bind medical science and humanity especially during the crisis of pandemic.

Cultivation of humanistic values in medical education through anatomy pedagogy and gratitude ceremony for body donors

BackgroundOne of the most important objectives of modern medical education is to empower medical students to become humanistic clinicians. Human anatomy plays a crucial role in this mission by using cadavers to cause reflections on death, dying, illness, and the role of medical practitioners in humanistic care. The objective of this study was to introduce, describe, and evaluate the impact of a ceremony in honor of the body donors on ethical and humanistic attitudes of medical students.MethodsWe used a phenomenological research approach to explore and understand the lived experiences of the anatomy teachers as they teach anatomy in the context of humanism and ethics. A separate survey of third-year medical students was carried out to understand their perceptions of changes in themselves, respect for donors and donor families, and their relationship with patients. Data were collected in two phases: a desktop review of teaching materials followed by in-depth interviews of the main anatomy teachers followed by a self-administered, 5-item Likert scaled questionnaire given to students.ResultsIn the present article, we describe the rituals conducted in honor of body donors at our School of Medicine. We also describe the lived experiences of anatomy teachers as they work on improving humanistic education quality through the introduction of the concept of “silent mentor” which refers to a cadaver that quietly allows medical students to learn from it. In turn, a ceremony in honor of body donors who have altruistically donated their bodies so that learning anatomy through dissection would be possible is also introduced. A survey of the impact of the ceremony in honor of body donors on medical students revealed positive responses in terms of promoting studying anatomy (3.96 Vs 3.95) as well as reflections on own death (4.44 Vs 4.35), the life of body donors (4.07 Vs 4.04), and how to humanely view future patients and their significant others (4.32 Vs 4.24) relative to those that did not attend the ceremony (5-item Likert scale). The majority of the students that attended the ceremony also indicated that it had a positive impact on their future doctor-patient relationship, thinking about the possibility of donating their body for teaching as well as about medical ethics. Most of them also think that attending the ceremony helped reduce their anxiety, fear, and disgust of seeing corpses or dissecting and 90% insisted that memorial ceremonies should continue being conducted at Zhongshan Medical School.ConclusionThe combination of the anatomy component of the basic medical curriculum and gratitude ceremonies as well as activities to promote body bequeathal programs might help to accomplish the goal of cultivating high-quality medical students and professionals for the future. The long-term benefits would be a medical graduate who exudes empathy, relates well with patients and their significant others, leading to a productive doctor-patient relationship.

‘Silent mentors’: Donation, education, and bodies in Taiwan

Unlike cadaver donation in the West, which has to a large degree maintained the anonymity of the body used to teach medical students, the Taiwanese Tzu Chi Buddhist Silent Mentor programme at the centre of this article foregrounds the identity of the trai

Nursing Students' Perceptions of a Silent Mentor Program in an Anatomy Course.

Anatomy is a core course in undergraduate nursing curriculum. In today's nursing profession, the integration of biosciences and humanities is increasingly emphasized. Anatomy is considered one of the most essential bioscience subjects for nursing practice. Thus, integrating a silent mentor program into the anatomy course can enrich the knowledge of undergraduate nursing students regarding biosciences and humanities and enhance their future patient-centered care competencies. This article aimed to understand the students' perceptions of integrating a silent mentor program into the anatomy course. Qualitative approach included four focus group interviews. Themes were developed using the analytic induction technique. Twenty-five second-year undergraduate nursing students from a university were recruited. Semi-structured interviews were used to guide four focus group interviews. Focus group interviews were digitally recorded, transcribed, and analyzed. According to the preliminary findings, nursing students regarded silent mentors not only as teaching tools but also as tools to learn more than anatomy. Students greatly respected the silent mentors and were highly engaged in the anatomy course. They expected to become better students or future nurses. Four themes were identified from the interviews: emotional transformation, caring spirit, course engagement, and self-expectation. The findings suggest that the silent mentor program offered students a beneficial learning experience and stimulated their developing competency in nursing humanities. How the silent mentor program can help students achieve optimum academic performance and how their positive experience of the program and humanistic spirit translates into clinical practice in future should be studied further.

Turn a Loss to a Gift: The Final Wishes of Silent Mentors

Background: Birth, aging, illness and eventually death are the natural events in the life. As our body is not permanent, we can do something meaningful even after death, such as donating body as a Silent Mentor. This concept was initiated by Dharma Master Cheng Yen from Taiwan at Tzu Chi University in 2002. University of Malaya started this program in 2012 with intention to provide surgical skill training and cultivate humanistic values. In each workshop, 4 to 6 Silent Mentors are initiated and ten medical students are assigned to one mentor. The program includes receiving the Silent Mentor within six hours of death and placing into deep freezer, performing home visits to the relatives to know the life story, medical illness, verbal or written final wish of the donors and their expectation on medical students, preparing their own mentors before, during, and after each workshop, presentation about their mentors before workshop and at gratitude ceremony and sending off their beloved mentors by medical students and relatives after gratitude ceremony. The students have the opportunity to learn anatomy and basic surgical skill on their mentors over three evenings, and also opportunity to take care of their mentors with utmost respect during the program. Until to date, we conducted 21 workshop sessions. Over 800 medical students from local and oversea universities have been trained by volunteer trainers. Within six years, many pledgers with great love have signed up to donate their bodies for medical education and research in this holistic approach. Aim: (1) To study the characteristics of donors for Silent Mentor program. (2) To describe their final wishes and expectation on medical education, training and research. Methods: Retrospective analysis of the demographics, social characteristics and final wishes of donors who had contributed to the Silent Mentors Program of University Malaya, based on information derived from their registration data and home visits. Results: From March 23, 2012 until March 28, 2018, 1174 individuals have signed up for this program, and 84 had already served as Silent Mentors. Most died due to cancer. Among them, 42 were men and 42 were women. Sixty were Buddhists, 13 Christian, 4 Catholic, 2 Hindu, 3 Taoism and 2 from other religion. Their final wishes expressed that medical students and doctors are able to learn procedures from their donated body to become skillful doctors to help suffering patients in future. They also wished that students may become caring doctors and will contribute to the medical field regardless of monetary benefits. They hoped that medical students develop the heart and soul of a holistic doctor. Conclusion: Silent Mentor program offers a different approach in medical education and research. There was no gender difference among the donors. Most of selfless Silent Mentors wished that they can help to train students to become not only competent, but also empathic and compassionate doctors.

A New Approach to Body Donation for Medical Education: The Silent Mentor Programme.

Cadaveric dissection is an integral component of medical education. There had been concerns about negative impact on medical students exposed to deceased donors before their clinical years, but most studies reported overall positive outcome following this form of teaching. Due to reducing number of body donations in most parts of the world, many institutions are adopting alternative models especially for the teaching of gross anatomy. A new body donation programme that incorporate humanistic values in the procurement process was initiated by Tsu Chi University of Taiwan in 1996. Early observations following teaching with the so-called “silent mentors” noted less negative emotional impact on the students. With increasing number of body donation following the initiation of the silent mentor programme as reported in some regions, we will be able to continue the time-honoured cadaveric dissection for anatomy teaching, at the same time promoting humanistic values on junior doctors.

Effects of a \u201csilent mentor\u201d initiation ceremony and dissection on medical students\u2019 humanity and learning

ObjectivesMany medical schools in Taiwan have adopted a dignified “silent mentor” initiation ceremony to strengthen student’s medical humanity and increase their learning attitudes. This ceremony consists of introductions of the body donor’s conduct and deeds, wreath-laying, and a tea party. However, few empirical studies have examined the influences of the ceremony and dissection on medical humanity. This study explored if the initiation ceremony and the course can help students care more about others, develop more positive attitudes toward death, improve learning effectiveness in the course, and decrease negative emotions the first time they see a cadaver.MethodsThe Attitudes Towards Death and Love and Care subscales of the life attitude inventory, Learning Effectiveness of Gross Anatomy Laboratory Scale (LEGALS), and Emotional Reactions Towards Cadavers Scale were adopted to examine differences before (T1) and after (T2) medical students attended an initiation ceremony at a university in northern Taiwan. Whether these effects lasted to the end of the semester (T3) was also tested.ResultsAfter the ceremony, students’ attitudes towards death increased, negative emotions towards cadavers decreased, but love and care and the LEGALS did not significantly change. Data from T3 showed a similar pattern, but high-level emotions (e.g., being respected, cherished, and grateful) and the LEGALS were significantly higher than those at T1.DiscussionThe initiation ceremony, which showed a body donor’s deeds and attitudes toward life and death when they were alive, could help medical students gain more mature attitudes towards death and decreased negative emotions. Learning between T2 and T3 might have caused significant changes in high-level emotions and the LEGALS at T3. Arranging reflective writing with guided discussion by a teacher before and after the ceremony is highly recommended.

How the silent mentor program improves our surgical level and safety and nourishes our spiritual life.

We briefly share our experience of using the silent mentor program in the Medical Simulation Center (MSC) of Tzu Chi University (TCU), Hualien, Taiwan, to improve our minimally invasive surgical level and patient’s safety. The silent mentor program, established in 2000 by the Department of Anatomy of TCU, is a pioneering clinical skill training program based on unembalmed bodies. This program provides three valuable advantages for surgery. The first is the comprehensive understanding of the deep or rarely observed but crucial structures of the human body, which is normally difficult to achieve in living humans. The second is gaining the first experience of a novel procedure or surgery on silent mentors rather than on living humans, which is essential for young surgeons to begin their careers. The third is evaluating the safety and feasibility of a novel surgical method. In addition to surgical techniques, the most valuable point of the program is the humane ceremonies conducted for silent mentors to nourish our soul. After the workshop, all the incision wounds on every silent mentor were carefully checked and sutured in the same manner as in closing surgical wounds in a patient. Subsequently, encoffining, cremation, and thanksgiving ceremonies were solemnly held, in the hope that the medical students or trainees would imperceptibly understand their responsibility to society and the silent mentor’s expectations. The Asia-Pacific Association for Gynecologic Endoscopy and Minimally Invasive Therapy, or the Taiwan Association for Minimally Gynecology Therapy, or both can consider initiating a regular silent mentor program in the MSC of TCU. It is not only intended to improve the skills of surgeons but also to allow them to participate in the interactive ceremony and thus refresh their humanitarian knowledge.

Preferred Modalities for learning Anatomy: Medical students' opinion

Learning anatomy is the basic and essential component of medical study when students start to learn in medical career. Since five hundred years ago, the human cadaver has been used as the silent mentor for students in learning anatomy. Later, pre-dissected specimens were used in addition to hands-on dissection of human cadaver. Current advances promote the use of anatomical models as well as plastinated specimens. This study focused on analyzing the preference of students towards different learning modalities available for anatomy teaching. It was conducted on first year medical students at the Faculty of Medicine and Health Sciences, University Malaysia Sabah (FPSK, UMS). A total of 76 students (27 males and 49 females) participated in this study. Out of 76 students, 57 (75%) students preferred using human cadaver for anatomy learning. Four students (5.3%) opted for plastinated specimen while 15 students (19.7%) chose the plastic model. Knowledge gained in learning Anatomy was said to be easier from cadaver (67.1%), followed by plastinated specimen (35.5%) and plastic models (52.6%). In the present study, 97.4% responded that plastic model was easier to apply their knowledge in objective structured practical examinations. The present study found that using cadaver was still favoured by medical students. Further studies are required to determine the preference between hands-on cadaveric dissections versus pre-dissected specimens.

The Tzu Chi Silent Mentor Program: Application of Buddhist Ethics to Teach Student Physicians Empathy, Compassion, and Self-Sacrifice.

The Buddhist Tzu Chi Silent Mentor Program promotes the donation of one's body to science as a selfless act by appealing to the Buddhist ethics of compassion and self-sacrifice. Together, faculty, families, and donors help medical students to learn the technical, spiritual, emotional, and psychological aspects of medicine. Students assigned to each "Silent Mentor" visit the family to learn about the donor's life. They see photos and hear family members' stories. Afterwards, students write a brief biography of the donor which is posted on the program website, in the medical school, and on the dissection table. In this paper, we: (1) summarize the Silent Mentor Program; (2) describe findings from an assessment of medical students who recently completed a new version of the program in Malaysia; and (3) explore how healthcare settings could benefit from this innovative program.