Physician Assistant Students and Their Cadavers ...

Research Article

Physician Assistant Students and Their Cadavers:
Narratives on the Gross Anatomy Experience

Lisa Henry, PhD; Roderick S. Hooker, PhD, PA; Michel Statler, MLA, PA-C

Purpose: The goal of this study is to understand the sociocultural experience of gross anatomy on physician
assistant (PA) students. By understanding this experience, we hope to better understand its impact on the
process of acculturation to the medical profession. By contributing to the PA literature on cadaveric
dissection, we hope to expand the knowledge base of PA educators, enabling them to make appropriate
educational decisions for their students. Methods: To understand the sociocultural experience of PA students
in this area, we systematically obtained 157 anonymously written narratives about students’ human anatomy
laboratory experiences. These narratives were analyzed using specialized software and anthropological
interpretation. Results: Three main themes emerged from the narratives: how the PA student regards the
experiences of the lab, the cadaver’s life, and the career-enhancing experience of working on a human
specimen. Discussion: The laboratory-sanctioned necropsy process may expedite student development of
coping mechanisms, detachment, feelings towards patients, as well as reinforcement of their commitment to
medicine and other psychosocial effects associated with the development of competent clinicians.

(Perspective on Physician Assistant Education 2002;13(1):17-23)

Introduction source of bodies, bodily trespass, inva- • Gross anatomy of a human
sion of privacy, death, dying, and their cadaver with plasticized organs for
The education of physician assis- own mortality.2 Facing and expressing examination by students
tant (PA) students significantly paral- the aversions, fears, and fantasies asso-
lels that of medical students. Medical ciated with human dissection is • Textbook and computer models of
students begin their education with believed to help prepare the student humans (e.g., ADAM [Animated
the gross anatomy laboratory, which is for academic work in the anatomy Dissection of Anatomy for
often considered a rite of passage into laboratory and for the emotional work Medicine] software is a versatile,
the medical community.1 Dissection of implicit in patient care.3,4 multimedia computer program
the human body raises universal ques- designed for students as well as
tions for medical students about the PA programs, however, are not always physician-patient interaction)
in agreement with the necessity for
Lisa Henry is an assistant professor at the University of anatomic dissection. The Accreditation Views on human dissection vary from
North Texas, Denton, Texas. Roderick Hooker is a fac- Review Commission on Education for ascribing the value of the anatomy labora-
ulty member at the University of Texas Southwestern the Physician Assistant (ARC-PA) tory with its attendant smells, emotional
Medical Center Physician Assistant Program, Dallas, does not mandate dissection. While adjustment, and acculturation process, to
Texas. Michel Statler is the academic coordinator for some programs provide a gross questioning the expense and benefit of
the University of Texas Southwestern Medical Center anatomy laboratory for their students, such an experience. Much of the discus-
Physician Assistant Program, Dallas, Texas. other programs offer alternatives. sion centers on whether dissection is a
Discussions with faculty suggest there requisite for becoming a competent clini-
Correspondence should be addressed to: may be three types of anatomy course cian. Those endorsing the necessity of
instruction offered in PA programs. anatomic dissection hold out a number of
Lisa Henry, PhD These are: studies to support their views. Blackwell
University of North Texas et al contend that issues that emerge in
Department of Anthropology • Gross anatomy of a human cadaver anatomy lab help students focus feelings
PO Box 310409 with or without prosection
Denton, TX 76203
Voice: 940-565-4160
E-Mail: [email protected]

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towards cadavers and death that have process of acculturation to the medical dying, team work, humor, and body
subsequent impact on patient interac- profession. By contributing to the PA donation. Although these additional
tions.5 Observations reported by medical literature on cadaveric dissection, this data sets helped establish prevailing
students addressing self-esteem and study hopes to expand the knowledge themes, the results of this study are
medical attitudes before, during, and after base of PA educators, enabling them to concluded from the narrative analysis.
cadaver dissection suggest that the intense make appropriate educational decisions
emotional experience can effect attitudes for their students. Results
towards patient care long afterwards.6
Other studies suggest that the rapid Method Content analysis of the narratives
development of coping mechanisms revealed three main themes regarding
leading to emotional detachment tends to Research was conducted at the the sociocultural experience of gross
carry over to meaningful interactions with Department of Physician Assistant anatomy. The first theme involves
real patients.7 Studies at the University of Texas general discussion of the human labora-
Southwestern Medical Center in Dallas. tory experience. This category fulfills
An examination of the cadaver dissec- The program began in 1973 and incor- student desires to express the positive
tion literature suggests that this important porated a necropsy section shortly after- and negative aspects of their personal lab
initiation into feelings of uncertainty and wards. Thirty-six students are enrolled experience. Subtopics within this theme
detachment ultimately sets medical each year and enter the gross anatomy include anticipation of the first day, indi-
students apart from laymen or society as a lab the first semester. From 1997 to vidual experiences and emotions, coping
whole.8 In order to understand if this 2000, incoming students were asked to strategies, and desensitization. The
experience has a downstream effect, Pabst chronicle their thoughts during the first second theme involves discussion of the
undertook a retrospective evaluation of semester in the lab and to write an cadaver. Students spent a significant
fourth-year medical students regarding anonymous narrative of their experi- amount of time thinking and writing
the value and relevance of the gross ence at the conclusion of the course. about the cadaver’s life, donation, name,
anatomy dissection course taken during No grades were assigned to the narra- anomalies, and diseases. The third theme
the first year of training. Student tives, and although it was stressed that involves discussion about the career-
responses indicated a desire to repeat the assignment was optional, most enhancing experience of working on a
dissections because it was so valuable as an students contributed to the project. human specimen. Students wrote at
integration tool in clinical training.9 This unique method allowed the length about teamwork with tank mates,
students to discuss the important the invaluable experience of working
Although there is no specific litera- aspects of their experiences without with cadavers, and the rite of passage
ture about PA educators wanting to probes of specific questions. into the medical field.
forego anatomic dissection, the authors
are familiar with the contention of some One hundred and fifty narratives Lab Experiences
PA educators that the value of cadaver were read by all authors and discussed
dissection should be examined more for prevailing themes. The narratives The students used the narrative exer-
carefully. One reassessment of the dissec- were then subjected to content analysis cise as an outlet to express their feelings
tion lab centers on clinical ethos, ques- with Ethnographer 5.0, a software and attitudes toward the lab experience.
tioning the benefits and values versus program that facilitates the quantifica- One of the major topics was the initial
cost and educational merits of exposure tion of qualitative data sets. No changes anticipation of the gross anatomy lab
to cadavers.10 Many medical students were made in the spelling, grammar, and the dissection process. Seventy-
question career choice when confronted punctuation or any other part of the eight students (52%) wrote 98 narrative
with the reality of a strenuous workload narrative other than to standardize the accounts about their feelings and
and exposure to death. Moreover, the font and size of the type. emotions leading up to the first day of
emotional detachment result is not the dissection lab. Only 10% of the
always viewed as a positive experience.11 Additional data were collected by students reported having no worries or
Some researchers suggest the levels of two other methods. Students were apprehension about the upcoming expe-
distress manifested by anxiety, stress, and asked to complete a pre-anatomy ques- rience. Of the 98 total responses, 34
depression in first-year medical students tionnaire that queried their experience comments (35%) detailed feelings of
give rise to escape-avoidance coping with animal and human dissection, apprehension, worry, and/or fear. One
strategies such as gallows humor and death, human anatomy, and anticipated student wrote:
introspective dialogue.12 problems in the lab such as odor, illness,
and revulsion. At the completion of the Tomorrow’s the big day. I
The goal of this study is to under- course, the students also participated in don’t think I’ll make it. I’ll be
stand the sociocultural experience of small focus group discussions. These
gross anatomy on PA students, and thus discussions centered on death and
better understand its impact on the

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the one that has to leave the When discussing their lab experi- dissection lab experience. The narratives
room and throw up. Maybe I’ll ences, students wrote most often about revealed 154 accounts of coping strate-
just pass out while I’m in there. their individual experiences. Seventy-six gies ranging from disassociation from
Hopefully there will be others. I students (51%) wrote 126 accounts of the cadaver (55 accounts), to desensiti-
don’t want to be the only one. personal experiences in the lab. These zation of the experience (41 accounts),
Maybe I’m not cut out for this experiences were quite diverse; however, to use of humor in the lab (15 accounts).
line of work. Did I make a huge a few patterns and generalizations were Although some students reported never
mistake? Maybe I’ll like it. found when analyzing the responses. associating the cadaver with a living
Maybe if I just go to sleep, I The most common topic students wrote human (5 accounts), many students
won’t think about it. about was the emotional response to the discussed the need to consciously stop
dissection process. These feelings were thinking of the cadaver as human in
Other students (21%) commented generally sadness, confusion, and/or order to proceed with the scheduled lab
that they simply were not sure what depression. The following quote comes assignments (20 accounts). The follow-
their reaction would be when entering from a student who also reflected on the ing quotes emphasize this disassociation:
the lab and seeing the cadaver for the cadaver’s life and family:
first time. The following are comments After a few weeks of lab, I
from two students: As the initial week pro- stopped thinking about the fact
gressed, I did feel some sadness that I was dissecting and destroy-
From the moment I received while in lab. But like my funeral ing what used to be a living body.
my acceptance letter to the pro- experiences, my sadness was not After a while it all simply became
gram I began to think about how evoked by the sight of the body. learning. To me it may as well
I would react to seeing a human When you spend a lot of time in have been a cat or an artificial
cadaver. Would he be young or the lab and you’re not constantly body, I no longer thought of it as
old? Would he be tall or short and busy doing the dissections, your a human being.
would his face leave an image in mind can often wander. These
my mind for the rest of my life? are the times, during the begin- Physically, I have learned to
After all, I had never seen cadaver ning of the summer, when I block out the smell, and mental-
before or even experienced death would sometimes wonder about ly, I don’t “see” the human char-
in my immediate family. Not until the man’s life; what he did for a acteristics as much now. But it
a few days before class did I real- living, what kind of family he has been interesting to watch the
ize that He could be a She. had, if he was in pain when he emotions of other classmates, as
was dying. Personifying our well as recognizing my own
My experience in the anato- cadaver in my own mind like this reactions to lab.
my lab is sure to be one of the would definitely provoke sad-
most memorable times in my ness, and still does as I’m think- Students also noted that they were
life. Before beginning dissec- ing about these things right now. better able to cope with the experience of
tion, I was unsure of what my lab over the duration of the semester (21
reaction would be. I did not Another student explains in a letter accounts). Some commented that they
know if I would feel nauseous, to the cadaver: were surprised when they actually started
upset, disgusted, excited, or any looking forward to going to lab each day;
other range of emotions. It was death. Death was what the tasks began to get a little easier as the
bothered me about this lab. students became more comfortable with
Mixed emotions were also expressed Whenever anyone talked about dissecting the cadaver. Another coping
about the first day of the dissection lab the lab my eyes would fill with strategy discussed at length in the litera-
(19%), as described by the following tears and I thought of you. I just ture is humor in the lab.13-15 Students
student. kept thinking one Friday as an reported that when the dissections
instructor assured us it was ok to became difficult and tedious, communi-
It’s the first day of anatomy feel ill at the smell or the sight of cation and a sense of humor enabled
lab…I am both excited and wor- the body that the problem was them to complete the task and maintain
ried. I’ve seen quite a few more of just not wanting to look the morale of the group. One student
deaths, and have cleaned up at death. It was too close. commented on humor within his group:
quite a few corpses after invasive
procedures, but this is a whole Another topic students discussed a I personally feel that [humor]
different ballgame. great deal was how they coped with the aided us in our dissection process.

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Some of the dissections were dif- and wondering if they had ever met in and that they were not working on the
ficult, like the face. However, talk- life. The following comments are from indigent without families.
ing and laughing about other two different students:
issues or our mistakes, [of] which Another theme involved the
there were a couple, enabled us to I have spent considerable students’ decisions to name their cadav-
dissect for the purpose of learning amount of time thinking, study- ers. Out of forty-nine students (33%)
and eased our thoughts about the ing, and trying to figure out what who discussed naming the cadaver, only
actual process of what we were your body is made of, inside and 8 students (2%) stated they felt no
doing. Some individuals may dis- out. I cannot help but to ask reason to provide a name for their
agree with our methods of laugh- myself how your life was before cadaver. One student explains the deci-
ter and jokes. However, we had you passed away. Wondering sion not to name the body:
good dissections, always accom- whether you had a lonely, hard
plished our goals, and always left life or did you have a good life I saw no need to name my
with a positive attitude. with loved ones at your side cadaver like many others had. I
offering compassion and support. couldn’t understand the reason-
The literature on medical students’ ing behind it. First of all, we
experiences in the dissection lab For the first few days of the couldn’t find out his real name—
discusses how this experience helps class, your face keeps appearing in naming it by his real name seemed
students become desensitized to poten- my mind. There were a few nights more appropriate. Secondly, this
tially disturbing procedures and helps when I lie awake wondering who was just a body, an encasement of
them create a learned detachment from you were before you died. How the soul—it no longer had life. A
the person.16-18 In this study, 41 was your life like in your youth? I person should be known by
students (27%) commented on the imagined faces of strangers that his/her life rather than in their
process of desensitization in the lab. Of could have been your wife, death. Naming a cadaver with a
those 41 students, 44% noted that this daughter, or son. I wondered if fictional name seems almost disre-
process happened over time and was they loved you. Then I can’t help spectful to me—we have no right
equated to coping strategies that but wish that I had known you to come up with a name.
allowed them to continue with the before you passed away.
dissection without becoming emotion- In contrast, 41 out of 49 students
ally sensitive to every procedure; 24% Sixty-two students (41%) commented who discussed the possibility of naming
noted that they never had a problem on the donation of the cadaver. The (84%), did choose names for their cadav-
with the dissection and that going majority of these comments discussed ers. Students reasoned that naming a
through the process of desensitization students’ gratitude for the donation and cadaver was appropriate since they would
was not necessary. how this inspired them to learn as much be spending three intimate months
as possible so the donation would not be exploring the body. Many of the names
Discussion of the Cadaver wasted. One student wrote: were not random, but rather illustrated
qualities of the cadaver. For example, a
When the students were asked to I am in awe of people who cadaver with massive layers of adipose
write a narrative, they were given the donate their bodies to science tissue was named “Toad.” A cadaver with
option of writing about their personal and have much respect for them. significant body hair was named “Harry.”
lab experience or writing a story about I feel that without their contribu- Another cadaver was named “Picasso”
the cadaver’s life. Twenty students tion, medical science would not because nothing about the body looked
(13%) chose to write a story about their be as advanced as it is today. I like the diagrams in the textbook.
cadaver’s life; yet, even those students personally benefited from the
who chose to write about their personal experience in many different The existence of anomalies in the
lab experience did not leave out discus- ways, but the most important is cadavers was another major topic of
sions of their cadaver. Results show a the concrete feeling that I now discussion in the narratives. Students
total of 57 students (38%) wrote about have for human anatomy. were both perplexed and fascinated that
the life of their cadaver. Most students each person (whether dead or alive)
were curious about the cadaver’s life, Some students questioned whether really is unique, both on the outside and
and they pondered questions about or not the donors knew what would on the inside, they function in essentially
what had life been like, whether or not happen to their bodies after donation, the same fashion. Frustration came when
s/he had a nice family, if the person but other students expressed reassur- students were trying to follow the dissec-
suffered, what type of person s/he was, ance that cadaver donation is voluntary tor guide, but their cadavers did not
resemble the images provided. Other
conditions of the body that interested

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students were implants, such as pace- nice to say. That’s pretty sad now partners stank. I wish that I
makers, hips, knees, an artificial lens, that I think about it. Life is just could have worked with PAs.
dentures, breast implants, and a penile too short to be lived that way.
prosthesis. Students began to under- However, the majority of narratives
stand the applications of forensic science Interestingly, students frequently about tank mates (41%) were quite posi-
as they discovered aspects of each body commented on lifestyles changes they tive. Students noted that each team
not apparent to the naked eye. intended to make after seeing the effects member brought specific strengths to
of disease on the body. the group, which allowed each of them
Fifty-one students (34%) wrote 67 to assume different responsibilities.
comments reflecting on the diseases that Discussion of Future Career Most groups divided in two, with each
they saw in the bodies during dissection. pair dissecting one side of the cadaver.
Most students maintained that, from a PA students wrote a considerable Some students were best at removing
professional viewpoint, it was interesting amount of material relating to their the skin or fat; others excelled in sawing
to see what effects disease has on the future as health care providers. The most and cutting bones; still others had a
body, but they wondered how the person prominent topic was how they managed steady hand and were patient with intri-
lived and if she or he suffered near the to work with the other members of their cate sections. Some students were more
end of life. One student commented: team. Eighty-six students (57%) wrote comfortable as readers of the dissection
142 narrative accounts of their experi- manual, directing those who were the
I pictured Betty as a survivor, ences with tank mates. Each cadaver tank main dissectors. Most of these students
as a fighter. She died at the age of was assigned 4 team members from expressed that their group achieved a
74 from chronic obstructive pul- various allied health programs such as fairly efficient team and managed to
monary disease and respiratory physical therapy, prosthetics, and work through personal conflicts. One
failure. Her right lung undoubt- orthotics. The instructors purposefully student describes her experience:
edly showed the pain that she arranged that no more than 2 PA
must have gone through fighting students were assigned to the same tank. Another issue that was con-
this dreadful disease. Later, we dis- Many students protested this arrange- fronted during this course for
covered that she had cirrhosis of ment, stating that they preferred to work many of us was learning to work
the liver as well. I dreaded finding with other PA students who have the with people with different person-
any more signs of illness because I same motivations and learning goals. alities and styles. It helps a person
hated to imagine her suffering so Results show that their concerns were confront the fact that we as health
much towards the end. justified because 20% reported their lab care professionals will need to
experience was less than enjoyable come together and overcome per-
Many students also speculated on because of their disagreements with lab sonal issues to accomplish our
the person’s lifestyle based on the types partners. One student explains: goals of saving lives. I heard of
of conditions and diseases they could see many groups that did not come
in the body. One student wrote the My experience with my lab together due to domination by an
following narrative from the perspective partners was negative. I did not individual group member or seg-
of the cadaver: like them, and I don’t think they regation by classification. For
liked me. I did not find them to those who have not come to real-
I also got a look at the dam- be prepared. They were lazy and ize that health care takes a team
age I induced on my liver. There did not contribute. It really infu- approach, I hope they discover it
are cysts all over it, they also riated me that I would spend in the course of their education.
found some tumors beside my hours on the weekends dissecting Open communication with the
liver. The doctors kept telling me what we were not able to do dur- people you work with is the only
to lay off the booze but I guess I ing class, because they were not way to dispel personality or style
was too hardheaded as always. I prepared. It also made me mad conflicts. There is a big enough
now wonder how long I might that they would come in and battle to fight disease and death
have lived if I hadn’t drank so learn off of the work that I had without having conflicts with each
much throughout my life. I could done. While I realize that we are other. Therefore we all need to
have been a total different person all in this together and trying to learn to come together if health
with a total different life. I could learn to reach a common goal, I care is to become our profession.
have been a part of my children’s do not feel that I need to facili- This course has served as an edu-
and grandchildren’s lives; all they tate their learning by enabling cational tool to help us work in a
knew me as was an old grouchy their laziness. Basically, my lab team concept.
drunk who didn’t have anything

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Students discussed several other value of the class lies. The actual and the (allied health) students
topics relating to their careers as well. experience of doing the dissec- around her (who at the time,
Fifty-six students (37%) wrote 80 narra- tion is virtually unattainable by didn’t know each other) stepped
tive accounts about how the dissection any other source. By going in and took care of her. I guess
lab was a life-changing experience for through the various layers and that is why we are doing this. The
them. They felt honored and privileged structures it provides a unique lack of the human touch, the lack
to have been given the opportunity to perspective and orientation of of treating the whole person, was
work on real cadavers and expressed the body that does correlate to what led me into this field. That
these feelings in terms of their rite of the living patient. first incident made me sure I was
passage from a lay person to a medical in the right place.
professional. Many students came to the This student’s comment about the
first day of lab with fears and reserva- relevance of gross anatomy to future Another student notes, “[the dissec-
tions; however, most left the lab on the patient interaction shows another tion experience] conveyed to me the
last day with a completely different view common theme in the narratives. Forty- importance of realizing the limits of
of the human body and a feeling of eight students (32%) discussed their most people’s knowledge of human
being among the privileged minority. future careers 68 times in the narratives. anatomy and how I need to take time to
One student noted, “We were among Generally speaking, they were grateful explain it to them in a clinical setting.”
the few, the proud, just like med for the knowledge they acquired while Students contend that by seeing and
students.” Another student commented, taking the gross anatomy course in feeling structures in the body during
“I could tell that I had grown even more order to help their future patients. dissection they are able to understand
distant from that scared boy who walked Interestingly, this knowledge was not what is inside the body when a patient
into lab that first day. I now belonged to limited to the memorization of body says, “It hurts here.” This knowledge is
a club that most were not allowed to structures, but rather included tech- an invaluable tool that students will
join.” These students contend that niques on how to work as a member of proudly bring to their careers.
participating in the dissection of a a team, how to understand pain and
cadaver was necessary for them to feel suffering, and gaining experience in Discussion
inducted into the medical field and dealing with personal emotions
transformed into a professional. surrounding death and dying. Thirty- Explanatory narratives provide a
one percent of these students specifically unique opportunity for students to express
In addition to feelings of privilege stated that the dissection experience their feelings, attitudes, and concerns
and honor, students commented that helped them understand how to identify about the dissection experience. This
the gross anatomy experience was and interact with patients. model for data collection was borrowed
invaluable to their education. Seventy- from Coulehan and colleagues, who
eight students (52%) wrote 94 narrative During the first week of lab, demonstrated that this provides an oppor-
accounts about how dissecting a cadaver at a tank a few rows down, there tunity for students to reflect on personal
was an important part of medical educa- was a female student crying. I growth and development.19
tion. Dissection provides an awareness started walking over to her. As I
of the simplicity, complexity, and beauty did so, I noticed two TA medical Three main themes emerged from
of the human body, students said. students looking at her, and they the narratives: how the PA student
Viewing pictures, studying animals, or backed away without saying any- regards the experiences of the lab (antic-
reading descriptions provided by others thing to her. I put my hand on ipation, coping, emotions), the
does not compare to the knowledge her shoulder and I asked her if cadaver’s life (respect, diseases suffered,
gained by examining a cadaver with she was all right. She kept saying, the life they led), and the career enhanc-
one’s own hands and eyes. Students “I don’t know why I’m crying, I ing experience of working on a human
noted that it is best to learn through don’t know why I’m reacting like specimen (rite of passage, teamwork
experience and the anatomy lab this...” I said, “because this is not with tank mates, first patient experi-
provided the opportunity to gain and a normal thing to do or see ... ence). Most of the students agree that
retain the knowledge they will need to people don’t see this.” She nothing compares to the feeling, touch-
become successful health care providers. stopped crying, and I went back ing, seeing, and exploring of the human
One student notes: to my own tank. I kept thinking body. More than 85% felt that the expe-
how funny it was that the (male) rience was so valuable that a computer
Looking at a book is not the medical students didn’t know program or plasticized models could not
same as doing the dissection and how to (or didn’t want to) handle substitute for the experience (both good
finding the structures on an actu- someone becoming emotional, and bad). Many students expressed feel-
al cadaver. This is where the real ings about the desensitization experi-

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Physician Assistant Students and Their Cadavers

ence, believing this experience may help learn to critique their own world view encounter. General Hospital Psychiatry.
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For the PA student, the introduction only are these learning objectives valued saw”: narratives of gross anatomy. Literature
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place in the classroom and an important learned by other processes. A. Effects of cadaver dissection on the atti-
part of it takes place in the gross tudes of medical students. Medical
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anatomy lab provides a rich and fulfilling gral part of the transformation from PA 8. Segal DA. A patient so dead: American
experience for learning “... a little more student to medical professional. Students medical students and their cadavers.
about birth and suffering and how close acquire knowledge of the human Anthropology Quarterly. 1987;62:17-25.
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the ultimate goal, and that of all living tioned necropsy process that probably ject or an essential part of modern medical
things, survival. No textbook, no lecture differs from available simulated models. curriculum? Results of a questionaire circu-
series, no beautifully executed anatomic According to this study, student develop- lated to final-year medical students.
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However, cadaver dissection remains prince into tadpole. In: Coombs RH,
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competent medical practitioners, there this study and to Jendyai Warren, who spective: Introduction. J of the History of
is a scarcity of literature on the subject prepared the narratives into a common Medicine and Allied Sciences. 1995;50:3-10.
of whether this process should even be a format for analysis. 13. Hafferty FW. Cadaver stories and the emo-
part of PA education. As a consequence, tional socialization of medical students.
not all PA programs have dissection of Author’s Note Journal of Health and Social Behavior.
human cadavers as part of their educa- 1988;29:344-356.
tion process. Instead, they rely on For further information and discus- 14. William JL. Don’t discuss it: Reconciling
various education techniques such as sion of this topic please see Brief Reports illness, dying, and death in a medical school
artificial anatomic parts and computer- on page 39. anatomy laboratory. Family Systems
ized instructional programs. Medicine. 1992;10(1):65-78.
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