Adding Humanity to Anatomy Lessons

In “When Our Medical Students Learn Anatomy, They See a Person, Not a Specimen” (Issues, Spring 2023), Guo-Fang Tseng provides a wake-up call to treat anatomy as a humanistic as well as a scientific discipline. This is not new, as a move in a humanistic direction has been evident for some years and across a variety of countries and cultures. However, within the Silent Mentor Program that Tseng describes, it goes considerably further than generally found elsewhere, with far more involvement of family members at every stage.

The Silent Mentor Program is conducted within a Buddhist culture. Should this be normalized and viewed as the ideal practice for those in different societies with varying religious or cultural perspectives? As arguments in favor, the practices have led to major increases in body donations within these communities, and they have enhanced the humanity and empathy of clinicians.

To gain further insight, my colleague Mike R. King and I conducted a study to explore why in most academic settings in the Western world cadavers in the dissecting rooms of anatomy departments are routinely stripped of their identity. This has meant that medical and other health science students have been provided with limited, if any, information on the identities or medical histories of those they are dissecting. The study, published in Anatomical Sciences Education in 2017, identified four ways that the cadavers were treated: total anonymization; nonidentification, low information; nonidentification, moderate information; identification, full information. We concluded that at the heart of the debate is the altruism of the donors and the integrity of those responsible for the donors’ bodies.

We further concluded that if potentially identifying information adds value to anatomical education, it should be provided. But other values also enter the picture, namely, the views of the donors and their families. What if the families do not wish to go down this road? This demonstrates that the direction outlined for the Silent Mentor Program depends upon full acceptance by all parties involved, with the families’ views being uppermost.

Then there are the students. It is unlikely that in a pluralist society all will want as much personal information about the body as possible. Thus, there must be a balance achieved between the students’ emotional or psychological reactions and the pedagogical value of the information.

The situation is more confused in some societies where certain ethnic or cultural groups oppose the donation of bodies on cultural grounds, so that students belonging to these groups must overcome an antipathy to the process of dissection. For them, identification of the bodies would likely be a step too far.

While the Silent Mentor Program is situated in a Buddhist society, it does not represent all Buddhist perspectives. For instance, donation programs in Sri Lanka have been the norm for many years, with Buddhist monks giving blessings for the afterlife of the deceased person in the deceased’s home prior to the cadaver being transferred to a local university anatomy department. After receipt of the cadaver, all identification marks are removed, thereby maintaining the anonymity of the deceased. The relatives have no further contact with the remains. Following dissection, Buddhist ceremonies are conducted by monks, thereby placing the whole process of donation and dissection within a Buddhist context, with participation by students and family members. This represents a variation on the Silent Mentors Program, encouraging altruism and involving the family in some aspects of the process of teaching anatomy within their own Buddhist context. This demonstrates that more than one model may serve to achieve humanistic ends.

D. Gareth Jones

The first systematic dissection of the human body has been attributed to the ancient Greek anatomist Herophilus, who lived from 355 BC to 280 BC. Unfortunately, Herophilus was ultimately accused of performing vivisections of living human beings. Dissection then ceased after his days and recommenced only in the mid-sixteenth century. As dissection began to play a prominent role in the learning of the human body, the growing shortage of cadavers resulted in body snatching from graves and even the commission of murders, leading to the enactment in the United Kingdom of the Anatomy Act of 1832, which also served to regulate human body donation.

Cadaver-based dissection of human bodies to learn human anatomy has now become a cornerstone of the curriculum of many medical schools. As students actively explore the body, they are able to perceive the spatial relationships of the different structures and organs, as well as appreciate anatomical variations of various body structures. More recently, alternative methods—including the use of 3D visualization technologies such as augmented reality, virtual reality, and mixed reality—have been increasingly utilized, especially during the COVID-19 pandemic, in the light of limited access to anatomy laboratories and the implementation of safe distancing measures.

In his essay, Guo-Fang Tseng elegantly highlights the humanistic approach to the teaching and learning of human anatomy through bodies willed to the Tzu Chi University’s School of Medicine, in what is called the Silent Mentor Program. What are usually termed as cadavers are now accorded the status of Silent Mentors. Indeed, while these altruistic individuals may no longer be able to speak, their donated bodies are still used to impart the intricacies of the human anatomy. Students are constantly reminded to treat their Silent Mentors with the utmost dignity, respect, and gratitude.

The Tzu Chi program is a unique human body donation program where students and residents not only learn how their Silent Mentors had lived while they were still in this world, but also have close interactions with their Silent Mentors’ families. At the end of the gross anatomy dissection course, students place all the organs and tissues back into their Silent Mentors’ bodies, suture the skin together, and dress their Silent Mentors in formal clothes. The students then join the family members in sending the bodies to the crematorium, followed by a gratitude ceremony where there is sharing and reflection by both the students and family.

Thus far, the Silent Mentor Program has served as a salient example to the anatomy and medical community of how the approach taken to understand the individual donor could enhance the humanity of doctors in training. Having had the privilege of attending a Tzu Chi Surgical Silent Mentor Simulation Workshop, I was able to witness firsthand the indescribably touching ceremony; it is certainly no exaggeration to say there was not a dry eye in the house. This vivid experience has remained firmly etched in my mind.

A critical reason why the Tzu Chi Silent Mentor Program is highly successful and is being emulated by other medical schools is that it has a hardworking team that truly believes in the humanistic approach to the learning of human anatomy, undergirded by unwavering support from the university administration, including Dharma Master Cheng Yen, the founder of the Tzu Chi Foundation. Guo-Fang Tseng himself also leads by example, and his lifetime dedication to the program is aptly reflected in his intention to deliver his last anatomy lessons as a Silent Mentor.

Boon Huat Bay

In his article for the Summer Issues, Guo-Fang Tseng describes the silent mentor program at Tzu Chi University’s School of Medicine, where medical students get to know the body they will dissect by meeting the deceased’s family. Tseng writes that there are notable, concrete outcomes to this approach, but he thinks the program’s effects “are much more profound: it enhances the humanity of clinicians and those they serve.”

I would like to highlight the high cost of not cultivating empathy and humanity in medical professionals. Consider pregnancy and birth, for example. As many as 33% of women report negative or traumatic birth experiences. Estimates of postpartum depression and post-traumatic stress disorder range from 5% to 25%. Even medical spending in the year following birth is substantially higher among women experiencing postpartum depression.

The causes of postpartum PTSD and depression are complex. However, dissatisfaction with social support, lack of control, and mistreatment by medical staff are reasons that rise to the top in studies on the issue—reasons that directly relate to lack of empathy.

In 2007, I visited a Viennese medical museum and saw an eighteenth-century wax anatomical model—a woman with her abdomen dissected and a fetus inside. At the time, I identified with the Enlightenment anatomists who made the model because as a former biology student, I had happily enjoyed dissecting animals. But later that same year, I gave birth for the first time and became one of the many women who left the hospital with a healthy baby and a troubled mind. I suddenly saw myself reflected in the wax model herself, and I felt heartbreakingly linked to the centuries-long anatomical tradition of disconnecting body and mind. In the operating room, I was reduced to an anonymous body on a table and my mind suffered for it.

I have spent years trying to understand what happened to me, and it took me a long time to realize that empathy was a critical missing component. I can’t help but wonder, what if a medical professional had looked me in the eye during or immediately following my ordeal and truly acknowledged all that had happened? I feel certain that regardless of the physiological complications I experienced, being treated as a whole human would have greatly lessened my struggle.

Tseng’s article about the silent mentor program brought tears to my eyes. Empathy can and should be taught, even with a dead body. Authentic human connection during health care interactions is not a nice to have—it is a critical requirement that helps us make meaning from our medical experiences.

Alison Fromme