The importance of teaching trainee doctors about the anatomy and dealing with death

Doctors save countless lives in the course of their work, but have to look death in the face on a daily basis.

Of paramount importance is their ability to handle bereavement with professionalism and to empathise with the friends and family of the deceased.

 Young trainees at Cardiff School of Medicine are confronted with cadavers in their first few weeks of study. The aim is to teach them practically about the body before they are thrown onto hospital wards.

Professor Bernard Moxham, an expert in anatomy at Cardiff School of Medicine, says: “We have an international reputation for teaching dissection, which stems from our belief in experiential learning. Imagine if the students didn’t see [a cadaver] and then their first experience of death was seeing a patient dying on the ward.”

Traditionally anatomy was taught theoretically. Students learnt from books and with the aid of a demonstrator. Since the 1832 Anatomy Act, doctors, teachers and students have been allowed to dissect. And today’s aspiring doctors learn from donated cadavers. 

Controversy hit the practise in 2002 when German anatomist Professor Gunther von Hagens performed a public post-mortem examination in the UK, even though the Government warned it was illegal. Channel 4 screened the first live autopsy since the 1830s in front of a paying crowd in London, despite complaints and police threats to intervene.

Body donations to the medical have fluctuated but are currently sufficient. Some of next year’s cadavers are already in storage, preserved like all the bodies in embalming fluid.

Prof Moxham said: “There is a real commitment in this community towards helping medical education, which means we unlike some medical schools are in a privileged position.”

Awe and curiosity are the overriding emotions of those stepping into the dissection room for the first time. All 300 students fill the room, dividing into small teams and taking different roles.

Death is a difficult lesson to learn, and the trainees are advised to  respond creatively to the experience. Prof Moxham said: “The students are encouraged to write short stories, poems or a dramatic dialogue. When we read the stories, they literally brings tears to my eyes.”

Hattie Clarke, a 21-year-old medic living in Cathays, said: “ It encourages us to treat them with respect, remembering they were people’s family and friends.” Her friend Grace Wright, who is about to complete her first year studying medicine agreed.  She said: “It’s important to reflect on what you do.”

Teaching the science comes by learning and applying case studies. This method enables students to put the theory of medicine into practice in the context of a clinical scenario. Case studies cover every aspect of surgery.

Professor David Wilson Sub Dean for Basic Medical Sciences at Cardiff said: “For example, the first case we have is a leg injury involving radiology. They need to learn the compartments of the leg before they can understand the injury.”

Dissection allows the trainees to observe the complexities of the human body in their entirety. Prof Wilson said: “Anatomy has always been the subject allowing students to put the whole picture together.

“We believe the anatomy of the dissection room is the anatomy of the future, even though some people say it is a subject of the past. Without dissection it’s very difficult to visualise structures.”

Experts maintain dissection is a cornerstone of modern medical practise. Prof Moxham added: “The very strong feeling of those entering the medical profession is these were real people with real relatives. This understanding could never be achieved by reading a book.”