Medical students should be better prepared for observing postmortem examinations
BMJ 2024; 387 doi: https://doi.org/10.1136/bmj.q2453 (Published 07 November 2024) Cite this as: BMJ 2024;387:q2453
- Annie Graham, fourth year medical student, UK
“Have you ever seen a dead body?” This was the only question I was asked by the autopsy technician before witnessing my first postmortem examination. It was a difficult one to answer. I had seen cadavers in anatomy rooms before, and even dissected them, but I had never seen a recently deceased person. I decided to say that I had, and with my psychological preparation deemed sufficient, I went into the examination room.
Observing a postmortem examination was presented to me as a fantastic way to gain a close understanding of human anatomy in a more immersive setting and to appreciate pathologies in their entirety. But the lack of information I was given about the technical practice of the examination meant that I was too shocked to take in much of the anatomy shown to me. It was a privilege to be able to observe, but receiving a detailed brief in advance would have helped to create a more receptive learning environment and maximise the educational benefit.
A mixed experience
Attending postmortem examinations is not a specific requirement of my university’s curriculum, but it was heavily promoted in our introductory lectures as an important “learning experience.” Studies have shown, however, that observing an examination can have mixed effects on students. One small study found that medical students may perceive the observation as an entirely practical “learning experience,” a slightly unnatural situation, or even just an opportunity to see how pathologists go about their job.1 For some students, viewing a postmortem examination is an excellent way to bridge clinical and pathological findings to elucidate the processes of disease and to cement their understanding of important anatomy. For others, the experience is too anxiety inducing and distressing to glean any relevant information, with students’ discomfort greatest at their first viewing.12
I was in the latter cohort. There are marked differences between the cadavers we examine in the anatomy centre at medical school and the bodies presented in a postmortem examination room that are merely days old. This contrast is not always made explicit to students beforehand, but it should be so that students understand the distinction between examining carefully preserved cadavers and bodies that are “closer to life.”
Some students may never have seen a dead person’s face before, as a number of UK medical schools have moved away from whole body dissections to a pro-section approach. This sees an experienced anatomist dissect the body before students examine relevant pathology, and in these instances the head of the corpse is usually covered by a sheet. Strong emotional reactions are not uncommon in the anatomy centre but medical students will have at least received detailed preliminary teaching to prepare them for the reality of a dissection. This preparatory teaching should be translated to postmortem viewings during clinical placements.
Structured support
In recent years the number of postmortem examinations carried out in hospital settings has declined,3 but students continue to shadow pathologists in mortuary environments and they should be provided with appropriate emotional and logistical support. Students’ expectations could be set using educational information sheets, discussions in pathology lectures, or simply a short introduction by an autopsy specialist before they enter the examination room. Whichever method is used, it would be helpful for educators to follow a standardised template to maximise students’ learning experience.
For families who wish to view the postmortem examination of a loved one, some trusts enlist a “cooling off” period that helps them to decide if this is a process they want to see.4 Although medical students will not have a personal connection to the subject, having a structured opportunity for reflection, where they can change their mind, would give students permission to skip observing the postmortem examination. It would also allow them to contemplate the reality of standing in that examination room, and whether it would be beneficial—on a personal level—for their education.
Feedback from medical students and tutors indicates that many students gain useful holistic pathological knowledge from viewing postmortem examinations—particularly those who are interested in pursuing a pathology specialty.5 The “shock factor” element of an examination should not discourage this cohort of medical students and their curiosity for human anatomy.
I don’t regret my experience of observing a postmortem examination. My subsequent reflections on death, maintaining a patient’s dignity after life, and my own psychological expectations of observing this procedure, have given me a better understanding of the approaches and values I hope will govern my future medical practice. However, the anatomical knowledge I learnt was limited, and I would have benefitted from being more thoughtfully and sensitively prepared before the observation.
The effect of observing death, especially during a postmortem examination, can be considerable, but it’s one that’s easily underestimated during medical training. I hope that in future, medical schools and educators place more emphasis on the ways they can support students to cope with these emotionally challenging experiences.
Footnotes
Competing interests: None declared.
Provenance and peer review: Not commissioned; not externally peer reviewed.