Observational Exercise in the Anatomy Lab and Narrative Reflection Contribute to Professional Identity Formation in Medical Students
Authors: Sorrentino Gina , Rennie William , Fornari Alice , Metzger Keith 
Published: November 2023

Background and Study Objectives

The anatomy laboratory can contribute to early professional identity formation by encouraging medical students to adopt and express the foundational values of humanism, professionalism, and reflection. Ideally, this should include considering the humanity of the donors, confronting any personal fears or reservations, developing a facility for asking questions and making hypotheses, and reflecting on the experience in writing. We designed an experience for first year medical students around these goals. This exercise involved unrestricted observation, inspection, and interaction with anatomical donors prior to dissection, followed by narrative reflection on the experience.

Methods

On their first day of medical school, students participate in a detailed observation of a donor body prior to a simple first dissection assignment. The goal is for them to observe all aspects of the donor's body and make inferences about the donor's life and possible underlying medical conditions. They are encouraged to touch, move, and examine the donor in any way they see fit. After 45 minutes, the students discuss their observations with the faculty facilitator. Later in the week, groups meet with their facilitators again and write a narrative reflection about their experience in the laboratory, which are shared with the group

Methods of Thematic Analysis

Grounded theory analysis was conducted to identify thematic categories and subthemes from student narratives (GS and KM). Narratives were reviewed until thematic saturation was established, and then 230 narratives representing three classes of students were independently coded by two of the authors (GS and KM). Following independent review, collaborative review was conducted and disputed thematic coding was mediated by additional authors (AF and WR).

Final Themes

We developed seven thematic categories with a total of 23 sub‐themes. Six of the major thematic categories involved the narrative's author describing some kind of interaction, and are defined by interaction with: (1) self, (2) the donor, (3) colleagues, (4) faculty, (5) the curriculum, and (6) the medical profession. A seventh theme was assigned to narratives that were not reflective and merely summarized the exercise.

Results and Conclusions

An average of 2.44 subthemes per narrative were identified. The most predominant thematic categories were reflection on personal reactions (59%), reflection on the donor (60%), and reflection on the medical profession (17%). The most frequent sub‐themes identified were recognition of the humanity of the donor (39%), gratitude towards the donor/donor's family (38%), and anxiety about the exercise with explicit resolution of emotions (34%). The frequency of these themes in the students' written reflections is evidence that the goals of the exercise have been accomplished. Students confront their own fears and nervousness, recognize the humanity of the donors, and begin to contemplate the steps they are taking towards a career in medicine – all of which contribute to the formation of their early professional identity.