Table 2.

Main findings from studies investigating personal preparation of medical students for anatomy dissection

Author, year, and journal	Main findings
Attardi et al. 2020, Anatomical Sciences Education [14]	Prior to beginning dissection, statistical equivalence was found in anxiety levels between the 2018 matriculants (38.81 ± 10.782), the 2019 non-video watchers (39.98 ± 12.220), and the 2019 video watchers (41.40 ± 11.909, p = 0.495). Students with prior anatomy experience had significantly less anxiety compared to their peers who did not have exposure (37.75 ± 10.186 vs 43.12 ± 12.569, p = 0.006).
Anyanwu et al. 2015, Advances in Physiology Education [22]	Average cohort stress level, measured with the PSM-9 questionnaire, significantly decreased from 42.7 ± 0.9 before the introduction of background music to 29.4 ± 0.6 after the introduction of background music during anatomy dissection (p < 0.001). Although a control group was included, no formal analysis was conducted.
Arráez-Aybar et al. 2004, The Anatomical Record [10]	Anxiety level in the experimental group before the first dissection was significantly lower than the average anxiety level of the control group (23.82 vs 26.82, p = 0.034). After the first dissection, anxiety significantly decreased in the experimental group (23.82 to 15.26; p < 0.001), and in the control group (26.83 to 13.55; p < 0.001). After the first dissection session, anxiety levels were not significantly different between the two groups (p = 0.17).
Bellier et al. 2020, Anatomical Sciences Education [23]	A significantly lower percentage of students experienced acute anxiety in the music intervention group than in the control group (40.4% vs 60.2%; p = 0.0215). There was a 58% relative decrease in acute anxiety in the experimental group (OR = 0.423; 0.160, 0.710).
Bockers et al. 2012, Medical Education [18]	Attendees of the educational course, in contrast to the control group, experienced significantly reduced mental stress, measured on a 10-cm VAS, from before to immediately after their first encounter with a donor body (3.12 ± 2.17 to 1.98 ± 1.74; p < 0.001). Significant reductions in mental stress were also observed when the experimental group was analyzed based on subgroups. The “infrequent” group decreased from 3.12 ± 2.17 to 2.23 ± 1.89, p < 0.001, and the “frequent” subgroup decreased from 3.12 ± 2.17 to 1.85 ± 1.64, p < 0.001. When asked if their first encounter with the body donor was “better” than expected the “frequent” subgroup significantly differed from the “infrequent” subgroup (3.27 ± 1.11 vs 2.89 ± 1.34, p = 0.046), measured on a 5-point Likert scale. One day before the start of the dissection course, attendees felt less often that anatomical dissection is an additional stress factor, as compared to the control group (1.57 ± 1.28 vs 2.48 ± 1.19, p < 0.001). They were also less likely to report a sense of disgust when thinking about donor bodies (0.65 ± 0.86 vs 0.77 ± 0.80, p = 0.022).
Casado 2012, Advances in Health Sciences Education [11]	Before the first dissection, anxiety levels, measured using STAI, in the experimental group were significantly lower than in the control group (18.6 ± 9.37 vs 24.77 ± 9.59; p < 0.001). After the first dissection session, anxiety levels decreased in the experimental group (18.6 ± 9.37 to 14.07 ± 8.72) and in the control group (24.77 ± 9.59 to 16.79 ± 9.00; p = 0.45). The groups did not significantly differ in anxiety levels after the first dissection.
Chiou et al. 2017, BMC Research Notes [20]	Students were surveyed prior to the ceremony (T1), immediately after during the first phase of the course (T2), and 3 months into the course (T3). Attitudes Toward Death (ATD) increased from 4.77 ± .54 at T1 to 5.04 ± 0.85 at T2 (p < 0.001). Negative emotions toward donor bodies decreased from 2.98 ± 0.94 at T1 to 2.52 ± 0.95 at T2 (p < 0.001). The LEGALS score showed no significant difference before and after the ceremony: 5.65 ± 1.04 T1 to 5.53 ± 1.10 at T2 (p = 0.132). The three-month follow-up (T3) showed ATD remained increased at 5.10 ± 0.75 (p < 0.001) in comparison to T1. Negative emotions remained decreased 2.34 ± 1.04 (p < 0.001) and the LEGALS score significantly increased from 5.84 ± 0.95 (p < 0.001).
Crow et al.2012, Teaching and Learning in Medicine [21]	Anatomy course (T1), 6 weeks later (T2), and at the conclusion of the course (T3). Compared to T1, students in interventional group assessed at T2 had a decreased perception of the donor as a person [2.94 ± 0.19 (T1) vs 2.51 ± 0.19 (T2), p < 0.001], improved perceptions of the dissection process [3.75 ± 0.24 (T1) vs 4.33 ± 0.18 (T2), p < 0.001], and increased perception of the donor as a patient [3.73 ± 0.23 (T1) vs 4 ± 0.17 (T2), p < 0.001]. No significant difference was found in students’ overall “emotions toward cadaver” [3.79 ± 0.2 (T1) vs 4.05 ± 0.15 (T2), p = 0.055], or perceptions of hurting the donor [4.52 ± 0.2 (T1) vs 4.75 ± 0.13 (T2), p = 0.299].
Dosani et al. 2016, Anatomical Sciences Education [12]	After viewing the video, negative attitudes toward dissection increased from 2.911 ± 1.397 to 3.217 ± 1.274 (p = 0.01) and the likelihood of seeing the donor as a person decreased from 4.234 ± 0.903 to 4.059 ± 0.915 (p 0.008). However, negative emotional response to anatomy experience decreased from 2.923 ± 1.087 to 2.655 ± 1.003 (p < 0.001) and positive initial reactions increased from 4.456 ± 1.316 to 4.767 ± 1.2 (p = 0.039).
González-Pinilla et al. 2020, International Journal of Morphology [15]	The experimental group showed a significantly higher number of stress symptoms in comparison to the control group (5.98 ± 4.11 vs 3.40 ± 3.16, p < 0.01). The experimental group was more likely to experience nausea and/or vomiting (p < 0.01), neck and shoulder pain (p = 0.038), diarrhea (p = 0.024), irritability (p = 0.047), and indigestion (p = 0.019). Experimental and control groups exhibited similar symptoms after the first dissection session. Both groups had increases in headaches (p < 0.01), neck and shoulder pain (p < 0.001 in control, p = 0.038 in experimental), and loss of appetite (p = 0.005 in control, p < 0.001 in experimental). Both groups experienced decreases in worrying thoughts (p < 0.001). The control group had a significant decrease in nervousness (p < 0.001) and heart palpitations (p < 0.001) while the experimental group had insignificant changes. After the dissection experience, the control group showed a reduction in stress symptoms, but the experimental group reported a higher rate of symptomatology.
Houwink et al. 2004, Clinical Anatomy [19]	On average, first-year students reported fewer symptoms than second-year students (1.55 vs 2.32). While 64% of first-year students reported symptoms, 88% of the second-year students reported symptoms (p < 0.02). First-year students, in comparison to second-year students, had lower incidence of anxiety (23% vs 48%, p = 0.07), headache (14% vs 36%, p = 0.01), light-headedness (11% vs 24%, no p-value reported), and disgust (9% vs 20%, no p-value reported). First-years were also more likely to report the smell of the laboratory to be better than expected in comparison to second-year students (92% vs 48%, p < 0.05).
Iaconisi et al. 2019, Anatomical Sciences Education [13]	Students were assessed at four timepoints: Immediately before watching the film, after watching the film 1 day before dissection, 60 days after the start of dissection, and 120 days after the start of dissection at the end of the course. Baseline BSI significantly decreased in all groups from the first to the second timepoint. GSI-BSI scores increased from the second to the third and fourth timepoints (p < 0.001). GSI scores in the control group were higher than the interventional groups, but without significance (p = 0.54).
Javadnia et al. 2006, Pakistan Journal of Medical Sciences [17]	The experimental group had significantly lower anxiety scores at the initial visit to the dissection laboratory (p < 0.01). In the control group, anxiety declined significantly (p < 0.08) over the study period and ultimately there was no statistically significant difference in anxiety rates between experimental and control groups at the 6-week mark.
Saylam et al. 2005, Surgical and Radiologic Anatomy [16]	Anxiety was measured using two STAI scales at two timepoints: before orientation and after dissection. In the experimental group, STAI Trait anxiety increased from 41.31 ± 9.06 at the first timepoint to 42.42 ± 7.51 at the second timepoint. STAI State anxiety decreased in the experimental group from 42.39 ± 8.29 to 41.44 ± 7.63. In the control group, STAI Trait anxiety increased from 40.14 ± 10.67 to 41.48 ± 9.32. STAI State anxiety increased in the control group from 42.67 ± 10.44 to 43.55 ± 11.28. None of the differences reached significance.

STAI State-Trait Anxiety Inventory PSM-9 Psychological Stress Measure-9, VAS Visual Analog Scale, ATD Attitude Towards Death, GSI-BSI Global Severity Index—Brief Symptom Inventory