Analysis of anxiety levels and perceived satisfaction after a first encounter with human body prosection among nursing undergraduates based on their self‐perceived presession nervousness: An observational study

Abstract

Human body prosection practices are a crucial educational tool for learning anatomy. However, the first exposure to donors' material can cause anxiety, which may affect students' learning experiences and emotional adjustment. This observational study aimed to analyze anxiety levels (state and trait) before and after a prosection session in first‐year nursing undergraduates, as well as perceived satisfaction, considering their previously perceived subjective level of nervousness. A total of 231 students participated voluntarily. Participants were grouped according to their self‐perceived nervousness (low vs. high). Anxiety was assessed using the State–Trait Anxiety Inventory (STAI) before and after the activity, along with postactivity satisfaction questionnaires. The results showed a significant decrease in both state and trait anxiety after the session (p < 0.0001), particularly among students who reported higher initial nervousness. Satisfaction with the activity was high in both groups, with no significant differences. Interestingly, higher presession nervousness was not associated with lower satisfaction. Correlation analyses revealed that higher anxiety was moderately associated with lower satisfaction only in the low‐nervousness group. In conclusion, the findings suggest that the most stressful aspect of prosection is the uncertainty about what students will encounter. After the session itself, anxiety levels decrease significantly. Therefore, future studies should explore interventions that help students become familiar with the dissection process before the practical session.

INTRODUCTION

Prosection, defined as the observation and study of anatomical structures in donors' bodies previously dissected by specialists, is an essential methodology in the teaching of human anatomy. This technique allows students to explore the morphology and spatial relationships of organs and systems in the human body in a detailed and realistic way, facilitating a deep understanding of bodily structure that is difficult to achieve through other learning methods. In this regard, Garvey et al. found that exposure to dissected human bodies in anatomy teaching provides nursing students with a positive and enriching learning experience. ¹

The use of donor bodies in medical education has been the subject of debate due to ethical, logistical, and emotional considerations. Despite the emergence of advanced digital technologies—such as augmented reality and three‐dimensional printing—that offer innovative alternatives for anatomy learning, human dissection, and prosection remain highly valued for providing irreplaceable tactile and visual experiences. ² , ³ These practices not only enrich theoretical knowledge but also develop essential practical skills for clinical practice. ⁴ A study conducted in 2010 concluded that exposure to donors' material enables nursing students to handle and interact with anatomical structures, contributing to a more integrated and applied understanding of the human body. ⁵

Anatomy is a fundamental subject in nursing education, as it provides the essential knowledge needed to understand human body functions and pathologies. A strong foundation in anatomy is crucial for performing accurate clinical assessments, planning care interventions, and communicating effectively with other healthcare professionals. The integration of practical teaching methods, such as prosection, into the nursing curriculum enhances knowledge retention and better prepares students to face real clinical situations with greater confidence and competence. The aforementioned research by Garvey et al. also concluded that students who participated in anatomy sessions involving dissected donors' bodies felt more prepared to deal with death‐related situations in hospital settings. ¹ The first contact nursing students have with human cadavers during prosection sessions can be an emotionally intense experience. ¹ This direct encounter with death can generate significant levels of anxiety and stress. However, confronting these emotions in a controlled and educational environment is essential for professional development. ⁶ , ⁷

Despite advances in understanding the factors that influence academic anxiety, there remains a notable lack of studies that segment samples based on students' subjective perception of nervousness prior to specific activities such as prosection. This omission is relevant, as the personal interpretation of a situation can modulate the intensity of the emotional response and influence both pre‐activity anxiety and postactivity satisfaction. According to Lazarus and Folkman's stress theory (1986), stress does not reside solely in the external stimulus but in the cognitive appraisal the individual makes of it. ⁸

In this line, in the present study, a distinction is made between self‐perceived nervousness and state anxiety, as measured by the STAI‐S. Self‐perceived nervousness refers to the student's subjective, anticipatory appraisal of the forthcoming prosection experience and is assessed prior to the exposure to the prosection environment. Such anticipatory evaluations constitute part of the primary cognitive appraisal process and may influence subsequent emotional responses, following Lazarus and Folkman's theory. In contrast, state anxiety reflects the individual's emotional and physiological response triggered by direct exposure to a stressor, then capturing situational emotional responses. Although related, these constructs are not conceptually equivalent: anticipatory nervousness represents an expectation‐based appraisal, whereas state anxiety represents a psychometrically measurable affective state.

This approach has been supported by recent research showing how subjective perception of academic stress is associated with significant consequences for students' mental health and academic performance. ⁹ In particular, longitudinal studies have demonstrated that elevated levels of academic stress are associated with increased depressive symptoms and decreased heart rate variability—an indicator of autonomic dysfunction—highlighting the need for interventions aimed at improving students' psychological well‐being. ¹⁰

Based on the above, the primary objective of this study was to compare, according to the previously perceived subjective level of nervousness, the degree of anxiety before and after the prosection activity among first‐year nursing students with no prior exposure to prosection. The secondary objective was to compare the level of satisfaction with the prosection activity in these same students, considering their previously perceived level of nervousness. The research hypothesis expects that (1) those subjects with a higher self‐perceived subjective level of nervousness will show a higher state anxiety before prosection; (2) both groups will reduce state anxiety after exposure to prosection; and (3) the level of satisfaction will be higher in those individuals showing lower anxiety levels.

METHODS

Study design and participants

A descriptive observational pre/postprosection practical activity study was conducted during the 2023–2024 and 2024–2025 academic courses with a total of 231 first‐year students enrolled in the subject Anatomy and Human Biology (12 ECTS, of which 8 ECTS correspond to anatomy; being 5.5 theoretical ECTS and 2.5 practical ECTS) within the Degree in Nursing at the Faculty of Medicine and Health Sciences at the University of Alcalá (Alcalá de Henares, Madrid, Spain). This year‐long subject comprises lectures, seminars, practical sessions with anatomical models, prosection sessions, and training in surface anatomy. The first prosection session (that of our study) took place halfway through the second semester. At that point, students had already completed a semester of theoretical and practical training and passed a midterm exam, which allows them to contextualize the prosection experience and integrate it with the anatomical knowledge they have previously acquired. The practical session involved a 2‐h human prosection focusing on the thoracic and abdominopelvic cavities.

Undergraduates' participation was voluntary, and those who agreed to participate in the study signed informed consent forms. Prior to the activity, all students were verbally informed about the session and the necessary precautions, including the use of appropriate clothing, in accordance with the “Dissection Room and Facilities Regulations of the Human Anatomy and Embryology Teaching Unit of the Faculty of Medicine and Health Sciences at the University of Alcalá” to ensure proper use and maintenance of the facilities and all materials.

Self‐perceived nervousness was used as a grouping variable, given the impact of this anticipatory evaluation on subsequent emotional responses. Then, participants were classified into two groups: “low nervousness group” and “high nervousness group.” Group 1 consisted of 118 participants reporting low levels of nervousness, whereas Group 2 included 113 participants with high self‐reported nervousness prior to the activity. The study was conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and adhered to the principles of the Declaration of Helsinki. ¹¹ It was approved by the Ethics Committee at the University of Alcalá (CEIP/2024/4/097).

Inclusion criteria

Participants were selected based on the following criteria: (a) enrollment in the Anatomy and Human Biology course of the Degree in Nursing and (b) no prior experience with human dissection or prosection.

Exclusion criteria

Participants were excluded if they had previously engaged in human dissection or prosection activities or if they did not have sufficient proficiency in Spanish to properly complete the self‐administered questionnaires.

Procedures and instruments

Twenty minutes before entering the dissection room, students completed a sociodemographic questionnaire, followed by another questionnaire specifically created for this study in which they were asked about prior experience with human dissection/prosection activities, their subjective level of nervousness measured on a 0‐to‐10 scale (0 = “not nervous at all,” 10 = “extremely nervous”), and their prior interest level in the activity on a 0‐to‐10 scale (0 = “no interest,” 10 = “maximum interest”). Subsequently, they completed the self‐administered State–Trait Anxiety Inventory (STAI) before the activity. After the session, undergraduates completed the STAI again, as well as a satisfaction scale regarding the activity.

The STAI is a validated self‐administered questionnaire for measuring anxiety in healthy adults in the Spanish population. ¹² It consists of two scales measuring state anxiety (STAI‐S) and trait anxiety (STAI‐T), validated as a whole in the literature, offering different aspects of the variable “anxiety,” and providing consistency. The STAI‐T assesses an individual's baseline anxiety level, whereas the STAI‐S evaluates how a person feels in a specific stressful situation. Both questionnaires contain 20 items answered on a 4‐point Likert scale: 0 = not at all, 1 = somewhat, 2 = moderately, 3 = very much. The STAI has a Cronbach's alpha of 0.93 for STAI‐T and 0.92 for STAI‐S. ¹²

Statistical analysis

Statistical analysis was performed using SPSS version 26.0 (SPSS, Inc., Chicago, IL) and GraphPad Prism 7 (GraphPad Software Inc., San Diego, CA, USA). Results with a p‐value ≤ 0.05 were considered statistically significant. Given the sample size (n = 231) and in accordance with the Central Limit Theorem, study variables were assumed to follow a normal distribution. Thus, parametric tests were chosen for inferential analyses. ¹³ , ¹⁴ , ¹⁵ , ¹⁶

In the first phase, data from the entire cohort of 231 participants were analyzed. Since questionnaires were completed by the same participants before and after the prosection activity, paired t‐tests were used for comparisons. Demographic data were analyzed using descriptive statistics and expressed as mean ± standard deviation (SD). Pearson's chi‐squared test was used to analyze between‐group differences in categorical variables such as sex and educational level, expressed as percentages (%). Independent samples t‐tests were employed to evaluate intergroup differences regarding age, prior interest level, and satisfaction with the activity.

In the second phase, a repeated‐measures ANOVA was applied to examine differences between groups and within groups in pre‐ and poststate anxiety and trait anxiety levels related to the prosection. Bonferroni post hoc tests identified significant differences in pairwise comparisons. Effect size for the ANOVA was estimated using partial eta squared (η _p ²), with values of 0.01–0.059 indicating a small effect, 0.06–0.139 a medium effect, and >0.14 a large effect. Cohen's d was used as an estimator of effect size for post hoc comparisons. Cohen's d values below 0.49 were considered small, between 0.50 and 0.79 medium, and above 0.80 large. ¹⁷

Relationships between variables were examined using Pearson correlation coefficients. A coefficient above 0.70 indicates a strong correlation, between 0.40 and 0.69 indicates a moderate correlation, and below 0.39 indicates a weak correlation. ¹⁸

RESULTS

The results of the study were divided into two phases: the first phase analyzing the entire sample and the second phase comparing the two groups.

Single‐sample analysis

The paired t‐test analysis revealed highly significant differences (p < 0.0001) when comparing scores before and after the prosection activity. As shown in Figure 1, both the STAI‐State (STAI‐S) and STAI‐Trait (STAI‐T) questionnaires demonstrated a significant reduction in mean scores postactivity. Notably, in the STAI‐S questionnaire, the pre‐ vs. postactivity difference was particularly striking, with a large visual variation in the graphical representation. Although the graphical difference in STAI‐T appeared less pronounced, statistical analysis still revealed a highly significant difference (p < 0.0001).

FIGURE 1.

Analysis of anxiety levels (state and trait) pre‐ and postprosection. Panels show the overall cohort (A and B), and subgroups classified according to prior subjective nervousness level (C and D). Measurements were assessed by the State‐Trait Anxiety Inventory (STAI). General population: (A) Mean scores (±SEM) of State Anxiety (STAI‐AS) pre‐ and postintervention. (B) Mean scores (±SEM) of Trait Anxiety (STAI‐AT) pre‐ and postintervention. Nervousness subgroups: (C) Mean scores (±SEM) of State Anxiety (STAI‐AS) pre‐ and postintervention for low (LNG) and high nervousness groups (HNG). (D) Mean scores (±SEM) of Trait Anxiety (STAI‐AT) pre‐ and postintervention for low (LNG) and high nervousness groups (HNG). HNG, High Nervousness Group; LNG, Low Nervousness Group; SEM, standard error of the mean; STAI‐S, State‐Trait Anxiety Inventory‐State Anxiety; STAI‐T: State‐Trait Anxiety Inventory‐Trait Anxiety. ****p < 0.0001.

Comparative analysis (“Low Nervousness Level” vs. “High Nervousness Level”)

Descriptive data

The sample consisted of 231 first‐year Nursing students, classified into two groups, “low nervousness group” and “high nervousness group,” based on the median of the self‐reported nervousness level on a 0 to 10 scale (0 = “not nervous at all,” 10 = “maximum nervousness”), with a median value of 4. Group 1 included 118 participants reporting low nervousness (1.56 ± 1.47), whereas Group 2 comprised 113 participants reporting high nervousness before the activity (6.31 ± 1.56). No statistically significant differences were found between the groups in terms of age, sex, prior interest level, or postactivity satisfaction scores. However, statistically significant differences were found in educational level and prior experience in health sciences, with higher education levels and more frequent previous exposure observed in the low‐nervousness group (p < 0.001). Table 1 presents a detailed summary of these variables for both groups.

TABLE 1.

Descriptive statistics of demographic data.

Variable	General population	Lower Nervousness Group (n = 118)	Higher Nervousness Group (n = 113)	p‐Value
Age (years)	20.09 ± 4.46	20.59 ± 5.33	19.57 ± 3.25	0.080b
Sex (% female)	85.3%	83.1%	87.6%	0.328a
Interest level (pre)	9.39 ± 1.26	9.34 ± 1.18	9.45 ± 1.35	0.535b
Nervousness level (pre)	3.88 ± 2.82	1.56 ± 1.47	6.31 ± 1.56	<0.001b
Education level (% higher education)	30.3	39.83%	20.35%	<0.001a
Prior related studies (%)	31.2	41.52%	20.35%	<0.001a
Postactivity satisfaction	24.09 ± 1.94	23.92 ± 1.87	24.27 ± 2	0.181b

Note: Values are presented as mean ± standard deviation or number (%). Statistical tests used: ^aChi‐squared test; ^bIndependent Student's t‐test. p < 0.05 was considered statistically significant.

Comparative analysis

Pre‐post anxiety (STAI‐S)

Regarding state anxiety, repeated‐measures ANOVA showed statistically significant differences in the time factor (F = 95.62, p < 0.001, η ² = 0.295), indicating a substantial reduction in anxiety levels before and after the activity. Additionally, a statistically significant interaction between time and group was observed (F = 36.28, p < 0.001, η ² = 0.137), suggesting that the evolution of state anxiety differed based on nervousness group. Post hoc analysis revealed significant within‐group differences in both groups, with a greater reduction in the high‐nervousness group following the activity (Table 2).

TABLE 2.

Within‐ and between‐group results of the primary variables.

Variable		Pre (mean ± SD)	Post (mean ± SD)	Mean difference (95% CI); effect size (d)
STAI‐AS	Lower Nervousness Group	10.87 ± 5.95	8.59 ± 8.33	2.28** (0.96 to 3.60); d = 0.31
	Higher Nervousness Group	20.12 ± 9.90	10.52 ± 9.35	9.59** (7.55 to 11.63); d = 0.99
Mean difference (95% CI); effect size (d)	LNG vs. HNG	−9.24** (−11.35 to −7.14); d = −1.13	−1.93 (−4.22 to 0.36); d = −0.22
STAI‐AT	Lower Nervousness Group	21.29 ± 9.1	19.58 ± 8.91	1.71** (1 to 2.43); d = 0.19
	Higher Nervousness Group	22.88 ± 8.64	20.90 ± 9.22	1.97** (1.09 to 2.85); d = 0.22
Mean difference (95% CI); effect size (d)	LNG vs. HNG	−1.59 (−3.89 to 0.71); d = −0.18	−1.33 (−3.68 to 1.02); d = −0.15

Abbreviations: CI, confidence interval; HNG, Higher Nervousness Group; LNG, Lower Nervousness Group; SD, standard deviation; STAI‐AS, State Anxiety Questionnaire; STAI‐AT, Trait Anxiety Questionnaire.

^** p < 0.001.

Pre‐post anxiety (STAI‐T)

Regarding trait anxiety, repeated‐measures ANOVA revealed significant differences in the time factor (F = 41.72, p < 0.001, η ² = 0.154), indicating a decrease in trait anxiety after the activity. However, no significant interaction between time and group was found (F = 0.21, p = 0.647, η ² = 0.001), indicating that the change in trait anxiety was similar across both groups. Post hoc analyses confirmed a significant reduction in trait anxiety within both groups, with no statistically significant differences between them (Table 2).

Satisfaction with the activity

The mean and standard deviation for satisfaction scores in the overall population was 24.09 ± 1.94 out of a maximum of 25. No significant differences were found between groups for this variable, although the highest satisfaction score was recorded in the high‐nervousness group (Table 1).

Correlation analysis

Table 3 presents the results of the correlation analysis examining bivariate relationships among variables for both groups. In the low‐nervousness group, only weak correlations were identified, with the most notable being a positive correlation between preactivity interest level and postactivity satisfaction (r = 0.375; p < 0.01), and a negative one between preactivity trait anxiety and postactivity satisfaction (r = −0.349; p < 0.01). In contrast, in the high‐nervousness group, a moderate negative correlation was observed between preactivity state anxiety and preactivity interest level (r = −0.473; p < 0.01) (Table 3).

TABLE 3.

Pearson bivariate correlation analysis.

		Age	Preactivity interest level	STAI‐AS pre	STAI‐AT pre	STAI‐AS post	STAI‐AT post	Postactivity satisfaction
Age	LNG	1	0.141	−0.284 **	−0.126	−0.218 *	−0.146	0.167
	HNG	1	0.024	−0.079	−0.253 **	−0.047	−0.227 *	−0.078
Preactivity interest level	LNG	0.141	1	−0.228 *	−0.036	−0.317 **	−0.069	0.375 **
	HNG	0.024	1	−0.473 **	−0.244 **	−0.315 **	−0.227 *	0.159
STAI‐AS pre	LNG	−0.284 **	−0.228 *	1	0.483 **	0.531 **	0.461 **	−0.251 **
	HNG	−0.079	−0.473 **	1	0.487 **	0.355 **	0.519 **	−0.200 *
STAI‐AT pre	LNG	−0.126	−0.036	0.483 **	1	0.479 **	0.905 **	−0.349 **
	HNG	−0.253 **	−0.244 **	0.487 **	1	0.197 *	0.862 **	0.000
STAI‐AS post	LNG	−0.218 *	−0.317 **	0.531 **	0.479 **	1	0.521 **	−0.250 **
	HNG	−0.047	−0.315 **	0.355 **	0.197 *	1	0.405 **	−0.291 **
STAI‐AT post	LNG	−0.146	−0.069	0.461 **	0.905 **	0.521 **	1	−0.337 **
	HNG	−0.227 *	−0.227 *	0.519 **	0.862 **	0.405 **	1	−0.058
Postactivity satisfaction	LNG	0.167	0.375 **	−0.251 **	−0.349 **	−0.250 **	−0.337 **	1
	HNG	−0.078	0.159	−0.200 *	0.000	−0.291 **	−0.058	1

Note: Bold indicated only in those cases were differences were found statistically significant.

Abbreviations: HNG, Higher Nervousness Group; LNG, Lower Nervousness Group; STAI‐AS, State Anxiety Questionnaire; STAI‐AT, Trait Anxiety Questionnaire.

^* p < 0.05.

^** p < 0.001.

DISCUSSION

The results of our study show a significant reduction in state anxiety levels among students following the prosection activity, regardless of their prior subjective nervousness. This indicates a reduction in the anxiety levels experienced by a transient and stressful situation (i.e., a prosection activity). This finding is consistent with the results of Romo‐Barrientos et al., who observed a decrease in state anxiety levels from a mean of 21.3 to 17.8 after the activity, suggesting a positive emotional adaptation following initial exposure to the cadaver. Such adaptation fosters deeper learning and better prepares students for real clinical situations by enhancing emotional regulation. ¹⁹

Similarly, our findings align with those of Mohedano‐Moriano et al., who studied podiatry students and reported a significant reduction in anxiety levels after prosection, although women showed higher anxiety levels both before and after the activity. Their study also found greater acceptance of this technique compared to alternatives such as clinical cases or images. ²⁰

In our study, trait anxiety levels did not differ between groups (lower and higher nervousness groups) before the activity, and neither after it. As exposed above, trait anxiety assesses an individual's baseline anxiety level, showing a more stable nature, compared to state anxiety. These data provide consistency to the comparison between groups by reflecting a similar basal anxiety state. On the other hand, trait anxiety levels showed a statistically significant reduction pre‐ vs. postprosection within each group, although the variation was less marked than that of state anxiety. This reduction may reflect a subjective reevaluation or recalibration of anxiety‐related self‐perception following the experience, suggesting emotional reappraisal after direct exposure. Whether this lower trait anxiety would be stable (maybe as a consequence of a vital experience dealing with death and life) or just transient (due to a momentary reevaluation of anxiety feelings) should be tackled in a longitudinal approach, with a more comprehensive methodology.

In contrast, a study involving physiotherapy students found no significant difference in anxiety levels before and after prosection, indicating a lack of effective emotional adaptation. Students cited factors such as the smell of the dissection room and viewing the donor's face as hindrances to the adjustment process. ²¹

Furthermore, according to Arráez‐Aybar et al., a gradual exposure or preparatory process (e.g., visits to the facility, verbal information, videos) can mitigate emotional impact by reducing anxiety levels as the experience is repeated. In our present study, no progressive desensitization strategies were applied. In the future, preparatory interventions could include dissection videos, a photographic guide to human body dissection, or even 3D corpse models. However, the fact that anxiety was significantly reduced after a single session supports the idea that even first exposure, when appropriately accompanied by instructors, can be effective. ⁶

This phenomenon becomes particularly relevant considering the findings of Maza‐Ramón and Carrión‐Cabrera, and those of Castillo‐Pimienta et al., who reported extremely severe anxiety levels in nursing students prior to such activities—levels notably higher than those observed in other health disciplines such as medicine. ²² , ²³ These data highlight the importance of providing emotional and academic support during students' first encounters with the human body.

Regarding satisfaction with the prosection experience, our results revealed remarkably high levels, with a mean score of 24.09 ± 1.94, very close to the maximum on the scale. This is consistent with the findings of Romo‐Barrientos et al. (2020), in which over 90% of participants recommended the prosection activity, emphasizing its educational and emotional value. ¹⁹ Similarly, Criado‐Álvarez et al. (2016) conducted a study with speech therapy students with no prior dissection experience and reported a high overall evaluation score (9.1 out of 10). ²⁴ The authors noted that curiosity and respect for the human body have a positive impact on students' holistic learning, ²⁴ a conclusion also reflected in our study, where interest prior to the activity was notably high (9.39 ± 1.26).

In this regard, although some studies—such as the one mentioned above involving physiotherapy students—did not observe significant anxiety reductions, they did report high levels of curiosity (81.8% of the sample), a factor that also played a key role in our study and appears to influence students' emotional and cognitive engagement. ²¹

Dissection and prosection remain fundamental tools in anatomical education for health sciences students. As noted by Mohedano‐Moriano et al., students consider this methodology superior to others such as medical imaging or clinical case analysis. ²⁰ Moreover, it provides holistic learning that extends beyond anatomical knowledge, fostering emotional and professional skills essential for clinical practice.

Exposure to human donors' bodies creates a space for deep personal reflection. Criado‐Álvarez et al. reported that over half of the students expressed thoughts about life and death, and 12.8% reported feelings of anxiety, reinforcing the comprehensive educational value of this experience. ²⁴ This human dimension cannot be replicated through virtual or exclusively digital resources. In this context, the role of the instructor is crucial: providing support, creating a safe environment, and guiding reflection are key components that facilitate progressive adaptation to the dissection setting. ⁶ In our experience, such support was essential in helping students—without prior exposure to prosection– engage with the activity with interest and satisfaction, despite initial nervousness.

In recent years, various technological tools have emerged to enhance anatomical learning, including virtual dissection tables, interactive atlases, and audiovisual resources. Aguado‐Henche et al. (2024) ²⁵ emphasize that while these technologies can complement corpse‐based learning—particularly in early stages—they cannot replace the physical experience of interacting with a real human body. ²⁵ As many authors agree, dissection remains irreplaceable for fostering empathy, respect, and emotional resilience. Therefore, we argue that new technologies should be viewed as supplements, not substitutes, for the human body experience. ²⁰ , ²⁴ , ²⁶

This study has several limitations that should be considered. Although the sample included over 200 students, the size may still be considered relatively small compared to other studies conducted with human cohorts, which may limit the generalizability of the findings. Additionally, the study population consisted solely of first‐year Nursing students, without including students from other health‐related disciplines such as Medicine or Physiotherapy. It would be interesting in future research to consider multicenter designs with samples from other universities and even to conduct comparative studies between different health science studies. Thus, expanding the sample in future research would enhance the breadth of the findings.

Moreover, the observational design of the study is an inherent limitation, as it does not allow for causal inferences between the variables. To address this, longitudinal or interventional studies are recommended to track students' emotional evolution over time and assess the effectiveness of coping strategies. In addition, potentially relevant confounding factors such as prior exposure to death, personal experiences of loss, or baseline mental health status were not assessed, as these aspects were not explored through specific questions in the questionnaire. While this decision was made to minimize respondent burden in an academic setting, future studies should consider including these variables, given their potential influence on students' emotional responses to human dissection or prosection. In this regard, it would be particularly valuable to monitor objective physiological variables such as heart rate variability, given that previous studies have linked high academic stress levels with autonomic dysfunction and depressive symptoms. These measures would allow for a more comprehensive evaluation of students' baseline emotional states and contribute to the development of more targeted interventions aimed at improving psychological well‐being.

In addition, an important methodological limitation is that self‐perceived nervousness was assessed using a single‐item 0–10 scale specifically designed for this study, which has not yet undergone formal psychometric validation in nursing students. Although this approach was adopted for pragmatic reasons, and to reduce respondent burden in a time‐constrained educational setting, single‐item measures may present lower psychometric robustness than multi‐item instruments. Nevertheless, there is evidence from educational and clinical contexts supporting the use of simple single‐item scales to assess anxiety or stress, showing acceptable validity and reliability for rapid screening purposes. ²⁷ , ²⁸ , ²⁹ , ³⁰ As far as the authors know, there does not exist any already validated single‐item measure to assess anxiety in health sciences students. Therefore, our findings should be interpreted with caution, and future studies should either validate the nervousness scale used in this study or design another one specifically for the context.

Finally, another important limitation is not having explored the reasons for students' perception of nervousness in depth through open‐ended questions, so in future research it would be interesting to consider the use of mixed methodological models to perform qualitative and quantitative analyses. Also, this methodology would allow us to identify first‐order and intrinsic concerns of undergraduates regarding the prosection, as well as their emotional adjustment and high satisfaction after the activity.

CONCLUSION

The results of this study showed that anxiety levels after a prosection activity were reduced in first‐year Nursing students with no prior experience in this practice. A particularly notable and statistically significant decrease was observed in the levels of state anxiety, showing a large size effect in the higher nervousness group (according to Cohen's d). Trait anxiety also showed a statistically significant reduction (with a small size effect) within groups, comparing the levels before and after the prosection activity. Whether this latter reduction is long‐lasting or just transient (due to a momentary recalibration of anxiety feelings) should be analyzed in a longitudinal experimental design. Moreover, although participants were classified according to their self‐perceived level of nervousness prior to the session, both groups showed significant reductions in anxiety levels afterward, with a greater decrease observed in the initially more nervous group. This suggests a strong capacity for emotional adaptation even among students who initially perceived themselves as more vulnerable. On the other hand, satisfaction with the experience was generally high and showed no significant differences between groups, reinforcing the pedagogical value of this practice. Taken together, these findings support the implementation of prosection activities as effective educational tools in early healthcare training and suggest that their early introduction may yield benefits both in competency acquisition and in the emotional management of students.

AUTHOR CONTRIBUTIONS

María Teresa García‐de Juan: Data curation; investigation; writing – review and editing. Irene Méndez‐Mesón: Investigation; writing – review and editing. Alba Sebastián‐Martín: Investigation; writing – review and editing; writing – original draft; validation. Mauricio Hernández‐Fernández: Investigation; writing – review and editing. Soledad Aguado‐Henche: Investigation; writing – review and editing; writing – original draft. Rafael Ramírez‐Carracedo: Investigation; writing – original draft; writing – review and editing. Rafael Moreno‐Gómez‐Toledano: Conceptualization; methodology; investigation; formal analysis; writing – original draft; writing – review and editing. Mónica Grande‐Alonso: Conceptualization; methodology; investigation; formal analysis; supervision; writing – original draft; writing – review and editing. Roberto Fernández‐Baillo: Investigation; writing – review and editing.

FUNDING INFORMATION

This research received no specific grant from any funding agency in the public, commercial, or not‐for‐profit sectors.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflict of interest.

ETHICS APPROVAL STATEMENT

This study was approved by the Ethics Committee at the University of Alcalá (CEIP/2024/4/097).

Biographies

Dr. Mónica Grande‐Alonso is a lecturer in the Department of Surgery, Medical and Social Sciences, within the Human Anatomy and Embryology Unit of the Faculty of Medicine and Health Sciences at the University of Alcalá (Madrid, Spain). She holds a degree in physiotherapy and a master's degree in advanced physiotherapy for chronic pain from the Autonomous University of Madrid. Her PhD, from the university's medicine program, focuses her research on neurophysiological, anatomical, and functional analysis and conservative intervention in patients with chronic musculoskeletal pain. She is also a member of the Spanish Anatomical Society. Her research is divided into two main areas: At the clinical level, she investigates functional and neurophysiological assessment in various chronic pain conditions, and in the field of educational innovation, she investigates different educational tools and resources applied to the teaching of anatomy in various university health sciences degree programs.

Ms. María Teresa García‐de Juan is a biologist and has been working for 28 years as a laboratory technician in the human anatomy and embryology area at the University of Alcalá, providing assistance to researchers (data analysis, experimental work, etc.).

Dr. Irene Méndez‐Mesón is a medical doctor (Autonomous University of Madrid), with a residence (MIR) of traumatology in the hospital of Guadalajara, and holds a PhD. She is a specialist in column surgery, and has worked in the hospitals of Guadalajara, Talavera, Torrejón, and Fraternidad. She is a lecturer in the Department of Surgery, Medical and Social Sciences, within the Human Anatomy and Embryology Unit of the Faculty of Medicine and Health Sciences at the University of Alcalá (Madrid, Spain). Her research interests include anatomy, column, and pain, among others.

Dr. Soledad Aguado‐Henche holds a degree (1988) and a PhD (2003) in medicine and surgery from the University of Alcalá (UAH). She was a clinician of the National Health Service, in the primary care area of Madrid, until 1997. Currently, she is a lecturer in the Department of Human Anatomy and Embryology at the Faculty of Medicine and Health Sciences (UAH). She has almost 30 years of experience teaching in the degree programs of medicine, nursing, physiotherapy, pharmacy, podiatry, and sports science. In addition, her research interests focus on the study of body composition using different techniques, osseointegration materials, and anatomical variations in the human body.

Dr. Rafael Ramírez‐Carracedo is a researcher affiliated with the Department of Surgery, Medical and Social Sciences, Area of Human Anatomy and Embryology, at the Faculty of Medicine and Health Sciences at the University of Alcalá. His research focuses on cardiometabolic diseases, nanotechnology, and cell signaling, with particular interest in the application of biomedical sciences to cardiovascular diseases.

Dr. Roberto Fernández‐Baillo is a professor of human anatomy and embryology at the Faculty of Medicine and Health Sciences, University of Alcalá. He is a coordinator of the teaching unit for human anatomy and embryology. Head of the Dissection Laboratory. Secretary of the Department of Surgery, Medical and Social Sciences. He holds a PhD in biomedicine from the Complutense University of Madrid. He also holds a professional master's degree and is a researcher in health and forensic expertise. His research interests include clinical anatomy, anatomical variants, and preservation techniques in anatomy, with specialization in the biomechanics of the larynx.

Dr. Mauricio Hernández‐Fernández holds a MD and a PhD in medicine and surgery, and is a university specialist in thanatology. He is a professor of human anatomy and embryology at the Faculty of Medicine and Health Sciences, University of Alcalá. His research interests and lines include studying anatomical variations and their applications in medical and surgical practice, as well as techniques and methods for preserving cadavers.

Dr. Alba Sebastián‐Martín is a lecturer in the Department of Surgery, Medical and Social Sciences, within the Human Anatomy and Embryology Unit of the Faculty of Medicine and Health Sciences at the University of Alcalá (Madrid, Spain). She holds a degree in biology, two master's degrees in molecular and cellular biology, as well as African studies and international relations (Universidad Autónoma de Madrid, Spain). Her PhD on molecular biosciences, focuses on human immunodeficiency virus type 1 and 2 reverse transcriptases fidelity. She has experience in a myriad of fields (HIV, COVID‐19, prostate cancer, etc.) and also as a project manager. She made an international three months of stay in KU Leuven (Belgium). In the field of educational innovation, she investigates different educational tools and resources applied to the teaching of human anatomy and embryology across different health sciences degrees.

Dr. Rafael Moreno‐Gómez‐Toledano. Holding a PhD from the University of Alcalá and specializing in therapeutic targets in cell signaling, this researcher stands out for a prolific and consolidated scientific career focused on the study of endocrine disruptors—such as bisphenol‐A and micro/nanoplastics—and their impact on human health and fetal development. Mastering the entire continuum of translational research, from basic science with in vitro and in vivo models to clinical epidemiology, his work provides a comprehensive perspective to the morphological sciences. This profound research maturity is the primary driver of his teaching in disciplines such as human anatomy and medical embryology. By directly integrating the findings of his extensive research line into the curriculum, he successfully connects fundamental anatomical and embryological structures with today's major clinical and toxicological challenges. His pedagogical approach, which is complementarily supported by educational innovations such as the use of 3D‐printed embryonic models, not only facilitates the spatial understanding of complex structures—consistently earning excellent evaluations from students—but also projects scientific knowledge directly into public health, training future healthcare professionals with a strong critical spirit and a vocation for research.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author (A.S.‐M.), upon reasonable request.