Authors: Matthew A. Carey, Soha R. Dargham, Avelin Malyango, Ziyad Riyad Mahfoud, Rachid Bendriss, Mange Manyama
Categories: Research, Anatomy, Dissection, Emotional preparedness, Coping mechanisms
Source: BMC Medical Education
Authors: Matthew A. Carey, Soha R. Dargham, Avelin Malyango, Ziyad Riyad Mahfoud, Rachid Bendriss, Mange Manyama
While human body donor dissection facilitates foundational experiences that enable medical students to appreciate anatomical structures, it can also be a source of emotional stress that may hinder their learning process. The current longitudinal study aimed to describe students’ emotional responses and attitudes toward body donor dissection and to analyze how these responses changed over time. In addition, self-reported coping strategies used by students during the dissection course were explored.
Students were surveyed three times throughout the anatomy once before comencing dissection, once immediately following the first dissection session, and once upon completing the final dissection session.
Results indicated that prior to beginning dissection most students (68.7%) reported feelings of curiosity and interest; however, the number of students reporting these feelings noticeably declined by the end of the sessions to 48%. In addition, nervousness and anxiety fell between the first survey and the second with a slight rebound in the final survey. Students noted that smell became a stronger stressor over time, rising from 63.9% initially to 78% by the end of the dissection sessions. Furthermore, discomfort associated with touching certain parts of the body significantly increased over time from 48% to 76% (p = 0.039). The dissection workload was also noted as a prevalent stressor after students commenced the dissection sessions (p = 0.004). The most frequently reported coping strategies were talking with a close friend and prayer; however, reported use of these coping mechanisms also decreased over time.
As there is evidence of a need for emotional support, the authors suggest the development of curricular strategies to support student emotional preparedness both inside and outside of the anatomy laboratory.
The online version contains supplementary material available at 10.1186/s12909-026-09164-0.
The anatomy course is often one of the first courses students encounter in medical education and, when taught using human cadaveric donors, represents their first encounter with death. Human body donor dissection allows medical students to appreciate the spatial arrangement of anatomical structures and develop foundational knowledge and skills essential for clinical training [1]. Despite these advantages, dissection is a physically and emotionally demanding activity. For some students, this experience may generate emotional stress that can affect learning and well-being [2, 3].
Previous studies have documented a wide range of student emotional and physiological responses to human donor dissection. Emotional responses reported by students include interest, curiosity, and calmness [4–6], as well as anxiety, fear, nervousness, sadness, worry, uncertainty, and emotional detachment [3, 7, 8]. Students have also reported strong physiological responses including feeling faint, tremor, dry mouth, and nausea [9–11].
These emotional and physiological reactions have been reported to be most intense before and during the first few dissection sessions. However, while emotional and psychological reactions tend to diminish over time as students spend more time in the laboratory [6, 8], some may continue to experience distress related to cultural, curricular, or individual factors [12].
Students who are able to overcome the initial strong emotional and physiological responses to human dissection utilize coping strategies throughout the process. Studies have reported student use of various coping strategies such as prayer, exercise, napping, and peer interaction [4, 8, 13]. Desensitization from repeated exposure over time, along with a certain level of conscious detachment, is also frequently cited as a type of coping strategy subconsciously implemented by students [14, 15].
Understanding how students manage emotional responses and develop coping strategies during dissection is therefore important for supporting student learning and well-being. Most students joining the medical school at Weill Cornell Medicine-Qatar (WCM-Q) are relatively young (compared to those in the U.S. or Canada) because they join the medical school immediately following high school. Therefore, most of them have little to no experience with dissection (human or other animals). Findings from a pilot program designed to emotionally prepare foundation students for their first visit to the anatomy lab at WCM-Q provided evidence of students indicating feelings of curiosity and interest in anticipation of the human gross anatomy laboratory visit while several students also reported feelings of anxiety [13].
However, during the pilot program, students only experienced a single exposure to the anatomy dissection lab and did not perform actual donor dissection. The current study builds on the previous pilot study to further investigate the emotional and physiological reactions associated with students’ prolonged exposure to body donor dissection and their use of coping strategies.
This quantitative study aimed to describe students’ emotional responses, perceived stressors, and coping strategies associated with body donor dissection and to analyze how these responses evolved throughout the anatomy course.
The gross anatomy course at WCM-Q begins in August and continues until December every year for a total of 17 weeks. Dissection sessions are held twice a week and last an average of two and half hours per session. The first day of the gross anatomy course consists of a 45-minute lecture on the back and spinal cord followed by a short break of 10 to 15 min. Following this break, students take part in a session titled “Meet Your Donors”. This first part of the session consists of a 20-minute lecture on the organization of the dissection course, laboratory conduct, and rules. Immediately following this first introduction, students enter the adjoining laboratory where they are introduced to their dissection table, the body donor, and their group members. Dissection groups typically consist of four to five students who remain in the same group throughout the duration of the course. This part of the “Meet Your Donors” session takes approximately 10 min, and then students take another 15 to 20-minute break. Following this break, students return to the anatomy laboratory to begin dissection of the back and spinal cord.
During the gross anatomy laboratory sessions, students primarily learn through dissection. However, other resources are also utilized in the course including prosections, plastinated specimens, virtual reality, and an Anatomage table. After completing the dissection sessions, students take part in a student-led memorial service for the donors.
The medical program at WCM-Q offers multiple entry pathways based on students’ academic background and qualifications, including a Foundation Year, a two-year Pre-Medical curriculum, and direct admission into the four-year Medical Program. Most students enter through the Foundation or Pre-Medical pathways and typically matriculate directly from high school, while fewer than 10% are admitted directly into the Medical Program with a prior undergraduate degree. All pathways converge into the same integrated Doctor of Medicine curriculum. There is usually a slight predominance of female students. The total number of first-year medical students enrolled in Fall 2023 and Fall 2024 was 45 and 54, respectively, with student ages ranging from 18 to 23 years.
Participants were recruited from the first-year anatomy class in the Fall 2023 and Fall 2024 semesters. Three anonymous surveys were conducted during the fall semesters of 2023 and 2024. In each survey, participants were asked to create a unique code to facilitate data analysis of changes within each individual’s emotional responses during the course of the longitudinal study while also protecting the participants’ anonymity. The first survey, referred to as the baseline survey, was conducted directly following the first anatomy lecture and before the participants entered the dissection lab. This first survey was intended to determine the emotional preparedness and varying degrees of mental stress participants may have experienced in anticipation of the initial exposure to body donors and their first human body donor dissection. Immediately following the first dissection session, a second survey (mid survey) was conducted to better understand participants’ initial reactions to dissection. At the end of the anatomy course, a third survey (end survey) was administered to document participants’ retrospective self-assessment of the dissection experience. Participants were encouraged to complete all three surveys; however, some of them did not complete all three surveys.
Items in all three surveys specifically asked participants about their emotional reactions during the experience. Additional items assessed perceived stressors, physiological reactions, and self-reported coping strategies used by students to manage stress associated with body donor dissection.
The survey instruments included an item assessing whether participants had received prior preparation on emotional readiness and coping strategies for working with body donors. This variable was collected to characterize the study cohort and to inform a separate analysis comparing emotional responses and coping strategies between students with and without such preparation. However, as the present study focused on overall longitudinal trends in student emotional responses and coping strategies, this variable was not analyzed in the current manuscript.
The surveys used in this study were developed specifically for this research. Survey items assessing emotional and physiological responses, as well as coping strategies used by students, were informed by and adapted from previously published studies [11, 16–18]. An English-language version of the survey instrument is provided as a supplementary file.
Descriptive statistics were used to summarize participant demographics and survey responses across the three time points (baseline, mid, and end surveys). Descriptive analyses were conducted using all available responses at each survey time point. Frequencies and percentages were reported for categorical variables to assess changes in emotional reactions, perceived stressors, coping strategies, and self-reported readiness for donor dissection over time. For longitudinal analyses, paired comparisons were conducted. Changes between the baseline and mid surveys were analyzed among students who completed both surveys. Analyses assessing changes across all three time points were conducted among students who completed all three surveys. Statistical significance for differences in proportion between time points was confirmed using McNemar’s test for paired categorical data. For those who completed all three surveys, statistical significance for differences in proportion across all three time points were confirmed using Cochran’s Q test. The level of significance was set at 5%. All analysis was conducted using SPSS.
A total of 108 first year medical students completed at least one survey or a combination of baseline, mid, and/or end surveys. Table 1 summarizes participant longitudinal demographics and emotional readiness for donor dissection. A total of 82 students completed the baseline survey, with 63 and 50 students completing the mid and end surveys, respectively. Across all surveys, female students consistently represented a greater proportion of respondents (59.0% at baseline; 68.0% at end). The study revealed that most first-year medical students did not receive any prior preparation related to emotional readiness or coping strategies for working with body donors before beginning dissection, with only 20.5% reporting any such preparation in the baseline survey. Furthermore, across all time points, a significant proportion of students believed that initial preparation would have better equipped them emotionally although this belief slightly declined over time (43.4% at baseline to 36.0% at the end).
Table 1Participant demographics and emotional readiness for body donor dissection Baseline Survey N=82Mid Survey N=63End Survey N=50n%n%n% Gender: Female4959.04162.13468.0 Male3339.82233.31632.0 Do you consider yourself a religious person? Extremely religious78.469.112.0 Very religious4351.83248.52754.0 Moderately religious2327.71827.31326.0 Slightly religious33.623.0510.0 Not at all religious11.211.512.0 *Received any initial preparation on emotional preparedness and coping strategies for working with body * Yes1720.5710.6816.0 No6679.55684.84182.0 *Initial preparation on emotional and coping strategies would improve readiness for * Yes3643.43147.01836.0 No2631.32334.82142.0Table 1 summarizes participant demographics and emotional readiness across three time points. Female students comprised the majority (59.0% at baseline; 68.0% at end). Most students (79.5%) did not receive prior preparation for emotional readiness. A significant proportion believed that initial preparation would have better equipped them emotionally
Figure 1 reports the emotional and physiological reactions to human donor dissection as they evolved over time. Before beginning the dissection sessions, feelings of curiosity and interest were most frequent (68.7%) although both declined noticeably by the end of the sessions (48.0%). Reports of anxiety and nervousness decreased in the time frame between before students began dissection and after students completed the first session, with anxiety falling from 39.8% to 19.7% and nervousness falling from 54.2% to 39.4%. However, after completing all of the dissection sessions, the number of students reporting anxiety and nervousness slightly rebounded to 34% and 48% respectively. The proportion of students reporting feelings of calmness increased slightly, from 13.3% before dissection to 20.0% at the end of the sessions.
Fig. 1Student-reported emotional and physiological reactions and coping strategies for body donor dissection across three time points. This figure illustrates the evolution of student-reported emotional and physiological reactions to body donor dissection across three survey time points. Data are presented as percentages of students reporting each specific reaction or coping strategy. These descriptive findings suggest patterns of emotional and physiological adaptation as students progressed through the dissection experience, though individual responses varied across the cohort
Several physiological symptoms reported by the students were particularly interesting (Fig. 1). Eighteen students initially reported that they anticipated symptoms of nausea before beginning dissection. After the first dissection session, 19 students reported experiencing nausea; however, upon finishing the course, only nine students reported symptoms of nausea. Similarly, nine students reported that they anticipated heart palpitations while dissecting, and after the first dissection session 10 students reported actually experiencing heart palpitations. By the end of the dissection sessions, only two students reported experiencing heart palpitations. It is interesting to note that only six students anticipated experiencing dizziness before commencing dissection; however, after the first dissection session 12 students, exactly double the number that was reported before beginning dissection, experienced dizziness. By the end of the dissection sessions, seven students reported experiencing dizziness.
The most stated stressor throughout was smell, rising from 63.9% before beginning dissection to 78.0% at the end of the sessions (Fig. 1). Other prevalent stressors included touching certain parts of the body donor including the hands, face, and genitals (increasing from 41.0% to 62.0%) and seeing the donor’s face or genitals, both consistently reported at around 40–50%.
The most frequently cited coping mechanisms reported by students were “talking with a close friend” and “prayer” (Fig. 1). Results show a noticeable shift in coping mechanism usage across the three timepoints. Before beginning dissection, 28.9% of students reported using prayer, followed by talking with a close friend (27.7%). After the first dissection session, talking with a close friend became the most common strategy (39.4%). Notably, by the end of the dissection sessions, the use of all coping mechanisms decreased.
An exploratory analysis was conducted to examine whether baseline emotional responses to the thought of body donor dissection differed by gender. Inferential analysis was performed using responses from the baseline survey only, as this survey had a larger number of respondents compared with the mid- and end-course surveys. Female students reported significantly higher levels of several emotional responses compared with male students, including anxiety (51.0% vs. 24.2%, p = 0.022), heart palpitations (18.4% vs. 0.0%, p = 0.009), nausea (32.7% vs. 6.1%, p = 0.004), sadness (28.6% vs. 9.1%, p = 0.033), uncertainty (63.3% vs. 36.4%, p = 0.017), and worry (42.9% vs. 6.1%, p < 0.001) (Table 2). No statistically significant gender differences were observed for other emotional responses.
Table 2Baseline emotional responses to body donor dissection by genderFemaleMaleP-value n % n %Feelings the thought/act of dissection arouse in Anger24.113.0> 0.999^a^ Anxiety2551824.20.022^b^ Breathlessness918.426.10.185^a^ Calmness714.339.10.733^a^ Curiosity3877.61957.60.054^b^ Disgust1428.6618.20.283^a^ Distaste Dislike1530.6515.20.110^a^ Dizziness510.213.00.393^a^ Dry mouth612.213.00.233^a^ Fear1224.539.10.077^a^ Heart palpitations918.400.00.009^b^ Horror510.213.00.393^a^ Interest3265.32472.70.479^a^ Joy612.2412.1> 0.999^a^ Nausea1632.726.10.004^b^ Nervousness3061.21545.50.159^a^ Pleasure48.213.00.643^a^ Revulsion48.226.1> 0.999^a^ Satisfaction612.2618.20.531^a^ Sadness1428.639.10.033^b^ Tremor612.213.00.233^a^ Uncertainty3163.31236.40.017^b^ Worry2142.926.1< 0.001^b^ Other24.113.0> 0.999^a^a-p-value estimated using Fisher’s Exact testb-p-value estimated using Chi-square testTable 2 presents baseline emotional responses to the thought of body donor dissection by gender. Female students reported significantly higher levels of anxiety, heart palpitations, nausea, sadness, uncertainty, and worry compared with male students (all p < 0.05)
Statistical significance for differences in reported emotional reactions among the 25 students who completed all three surveys was assessed using Cochran’s Q test. Declines were observed from baseline to end surveys in emotions commonly associated with engagement in learning, such as curiosity (72.0% to 44.0%) and interest (68.0% to 44.0%) (Fig. 2). Anxiety and nervousness also both visibly decreased over the course of the dissection sessions (48.0% to 36.0% and 68.0% to 60.0%, respectively). However, these changes in student-reported emotional responses were not statistically significant (p > 0.05). An increase was evident in discomfort, from baseline to end surveys, related to touching parts of the body donor (48.0% to 76.0%) (Fig. 3). Statistically significant differences across the three time points were observed for several stress-inducing aspects of the dissection experience, including touching certain parts of the body donor (p = 0.039), the smell of the body (p = 0.007), and fear of infection (p = 0.049). Furthermore, an increase was observed in students reporting unpleasantness caused by seeing the donor’s genitals between the mid and end surveys (28.0% to 52.0%) (Fig. 4). Significant changes across time points were also observed for several unpleasant aspects of dissection, including fear of infection (p = 0.039), the smell of the body (p = 0.014), seeing the donor’s hands (p = 0.044), and seeing the donor’s genitals (p = 0.008).
Fig. 2Changes in student-reported emotional reactions to body donor dissection from baseline to end of course. This figure presents changes in student-reported emotional reactions to body donor dissection from survey 1 to survey 3 among the 25 students who completed all three surveys. Data are presented as percentages of students reporting each emotional reaction at each time point. Cochran’s Q test revealed that these changes in student-reported emotional responses were not statistically significant (p > 0.05)
Fig. 3Student-reported stress-inducing aspects of body donor dissection across three time points. This figure illustrates the evolution of student-reported stress-inducing aspects of body donor dissection across three survey time points among the 25 students who completed all three surveys. Data are presented as percentages of students reporting each stressor at each time point. Statistically significant changes across the three time points were observed for touching certain parts of the cadaver (p = 0.039), the smell of the body (p = 0.007), and fear of infection (p = 0.049)
Fig. 4Student-reported unpleasant aspects of body donor dissection across three time points. This figure illustrates student-reported unpleasant aspects of body donor dissection across three survey time points among the 25 students who completed all three surveys. Data are presented as percentages of students reporting each unpleasant aspect at each time point. Statistically significant changes across the three time points were observed for touching certain parts of the cadaver (p = 0.039), the smell of the body (p = 0.007), and fear of infection (p = 0.049)
As the first two surveys captured students’ immediate reactions to the pre-dissection and the first dissection session, along with their chosen coping mechanisms, an additional data analysis was performed (Table 3). A total number of sixty-three students completed both the first and second surveys. Significant decreases in the percentage of students reporting nervousness (19% decrease; p = 0.023) and uncertainty (15.9% decrease; p = 0.031) were found. However, curiosity also showed a decline 22.2% (p = 0.009). Furthermore, students reported the dissection workload as being an increasingly stressing aspect of dissection with an increase of 23.8% (p = 0.004). Other stressors associated with dissection that demonstrated a significant difference between students’ pre-dissection expectations and their actual experience included smell, showing a decrease of 20.7% (p = 0.007 and seeing the donor’s hands, which increased by 15.9% (p = 0.21).
Table 3Changes in student emotions and coping strategies before and after first dissection sessionBaseline Survey Mid SurveyDifference %P-valuen%n%(Mid-Baseline) Feelings the thought/act of dissection arouse in you Anger34.800-4.8N/A Anxiety3149.22336.5-12.70.115 Breathlessness1117.51015.9-1.6>0.999 Calmness812.71625.412.70.057 Curiosity4774.63352.4-22.40.009* Disgust1422.21523.81.6>0.999 Distaste Dislike1523.81320.6-3.20.774 Dizziness69.512199.50.146 Dry mouth711.169.5-1.6>0.999 Fear1422.21117.5-4.70.549 Heart palpitations812.71015.93.20.754 Horror69.557.9-1.6>0.999 Interest4571.44063.5-7.90.383 Joy914.31015.91.6>0.999 Nausea1523.81930.26.40.424 Nervousness3860.32641.3-190.023* Pleasure46.357.91.6>0.999 Revulsion46.3812.76.40.219 Satisfaction1015.9812.7-3.20.754 Sadness1422.21625.43.20.832 Tremor711.134.8-6.30.344 Uncertainty3352.42336.5-15.90.031* Worry2133.31625.4-7.90.359 Stressing aspects of donor dissection Looking at certain part of the cadaver3352.43047.6-4.80.664 Touching certain part of the cadaver3047.62946-1.6>0.999 The smell of the body4165.13149.2-15.90.076 Dissection workload1117.52641.323.80.004* Religious incompatibility34.857.93.10.625 Fear of infection914.369.5-4.80.453 Thinking of practical exam 1320.61625.44.80.629 Unpleasant aspects for you in Unpleasant aspects for you in the dissection * I did not experience stress69.512199.50.18 Fear of infection711.146.3-4.80.453 Smell4266.72946-20.70.007 Touching cadaver2539.72539.70>0.999 Seeing cadaver's hands812.71828.615.90.021* Seeing cadaver's face 3555.62946-9.60.286 Seeing cadaver's genitals29462438.1-7.90.332 Coping mechanisms to help alleviate stress to prepare for or after the anatomy * I did not experience stress1320.61523.83.20.815 Talking with close friend2133.32641.380.442 Playing musical instrument23.211.6-1.6>0.999 Writing journal entry/reflective piece23.246.33.10.687 Napping121912190>0.999 Writing poetry23.200-3.2N/A Prayer2234.91727-7.90.267 Exercise1117.5914.3-3.20.754 Artistic expression (e.g., painting)11.611.60>0.999 Meditation34.823.2-1.6>0.999 Others914.334.8-9.50.109Difference in percentage is p-value < α=0.05Table 3 presents changes in emotional responses, stressors, and coping mechanisms among 63 students who completed both baseline and post-first dissection surveys. Significant decreases were observed in nervousness, uncertainty, and curiosity (all p < 0.05). Dissection workload, smell, and seeing the donor's hands showed significant changes
Most students reported that they had not received formal preparation related to emotional readiness and coping strategies for working with body donors. This finding reflects the current anatomy curriculum at WCM-Q, where emotional preparedness is not addressed beyond the initial “Meet Your Donor” session. Prior studies suggest that structured preparatory activities, such as audiovisual materials, guided discussions, or early exposure to the dissection laboratory, can help reduce anxiety and improve students’ readiness for dissection. Chadhuri [19] reported that students who participated in preparatory exercises utilizing faculty-curated YouTube videos and peer-reviewed articles experienced less stress and greater intrinsic motivation. Similarly, Arráez-Aybar et al. [20] found that students who viewed films about dissection and visited the dissection room beforehand were significantly less anxious, while Böckers [3] recommends audio-visual materials and open house days to familiarize students with the dissection lab.
Students’ emotional responses demonstrated a pattern of adaptation over time throughout the dissection experience. Curiosity and interest declined following the first exposure to the body donor, likely reflecting a shift from anticipatory curiosity to task-oriented engagement with anatomical learning as students became familiar with the laboratory environment. Concurrently, reported feelings of anxiety and nervousness declined over time while calmness increased. However, inferential analysis indicated that these emotional changes were not statistically significant across the three time points, suggesting that while descriptive trends toward adaptation were observed, the magnitude of change was modest or varied across individuals. These findings highlight that emotional adaptation to body donor dissection may occur gradually and heterogeneously across the student cohort rather than uniformly. Despite the lack of statistical significance in our findings, the observed patterns align with previous research showing emotional adaptation during dissection, including Arráez-Aybar et al. [21] who reported decreased interest, curiosity, and anxiety with experience, and Mohedano-Moriano et al. [22] and Romo-Barientos et al. [23] who found significant anxiety decreases without intervention. Other studies have reported success in decreasing student anxiety through active interventions such as listening to music or binaural beats while dissecting [24–26].
The physiological responses reported by some students, including nausea, dizziness, and heart palpitations, highlight the intensity of the initial dissection experience for certain individuals. These reactions are consistent with previously reported physiological stress responses during early exposure to cadaveric material [27, 28]. While the reduction in these symptoms over time did not reach statistical significance, the descriptive trend suggests students may have gradually adapted to the laboratory environment and become more familiar with the dissection process.
Despite evidence of general emotional adaptation, several aspects of the dissection environment remained challenging throughout the course. Sensory factors such as the smell of the body donor and direct interaction with certain body regions emerged as notable stressors, consistent with Leboulanger [16] who similarly identified smell and the sight of the donor’s face as prominent stressors. Importantly, the present study found statistically significant changes over time in stress related to the smell of the body donor and touching certain parts of the body donor, suggesting that these sensory and tactile elements may become increasingly salient as students gain more direct exposure during the course. The persistence of smell as a stressor may reflect the powerful role that sensory experiences play in shaping emotional responses within the dissection laboratory. Unlike visual learning resources commonly used in anatomy education, human body donor dissection exposes students to strong sensory stimuli that may initially be unfamiliar or uncomfortable.
Students also reported that seeing more intimate parts of the donor, such as the face, hands, and genitals, as emotionally challenging. Significant changes observed over time in responses to viewing these body parts may indicate that reactions to these regions evolved as students progressed through the course. These findings are consistent with previous studies showing that certain anatomical regions evoke stronger emotional responses during dissection [16, 29]. Moxham et al. [29] propose that viewing the donor’s face may be particularly distressing because it leads students to personalize the body donor rather than view it solely as an anatomical specimen, while the emotional response to viewing genitals may reflect cultural norms surrounding privacy and modesty [30]. Together, these findings suggest that students’ emotional responses during dissection are influenced not only by the learning task itself but also by broader psychological and social perceptions of the human body.
Fear of infection was identified as a source of stress for some students. This concern has been reported in previous studies examining students’ experiences during human body donor dissection [27, 31, 32]. The pattern observed in the present study suggests that apprehension about infection may be more prominent at the beginning of the dissection experience and may diminish as students gain familiarity with the laboratory environment. As students progress through the course, increased exposure to the dissection setting and greater understanding of the role of preservatives and germicidal agents used in preparation of the donor’s body may help alleviate these concerns, and repeated contact with the body donor without adverse health consequences may contribute to students developing greater confidence in the safety of the dissection environment. Although fear of infection has been documented previously, longitudinal evidence describing how this perception evolves over the course of dissection remains limited, so the findings of the present study provide additional insight into how students’ perceptions of biological risk may change as they become more accustomed to working with body donors.
The dissection workload was reported as a source of stress for some students, though the association between workload and stress was not statistically significant. Nevertheless, the descriptive pattern may reflect the gap between students’ expectations and their actual experience. Before entering the laboratory, students may underestimate the time, preparation, and technical effort required for dissection tasks. Once sessions begin, the cumulative demands of laboratory preparation, teamwork, and anatomical complexity become apparent, potentially contributing to feelings of being overwhelmed. Similar concerns regarding the demanding workload associated with anatomy courses have been reported in previous studies [11, 33, 34]. Providing clearer expectations regarding workload and offering structured guidance at the start of the course may therefore help students better prepare for the demands of dissection-based learning.
Exploratory gender analysis revealed that female students reported significantly higher levels of several emotional responses in anticipation of human donor dissection, including anxiety, worry, nausea, and uncertainty, suggesting that gender may influence students’ initial emotional responses to dissection. These findings align with previous studies examining stress and anxiety among medical students, where female students often report higher levels of anticipatory anxiety in unfamiliar or emotionally demanding learning environments [22, 23, 28]. Recognizing these gender-related differences may help educators design preparatory activities and support mechanisms that are responsive to the diverse emotional needs of students entering the dissection laboratory.
Students employed several coping strategies throughout the dissection experience, with descriptive patterns suggesting evolving usage over time. Due to limited responses for some coping strategies, inferential statistical analyses were not performed; therefore, the following observations are based on descriptive trends. Talking with a close friend was the most frequently reported coping strategy initially, though its use substantially declined by the final dissection session. This decrease may suggest that discussing their experiences early in the course helped students emotionally process the initial stress associated with encountering body donors. This finding adds to Kotze and Mole’s [8] study, which reported increased utilization of this strategy one month after commencing dissection, highlighting potential variations in coping patterns over the course of dissection.
Prayer was consistently reported as a coping strategy throughout the course, consistent with findings from several other studies [2, 11, 27], though with a slight decrease over time, possibly reflecting students’ increased comfort with dissection or a shift in prayer focus to topics beyond the anatomy lab.
Exercise usage showed a different while many students anticipated using it as a coping strategy before dissection, fewer actually employed it after commencing. This decline may reflect the physical and emotional fatigue associated with the early stages of dissection, which could reduce motivation for active coping strategies. In contrast, passive strategies such as napping appeared to become more common once students began participating in the laboratory sessions.
Together, these descriptive findings suggest that students employ a range of coping mechanisms that may shift as they adapt to the emotional and practical demands of human body donor dissection.
While this study has provided greater insight into how students’ emotions change and how they cope with stressors when first dissecting body donors, there are several limitations. First, because the study relied on self-reported perceptions and coping strategies and did not directly observe student reactions in the anatomy laboratory, the results may be influenced by self-reporting bias. The final survey, administered at the end of the anatomy course, asked participants to reflect on their entire dissection experience. Although the final survey captured students’ reflections at the end of the course, responses may still have been influenced by recency effects, whereby more recent laboratory experiences disproportionately shaped their overall assessments.
In addition, the quantitative survey design limited the ability to capture the depth and nuance of students’ emotional experiences. Qualitative methods, such as interviews and focus group discussions, could have provided richer insights into how students interpret and cope with these experiences. Another limitation is the variable survey completion across the three time points. Only a subset of students completed all three surveys, introducing potential nonresponse bias in the longitudinal analysis. Students who completed all surveys may differ systematically from those who did not, potentially influencing the observed trends.
Finally, the study cohort consisted primarily of young medical students, predominantly female and from the Middle Eastern region. These demographic characteristics may limit generalizability of the findings to medical programs with older or more diverse student populations.
This longitudinal study examined students’ emotional and physiological reactions to human body donor dissection and the coping strategies they employed throughout the course. Many students initially reported emotions such as anxiety, curiosity, and interest, along with physiological reactions including heart palpitations, nausea, and dizziness. However, the proportion of students reporting these reactions declined over time, suggesting gradual adaptation to the dissection experience.
The current study also reports on certain stressors that students experience throughout the course of dissection. Specifically, a high number of students reported smell and touching or looking at certain parts of the body as stressors. While the number of students reporting seeing or touching certain parts of the body as stressors showed little variance over time, the number of students reporting smell as a stressor increased. In response to stressors experienced during dissection, many students reported the use of several coping strategies including talking to a friend, prayer, and exercise.
Overall, this study contributes to the growing body of literature describing students’ emotional experiences in the anatomy laboratory. As our findings suggest that some students experience emotional challenges during their initial exposure to human dissection, curricular strategies that promote emotional preparedness and adaptive coping may support students’ professional development while working with body donors. Further research is needed to better understand the effectiveness of coping strategies used by students and how these strategies can be integrated into anatomy education.
Supplementary Material 1.
Supplementary Material 2.
Supplementary Material 3.