Medical students' first experience with a patient is often with a cadaver in a
gross anatomy course. Working intimately with a cadaver during a gross anatomy course captures the essence of the patient-provider relationship. Cadaver dissection is a challenging emotional and mental experience. Involvement, emotional coping, and ability are three themes that develop during the dissection experience. Medical students in a gross anatomy course may experience mixed emotions and variable reactions to cadaver dissection. Students who view their donor as a scientific specimen are less opposed to dissection, whereas students who view their donor as a former living person face greater difficulty with dissection and foster feelings of empathy towards the cadaver
. Because of the emotional impact of dissection, students may develop detached concern to cope with these feelings. In western countries, medical education emphasizes a "body as first patient" philosophy for dissection. This
anonymizes cadavers which fosters a different relationship than in eastern countries. Many eastern countries adopt a mindset of donor as "first teacher". For example, in Thailand, students are encouraged to develop a personal relationship with their donors. The students are instructed to view their donors with the highest honor and view the cadavers as a "great teacher". This intention allows medical students to form a relationship that is familiar to them, one of a teacher and student, as opposed to approaching their donor as a doctor, a practice that new and unfamiliar to students. Although eastern and western countries handle cadaver relationships differently, it can be generalized that gross anatomy courses offer an opportunity for students to examine their feelings on life, death, and dying. These courses also promote development of coping strategies for stressful situations. Female students are more likely to enter people-oriented specialties whereas men are more likely to enter technology-oriented specialties. Female students score higher than male students on the Jefferson Scale of Physician Empathy across all years of medical school education. Female students also have a greater likelihood than men to disagree with a need for detached concern in order to provide the best medical treatment. Several studies have indicated that clinical empathy may decline in students during medical school, with a change even being observed from the start to the end of first year. If this is the case, there could be negative consequences, as it is feared that a reduction in empathy may affect professionalism and quality of care. A recent study investigate the causes of the decline. It seems that a "
hidden curriculum" which includes a high workload, paucity of adequate role models, and lack of support can cause adaptations such as cynicism and detachment. In addition, the decrease may be due to the medical curriculum which may cause students to develop more of a scientific instead of a holistic approach to medicine.). Another reason is that medical school is a competitive environment that can cause students to prioritise their performance in medical school, rather than maintaining a caring demeanour. Similarly, it has also been suggested that as the pressure to obtain medical knowledge increases throughout medical school, students become more worried about retaining this knowledge alongside having to remain empathetic and caring towards patients. Students are more likely to lose their empathic qualities as compensation to allow them to still feel as though they are capable of learning all of the information they are required to. Furthermore, as students’ progress through medical school, they may be more likely to dehumanise patients to protect themselves from feelings of distress as they encounter increasingly challenging patients. As a result their empathy for patients may suffer. == Maintenance ==