The “difficult” cadaver: weight bias in the gross anatomy lab

Figures & data

Table 1. First-year medical student class and survey demographics overall and by survey year, Perelman School of Medicine (PSOM) 2015–2018

	Overall*	2015	2016	2017	2018
MS1 Class	613	156	146	159	152
Gender
Female	308 (50)	74 (47)	73 (50)	80 (50)	81 (53)
Male	305 (50)	82 (52.6)	73 (50.0)	79 (49.7)	71 (47)
Age	24 ± 2	24 ± 2	24 ± 2	24 ± 2	24 ± 2
Survey Respondents	319 (52)	90 (57.7)	116 (79.5)	37 (23.3)	76 (50)
Gender
Female	165 (52)**	45 (50)	54 (47)	23 (62)	43 (57)
Male	154 (48)**	45 (50)	61 (53)	14 (38)	34 (43)
Other	1 (0)	0	1(0.9)	0	0
Age	23.9 ± 2.1**	23.9 ± 2.1	23.8 ± 2.2	23.8 ± 1.9	23.9 ± 1.9

All values are means ± SD or n (%). MS! = First-Year Medical Student Class

*All survey data self-report, class size and demographic information provided by PSOM Registrar, ** Not significantly different from MS1 class (P = 0.67)

Table 2. Selected survey responses overall and by survey year, first-year medical students, Perelman School of Medicine 2015–2018

	Overall*	2015	2016	2017	2018
‘Before the first day of anatomy lab, [I] had … seen a dead body’	193 (61)	65 (72)	71 (61)	20 (54)	37 (49)
‘The cadaver is tissue/an inanimate object/a specimen’	97 (30)	24 (27)	43 (37)	10 (27)	20 (26)
‘The cadaver is a person who used to be alive’	221 (69)	66 (73)	73 (63)	27 (73)	55 (72)
‘The anatomy lab experience changed how [I] feel about people with overweight/obesity’	71 (22)	21 (23)	26 (22)	11 (30)	13 (17)
‘The anatomy lab experience changed how [I] feel about [my] own weight’	83 (26)	25 (28)	32 (28)	8 (22)	18 (24)

All values are means ± SD, n (%). * Reported N (%) indicate a ‘yes’ response

Table 3. Significance (P-value) of associations between selected survey responses, first-year medical students, Perelman School of Medicine (2015–2018)

	‘The anatomy lab experience changed how [I] feel about people with overweight/obesity’	‘The anatomy lab experience changed how [I] feel about [my] own weight’
Year	0.48	0.81
Age	0.10	0.46
Female	0.82	0.30
‘The anatomy lab experience changed how [I] feel about [my] own weight’	<0.0001	N/A
‘The anatomy lab experience changed how [I] feel about people with overweight/obesity’	N/A	<0.0001
‘Before the first day of anatomy lab, [I] had … seen a dead body’	0.16	0.13
‘The cadaver is a person who used to be alive’/‘The cadaver is tissue/an inanimate object/a specimen’	0.39	0.30
‘Overall the anatomy lab experience has been … ’ (Not at all and Somewhat positive vs. Very positive)	0.24	0.36
‘How upsetting was the first day of anatomy lab?’ (Not at all upsetting vs. Somewhat and Very upsetting)	0.62	0.17
‘How upsetting is anatomy lab now?’ (Not at all upsetting vs. Somewhat and Very upsetting)	0.13	0.08

All results are P-values from Chi-square or t-tests.

Table 4. Selected quotations describing attitudes about body weight in four domains: Cadavers, Patients/Living Individuals, Students’ Own Bodies, and the Classroom Environment, first-year medical student interviews (2012, 2015) and surveys (2015–2018)

Theme	Difficult Bodies	Unhealthy Bodies	Disgust
Cadavers	All of the nerves run through it and were enveloped in it. The heart was enveloped. Everything was just very difficult (Female, 2012 interview). I get frustrated in anatomy a lot of times. Sometimes I’m not getting everything. My cadaver was fairly obese and has a lot of medical issues that distorts much of the anatomy, so it’s been difficult, especially when we’ve been doing the musculoskeletal system to see a lot of the anatomy you’re supposed to be seeing. You know, some cadavers are quote-unquote ‘better’ than others (Male, 2012 interview).	Seeing the fat inside has made me see what fat actually does to the internal organs (Female, 2016). The first time that I saw a cadaver that was overweight it was a pretty visceral experience of like, oh, wow, I can totally understand why being overweight would be bad for your internal organs and bad for your health (Female, 2015 interview).	Seeing how thick and heavy the fat is has been a little eye-opening and it grosses me out to think that that is what’s inside people (Female, 2016 survey).
Patients/Living Individuals	I can see how surgeons have difficulty operating on people with obesity (Male, 2015 survey). It has made me more worried about working with overweight/obese people because I think it will be more difficult to diagnose/complete procedures due to the excess adipose (Female, 2015 survey).	The negative health implications associated with being obese are more apparent now. (Male, 2015 survey).	I think anatomy lab does make you feel more negatively about trying to treat bigger patients, because in class, the fat is so gross and makes it hard to find things, and it seems like that would be true in terms of feeling parts on a live person as well (Female, 2015 survey).
Students’ Own Bodies	I imagine if someone cut me open one day and saw all of my fat and had to dissect through it (Female, 2015 survey). I would be so unsatisfying to dissect (Female, 2017 survey).	I worry more about becoming overweight and developing comorbidities (Female, 2016 survey). It’s helped me see some of the damage I’m doing to myself; I’m obese (Male, 2017 survey). I have started eating healthier and exercising more because of my cadaver. I have begun worrying much more about being overweight and I constantly picture how thick my Camper’s fascia would be! (Female, 2016 survey). Having seen what it does to you, I will never be overweight (Male, 2018 survey).	It’s disturbing to see how fat truly invades your body. It makes me never want to be overweight and to encourage others to not be overweight (Female, 2015 survey). Admittedly, I’ve thought that I would look ugly in a midsagittal sternum to pubic symphysis cut (Male, 2016 survey).
The Classroom Environment	I actually heard this: ‘The TAs [teaching assistants] will neglect you if your body is bad. You don’t learn the way that your peers are learning if they have a better body than you’ (Female, 2012 interview). Some of the physicians who would come around would be like, ‘Oh this is so difficult.’ And we hadn’t really labeled it as difficult because it was the only thing we had known. But I was like, I don’t want to be considered difficult. It wasn’t really a cosmetic concern. It was like, I don’t want someone to do an appendectomy and be complaining about all of my fat (Female, 2015 interview).	I’ve heard people say this: ‘My body is useless. My cadaver is so fat I can’t see anything. The muscles are totally atrophied. There’s fat all over the kidneys, we couldn’t even see the renal artery,’ and so on and so forth (Female, 2012 interview).	Frequently the statements of, ‘Oh my body is fat, we have all this fat to get through. It’s gross, disgusting … I wish I had a skinnier body.’ People say that: ‘I wish I had a skinnier and smaller body to work with’ (Male, 2015 interview).