The Lifecycle of a Clinical Cadaver: A Practice-Based Ethnography

Abstract

PhenomenonCadavers have long played an important and complex role in medical education. While research on cadaver-based simulation has largely focused on exploring student attitudes and reactions or measuring improvements in procedural performance, the ethical, philosophical, and experiential aspects of teaching and learning with cadavers are rarely discussed. In this paper, we shed new light on the fascinating philosophical moves in which people engage each and every time they find themselves face to face with a cadaver. ApproachOver a two-year period (2018/19–2019/20), we applied ethnographic methods (137 hours of observation, 24 interviews, and the analysis of 22 documents) to shadow the educational cadaver through the practical stages involved in cadaver-based simulation: 1. cadaver preparation, 2. cadaver-based skill practice with physicians and residents, and 3. interment and memorial services. We used Deleuze and Guattari’s concepts of becoming and acts of creation to trace the ontological “lifecycle” of an educational cadaver as embedded within everyday work practices. FindingsWe delineated six sub-phases of the lifecycle, through which the cadaver transformed ontologically from person to donor, body, cadaver, educational cadaver, teacher, and loved one/legacy. These shifts involved a network of bureaucratic, technical, educational, and humanistic practices that shaped the way the cadaver was perceived and acted upon at different moments in the lifecycle. By highlighting, at each phase, 1) the ontological transitions of the cadaver, itself, and 2) the practices, events, settings, and people involved in each of these transitions, we explored questions of “being” as it related to the ontological ambiguity of the cadaver: its conceptualization as both person and tool, simultaneously representing life and death. InsightsEngaging deeply with the philosophical questions of cadaver-based simulation (CBS) helped us conceptualize the lifecycle as a series of meaningful and purposeful acts of becoming. Following the cadaver from program entry to interment allowed us to contemplate how its ontological ambiguity shapes every aspect of cadaver-based simulation. We found that in discussions of fidelity in medical simulation, beyond both the physical and functional, it is possible to conceive of a third type: ontological. The humanness of the cadaver makes CBS a unique, irreplaceable, and inherently philosophical, practice.

Keywords:

• Cadaver-based simulation
• human body donation
• philosophy of science
• ontological fidelity
• medical education

Disclosure statement

The authors have no conflicts of interest to report in this work.

Ethical approval

This study was approved by the Research Ethics Board of the regional health authority.

Informed consent

We obtained informed consent from all the participants in this study. We followed standard procedures as outlined by the Tri-Council Policy Statement (TCPS-2): Ethical Conduct for Research Involving Humans Course on Research Ethics (CORE).

Presentations

Material from this manuscript was presented at the Canadian Conference for Medical Education on April 17, 2021 (oral presentation).

Additional information

Funding

This study was funded by grants from the Social Sciences and Humanities Research Council [Grant number: 430-2018-00274] and the Royal College of Physicians and Surgeons of Canada [Grant number: A. MacLeod_2018 RC MERG].