The Lifecycle of a Clinical Cadaver: A Practice-Based Ethnography. Issue 5 (20th October 2022)

• Record Type: Journal Article
• Authors: MacLeod, Anna; Luong, Victoria; Cameron, Paula; Kovacs, George; Fredeen, Molly; Patrick, Lucy; Kits, Olga; Tummons, Jonathan
• Is Part Of: Teaching and learning in medicine. Volume 34:Issue 5(2022)
• Page Start: 556
• Page End: 572
• Publication Date: 2022-10-20
• Subjects: Cadaver-based simulation -- human body donation -- philosophy of science -- ontological fidelity -- medical education; Medical education -- Periodicals; 610.7
• DOI: 10.1080/10401334.2022.2092111
• Languages: English
• ISSNs: 1040-1334

Abstract

Abstract: Phenomenon Cadavers 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. Approach Over 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. Findings We 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. Insights Engaging 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.