Body Donation and Medical Workshop

Body Donation and medical workshop

Executive Summary

Silent Mentor program, a national body donation program for medical education, training and research, was founded in Malaysia on 23rd March 2012 through the Directorship of Professor Dr Chin Kin Fah with the vision to ‘Make a difference to the provision of healthcare with the touch of humanism through the altruistic teachings of our Silent Mentors’. The program has been supported through a charitable trust fund and a private social responsibilities initiative. Through the technology of rapid freezing treatment of our Silent Mentors, we are able to offer a surgical dissection model that is comparable to operating on a live human being, to facilitate realistic surgical training without risk to the patient. Although errors during the procedures are made on the Silent Mentors, it is ultimately our vision that none of these errors will be repeated on future live patients. The Silent Mentor programme is not solely a medical programme, but also a programme underpinned with empathy teaching and thus benefits the participants in learning soft skills in a holistic environment. Through the altruistic donation of their bodies with the support of their family members, silent mentors help students to acquire the skill of empathy, which will help make them more compassionate clinicians. This is a program that holds a value in its most simplistic form: ‘a relationship between a great teacher, the silent mentor, and the students, that uphold great love, respect and gratitude’.

With the vision of providing a liberal arts education to a broader group of learning institutions and Universities through the altruistic teachings of Silent Mentor, a public limited company by guarantee was registered with the Malaysian Government under the name of ‘Academy For Silent Mentor’ (AFSM). The new program is called: i•Silent Mentor Program, which in essence means ‘Altruistic love’.

Principles

To turn the foul and rotten into the rare and ethereal and provide selfless love to the benefit of the society; to let life have a greater significance.
Popularise education opportunities, cultivate more medical professionals with competence and medical ethics.
Liberalise education – achieving freedom of mind through diversified and balanced learning.

Transportation Network

The transportation networks of AFSM (KL) for the silent mentors upon their passing away are provided for the all the states in West Malaysia, except Kelantan and Terengganu due to logistical reasons. Similarly, AFSM (Kuching) shall cover the transportation within the Southern part of Sarawak. The transporter will help with the issue of the death certificate and forms to the Academy For Silent Mentor.

Methodology of Body Treatment

Fresh body treatment: The body will undergo rapid freezing to -300c at the Silent Mentor Institute and is maintained at that temperature until the planned workshop when the body will undergo gradual thawing. Following thawing, the body will be used for a period of four days before cremation.
Soft body treatment: The body will undergo arterial injection treatment with a mixture of formaline and glycerol. Following embalmment, the body will be kept for a period of one year at a 40c freezer for treatment.

1) Home visit and interacting with family members

By visiting and interacting with the family members, students (medial officers, house officers and medical students) learn the life story and the wills of their silent mentor as a person rather that a cold cadaver for practice and look up-on their silent mentor as a role model.

2) Silent Mentor Appreciation Ceremony

Students use words and descriptions to paint a rich picture of the life and personality of their silent mentor and share their experiences during the home visits.

3) Initiation ceremony

After the admission of the silent mentor to the AFSM Training Centre, the first of the blessing of life’s final rites, the initiation ceremony with the attendance of family members, volunteers and students blesses and launches the 5 days program with participants getting acquainted at the AFSM Training Centre.

4) Professional training workshops

Workshop commences; silent mentors gracefully facilitate medical training. The participants gain not only medical knowledge but are also imbued with a new perspective on the philosophy of life.

5) Suturing, dressing and coffining

A part of the blessing of life’s final rite: at the end of the professional training, the students carefully examine their silent mentors again to make sure all the wounds are appropriately closed, dress their silent mentor properly in dignity, and with their deepest gratitude place their silent mentor in a gracefully designed coffin.

6) The ceremony of cremation

As part of the blessing of life’s final rite that prepares the silent mentor for cremation, family members, students and volunteers escort the silent mentors for cremation at Xiao EN Nilai Memorial Garden – a ceremony that signifies that the silent mentor has walked through the last stretch of the journey of their lives.

7) Gratitude ceremony

The students express their gratitude to the silent mentors by placing the silent mentor’s name on the monument at the Xiao EN Nilai Memorial Garden. This reinforces the students to develop a life-long philosophy of gratitude, respect and love.

Values

Value of Being a Silent Teacher, a Silent Mentor’s perspective

‘Among the many values, perhaps the most prominent is the act of selfless sacrifice for the good of mankind. Silent mentors, being great teachers, donate their bodies self-willingly without any conditions across the boundaries of race, colour and religions. They are eternal teachers without border.’

Value of being the student of a Silent Mentor

a) Value of Anatomical dissection
The cultural changes, scientiﬁc progress and new directions in medical education have modiﬁed the role of dissection in teaching anatomy in today’s medical schools. The beneﬁts of dissection include the gaining of practical skills such as appreciation of the human body, ﬁrsthand understanding of anatomical variability, learning teamwork and peer interaction, as well as ultimately gaining a ﬁrst-hand appreciation of human life through a ﬁrst-hand understanding of death and dying (Granger, 2004)

However, the students in silent mentor program learn a different form of dissection, a dissection that not only fosters their knowledge of applied human anatomy but the learning of humanism in clinical skills through the altruism of their silent mentors. The learning of their silent mentor’s life history and disease pathology together with their dissection enhances the holistic education.

b) Value of cadaveric dissection in basic and advanced surgical training
Although laparoscopic surgery has been practiced worldwide for the last 20 years and has found many applications in the field of General Surgery, there are limited opportunities for a structured program to teach and train laparoscopic skills across continents. The lack of training procedures needs to be overcome by structured training programs (dry lab, animal lab), and the gained experience needs to be transferred into daily clinical practice. Therefore, an exposure to a Structured Training Program at an early stage of the career is essential in minimal access surgery.

The availability of cadaver dissection environment provides two significant advantages over conventional teaching situations. Firstly, training can be standardized, controlled and taught with appropriate instruction, supervision and advice. Secondly, the training can be repeated until a defined performance criterion is met. There are, however, other advantages:

1. Opportunities to objectively measure performance and training
2. Validity of training methods is better evaluated.
3. Safety – no risk to patients.
4. Cost – may be cheaper in the long run.

The value of this skills laboratory setting is not only that it removes such learning experiences from the operating room, but it also provides an opportunity to base training on a level of proficiency reached rather than a fixed number of repetitions. Furthermore, in an appropriately structured skills laboratory environment, assessment can occur and individuals can be reliably credentialed for the performance of certain activities, which may have relevance in the operating environment.

Values to the family members

Through the teaching of the selfless act of body donation and the life events around the silent mentor, the family members will gain the respect, gratitude and love from the students, which may help to achieve a final closure of the bereavement. The family members may later participate as volunteers of the silent mentor program.

Medical Humanity Values In The Silent Mentor Program

i～Silent Mentor Program plays a key role in the Medical Education. It is formulated as a Selective Soft Skill Program where the medical students can acquire the skills in the field of Medical Humanities and Bioethics.

Using the Silent Mentors as the conduit, the students in medicine and other healthcare professions will learn about the six Prominent Pinnacles of medical humanities as below:

Prominent Pinnacle 1: Death Education, dying and Bereavement care
Prominent Pinnacle 2: Empathy and respect
Prominent Pinnacle 3: Culture, spirituality and healing
Prominent Pinnacle 4: Communication and conflict management
Prominent Pinnacle 5: Bioethics
Prominent Pinnacle 6: Volunteerism

Using the altruism of our silent mentors, the students can learn the essential skills in performing medical procedures, some of which could be lifesaving emergency procedures, with upmost devotion and concentration. At the end of the Silent Mentor Program, the students will achieve the learning outcomes of the Six Prominent Pinnacles of Medical Humanities and Practical Surgical Skills.

In order to achieve maximal benefits, the students will attend respective preprogram workshops to acquire certain standard of soft skills before attending the Silent Mentor Program.

Medical humanities value to other Professions

In addition, students from other faculties such as Business management, Mass Communication, or Hospitality and Creative Arts, may attend the above silent mentor workshops to enhance their soft skills set for a holistic approach towards learning of life skills with emotional well-being. The students may get involved in the following associated activities of the AFSM:

Intern in the event management and stage-show of the Silent Mentor workshop, public talk and fund raising event. (Business management, Hospitality)
Hospitality as the Usher and Culinary team
Event photography and video shooting (with the sensitivity for public viewing and with specific professional requirement for medical record). The students may also be involved in the final video editing and slide presentation of the workshop.
Literature student may be involved in the writing of the event and the life stories around the silent mentors.

The Six Prominent Pinnacles of Medical Humanities

Prominent Pinnacle1

Death Education, dying and Bereavement care

Title of Workshop	In Pursuit of Balance: Death Education and Bereavement care
Key Teachers	Psychiatrist; Psychologist; Counsellor
Theme	Death Education, dying and Bereavement
Description of workshop	During the Silent Mentor Program, students will be introduced to the concept of death and its relevance to health care professional. They will also learn the basic skills of providing bereavement care to the families.
Learning outcomes	By the end of this workshop, students will be able to: Comprehend what it meant by death Provide bereavement counselling to the families of the deceived patients
Learning activities	To receive the body of the silent mentor during death and care of the body before deep freezing treatment or embalmment. Daily washing of the body of silent mentor and contemplating the process of death and the pathology process of mortem
Assessment	Worksheet: A personal journey on death with the silent mentor

Title of Workshop	In Pursuit of Balance: Care of the dying
Key Teachers	Palliative care physician; Counsellor
Theme	Death Education, dying and Bereavement
Description of workshop	During the Silent Mentor Program, students will be introduced to the silent mentor who is dying or during their palliative care pathway. They will also learn the basic skills of providing emotional support to the silent mentor and families.
Learning outcomes	By the end of this workshop, students will be able to: Comprehend what it meant by end of life care Provide counselling to the families of the silent mentor
Learning activities	To visit Silent Mentor pledgers during their hospital stays or at home for palliative care. Video recording of the visit and communication between the silent mentor and students
Assessment	Scoring system of performance based on video recording

Prominent Pinnacle 2

Empathy and respect

Title of Workshop	In Pursuit of Balance: Empathy
Key Teachers	Psychiatrist; Psychologist; Counsellor
Theme	Empathy and respect
Description of workshop	During the Silent Mentor Program, students will be visiting the families of the silent mentor. Thereafter, the students require to prepare a presentation and performance based on the life stories of the silent mentors.
Learning outcomes	By the end of this workshop, students will be able to: Comprehend what it meant by empathy Improvement in the Jefferson Empathy scale
Learning activities	Presentation of the silent mentor’s life stories to the family members of silent mentor in a small group discussion followed by having a dinner together.
Assessment	Jefferson’s Empathy Scale Qualitative assessment based on personal statement

Prominent Pinnacle 3

Culture, spirituality and healing

Title of Workshop	In Pursuit of Balance: Mindfulness, Contemplative Science and wellbeing in Surgical Practice
Key Teachers	Meditation and Yoga Masters; Psychiatrist; Psychologist; Counsellor
Theme	Culture, Spirituality and Healing (Stress Management)
Description of workshop	During the Silent Mentor Program, students will be introduced to mindfulness and its relevance to health care professional. They will also learn the basic skills of mindful practice in performing surgical procedures. They will develop a habit to practice the skills of mindfulness to adapt to the busy curriculum in medical school and improve the sense of joy and satisfaction in learning.
Learning outcomes	By the end of this workshop, students will be able to: Describe what it meant by mindfulness Acutely aware of the busyness of our mind and accompanying body sensations Be familiar with simple techniques to achieve being present “ in the present moment To enhance the sense of ‘present in the moment’ when performing daily life activities and during performing medical procedures
Learning activities	Discussion and reflection on effects of stress for medical students, doctors and healthcare professions. Practice the following: Sitting meditation / silent praying Body movements – simple yoga exercises Mindful walking / walking prayer through Cemetery Eating meditation Tea ceremony Mindful exercise on steps of surgical procedure on Imagination Mindful exercise on steps of surgical procedure on Silent Mentor Mindful exercise on washing of Silent Mentor
Assessment	Video recording for assessment of Mindfulness on performing tasks Worksheet: how to integrate mindfulness practice in medical school life

Title of Workshop	In Pursuit of Balance: Interfaith
Key Teachers	Psychiatrist; Psychologist; Counsellor
Theme	Culture, Spirituality and Healing
Description of workshop	During the Silent Mentor Program, students will be introduced to various religious practices for end of life and its relevance to health care professional. They will also learn the basic skills of tolerance and mutual respect.
Learning outcomes	By the end of this workshop, students will be able to: Comprehend what it meant by interfaith Respect the practice for end of life care in the context of religions and spirituality
Learning activities	Discussion and reflection on practice of religious ritual for end of life care for the silent mentors and their families.
Assessment	Worksheet: A personal journey on the insight of the various religious practices for the silent mentor as a means of respect to the silent mentors

Prominent Pinnacle 4

Communication and conflict management

Title of Workshop	In Pursuit of Balance: Communication and inter-professionalism
Key Teachers	Psychiatrist; Psychologist; Counsellor
Theme	Communication and conflict management
Description of workshop	During the Silent Mentor Program, students will be working with students from other Universities and other disciplines
Learning outcomes	By the end of this workshop, students will be able to: Communicate within the profession and other professions Team building Handling of conflicts
Learning activities	To communicate and organise the activities of the workshop within the team of medical students and other discipline. To record any conflicts in ideas and thoughts and steps to resolve that conflict within the group and within oneself
Assessment	Personal diary Third party assessment of the conduct of the meeting through video recording

Prominent Pinnacle 5

Bioethics

Title of Workshop	In Pursuit of Balance: Bioethics
Key Teachers	UNESCO
Theme	Bioethics
Description of workshop	During the Silent Mentor Program, students will be studying the issues of bioethics for the Silent Mentor Program.
Learning outcomes	By the end of this workshop, students will be able to: Comprehend what it meant by Bioethics Provide independent debate on ethical issues
Learning activities	To take part in obtaining consent from the Pledger and their family members in signing up for the silent mentor program. To discuss the issues of the following ethical issues for their own silent mentors as case studies Are the Silent Mentors and their family members well informed, and are their decisions based on self will? Are there any conflict of interest in the body donation? Is it ethical for the family members to wait for a long time after death before the final cremation and send off? Are there any steps taken for the bereavement support during the interval and are these steps ethical? Is there any ethical issues for keeping the body parts after the silent mentor workshop for further research and education?
Assessment	Worksheet: A personal journey on death with the silent mentor

Prominent Pinnacle 6

Volunteerism

Title of Workshop	In Pursuit of Balance: Volunteerism
Key Teachers	Volunteers
Theme	Volunteerism
Description of workshop	During the Silent Mentor Program, students will be introduced to the concept of volunteerism and its relevance to health care professional.
Learning outcomes	By the end of this workshop, students will be able to: Comprehend what it meant by volunteerism Provide voluntary service in society
Learning activities	To provide voluntary support to the Silent Mentor Program To do a sketch show on what had been learnt after the silent mentor program (Tripartite input: script, direct and perform)
Assessment	Attendance and sketch show based on a scoring system

Others

Bioethics of the body donation:

The UNESCO Bioethics Chair (Haifa University) appoints the establishment of UNESCO Bioethics Unit at AFSM and endorsement of i-silent mentor program within their network of Units. Any issues related to the Ethics of the program will be submitted to the Independent Ethicist and Humanitarian Board in AFSM for approval. This mechanism of safety is to protect the interest of the body donors and public at large.

Living mentors

Selected individuals with personal or family experience being a patient may be trained to be a Living Mentor by the Committee of Academicians. The Living Mentor will interact with the students so that the students may achieve an understanding and empathy from the patient perspective. The living mentors may also become the professional patients for the professional examinations.

Body Donation and Medical Workshop