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Introduction: Medical students often describe the gross anatomy course as both stressful and a rite of passage. Research differs as to whether the stress it engenders is significant or transitory. This qualitative study of first year anatomy student reports on the use of optional creative projects to promote reflection and reduce stress. Methods: Over a three year period, 115 students, or 38.72% of all eligible students, opted to complete 1-2 arts or written creative projects during the anatomy course. Of these, 34 students gave us permission to analyze their projects, while 12 project completers and 12 project noncompleters were interviewed to determine their views about the projects. Researchers developed coding schema and interview schedules that were used to assess and interpret the data. Findings: On average, over a three year period, a little less than 40% of students selected the creative project option, with approximately equal numbers of male and female students represented. Comparing types of projects, art works were more celebratory and less reflective than written works. Comparing phases of projects, initial projects appeared more conflicted, while later projects showed more desensitization, appreciation, and satisfaction. Students expressed anxiety and ambivalence about anatomy and employed various defense mechanisms to resolve their feelings. Students completing projects reported that they both reduced stress and caused them to develop a richer appreciation for both anatomy and medicine as a whole, while noncompleters acknowledged that viewing the projects helped them to better understand their own experience of anatomy. Conclusions: For some students, creative projects may offer a more reflective and introspective way of wrestling with the ambivalent emotions anatomy raises than simple desensitization strategies of exposure.

The anatomy course offers important opportunities to develop professionalism at an early stage in medical education. It is an academically significant course that also engenders stress in some students.Over a three-year period, 115 of 297 students completed creative projects. Thirty-four project completers and 47 non-completers consented to participate in the study. Projects were analyzed for professionalism themes using grounded theory. A subset of project completers and non-completers were interviewed to determine their views about the stress of anatomy and medical school, as well as the value of the creative projects. We also compared test performance of project completers and non-completers.Projects completed early in the course often expressed ambivalence about anatomy, whereas later projects showed more gratitude and sense of awe. Project completers tended to report greater stress than noncompleters, but stated that doing projects reduced stress and caused them to develop a richer appreciation for anatomy and medicine. Project completers performed significantly lower than non-completers on the first written exam (pre-project). Differences between groups on individual exams after both the first and second creative project were nonsignificant.For some students, creative projects may offer a useful way of reflecting on various aspects of professionalism while helping them to manage stress.