Human Skeletal Remains at US Medical Schools: Provenance, Management, and Barriers to Ethical Stewardship

Abstract

Following calls to action to ethically interact with human skeletal remains (HSR), the Task Force for Legacy Anatomical Collections within the American Association for Anatomy published guidelines on how to ethically manage HSR. Despite calls to action and recommendations, the literature lacks empirical investigation into the provenance of HSR and the current state of HSR management at US medical schools. Therefore, the purpose of this study was to investigate the provenance(s) of HSR at US medical schools, their current management, and barriers to improving management. To investigate provenance and current management of HSR, a questionnaire was nationally distributed via email to gross anatomy educators and lab managers identified through an internet search. Results were analyzed using descriptive statistics. To investigate the barriers experienced by faculty and staff in improving HSR management, 60-minute focus groups were conducted; data was analyzed using framework thematic analysis. The Theoretical Domains Framework was applied to the inductively interpreted themes. The results of this work show that provenance for HSR at US medical schools is largely undocumented and that the quality of HSR management varies by operational domain. For example, storage conditions and handling procedures are largely in line with professional recommendations at most medical schools. However, inventories and oversight committees are not active at over half of US medical schools and provenance investigations are not occurring at most US medical schools. Described barriers that hamper improvement of HSR management include ‘Social Influences’ and ‘Environmental Context and Resources’ from a lack of collegial and financial support as well as the management of HSR being a low ‘Goal’ for faculty and staff due to an overload of responsibilities. This work provides empirical evidence that most HSR at US medical schools are of unknown provenance and shows that there are relatively few aspects of HSR management where US medical schools currently excel. It also demonstrates barriers experienced by faculty and staff in improving the management of HSR and provides potential solutions to those barriers. Lastly, this work serves as a further call to action to show HSR the respect and dignity they deserve.