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Día de Muertos: A Confluence of Gross Anatomy, Culture, and Spirituality

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Title: Día de Muertos: A Confluence of Gross Anatomy, Culture, and Spirituality
Language: English
Authors: Hannah L. Herriott (ORCID 0000-0002-5410-0360), Neftali R. Del Rio, Daniel P. Justin
Source: Anatomical Sciences Education. 2024 17(8):1606-1617.
Availability: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
Peer Reviewed: Y
Page Count: 12
Publication Date: 2024
Document Type: Journal Articles
Reports - Descriptive
Education Level: Higher Education
Postsecondary Education
Descriptors: Religious Factors, Religion, Reflection, Anatomy, Higher Education, Catholic Schools, Catholics, Hispanic American Students, Minority Serving Institutions, Cultural Influences, Holidays, Graduate Study, Doctoral Students, Allied Health Occupations Education, Physical Therapy, Culturally Relevant Education
DOI: 10.1002/ase.2490
ISSN: 1935-9772
1935-9780
Abstract: "Is there room for spirituality and reflection in gross anatomy?" While Jesuit institutions have incorporated contemplation and reflection into their curricula for centuries; the integration of reflective practices into the gross anatomy curriculum has gained traction in recent years. Additionally, more emphasis has been placed on diversity, equity, inclusion, and belonging within health professions education. As a Jesuit, Catholic university that is simultaneously classified as a Hispanic-Serving Institute (HSI), Regis University was well-positioned to integrate reflective and celebratory activities in honor of Día de Muertos (the Day of the Dead) into a graduate level anatomy course for Doctor of Physical Therapy students. From a communal "ofrenda" (altar) to a celebration during a lecture to a reflective ceremony honoring body donors in the laboratory, students and faculty constructed a learning environment that incorporated spirituality and culture into anatomy in a thoughtful manner. Furthermore, by seeking student input on the design of this innovative educational experience, each of these activities aided in fostering a sense of cultural and spiritual belonging for Hispanic and Latine students who are historically marginalized in health professions, thereby promoting diversity, equity, inclusion, and belonging through a gross anatomy course.
Abstractor: As Provided
Entry Date: 2024
Accession Number: EJ1447793
Database: ERIC
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  Value: <anid>AN0180775311;[8z8k]01nov.24;2024Nov12.04:46;v2.2.500</anid> <title id="AN0180775311-1">Día de Muertos: A confluence of gross anatomy, culture, and spirituality </title> <p>Is there room for spirituality and reflection in gross anatomy? While Jesuit institutions have incorporated contemplation and reflection into their curricula for centuries; the integration of reflective practices into the gross anatomy curriculum has gained traction in recent years. Additionally, more emphasis has been placed on diversity, equity, inclusion, and belonging within health professions education. As a Jesuit, Catholic university that is simultaneously classified as a Hispanic‐Serving Institute (HSI), Regis University was well‐positioned to integrate reflective and celebratory activities in honor of Día de Muertos (the Day of the Dead) into a graduate level anatomy course for Doctor of Physical Therapy students. From a communal ofrenda (altar) to a celebration during a lecture to a reflective ceremony honoring body donors in the laboratory, students and faculty constructed a learning environment that incorporated spirituality and culture into anatomy in a thoughtful manner. Furthermore, by seeking student input on the design of this innovative educational experience, each of these activities aided in fostering a sense of cultural and spiritual belonging for Hispanic and Latine students who are historically marginalized in health professions, thereby promoting diversity, equity, inclusion, and belonging through a gross anatomy course.</p> <p>Keywords: anatomy education; culturally responsive; diversity, equity, inclusion, and belonging; gross anatomy; reflection; spirituality</p> <hd id="AN0180775311-2">INTRODUCTION</hd> <p>Gross anatomy courses are particularly salient opportunities for students to reflect, either formally or informally, on death and mortality as they dissect a human donor.[<reflink idref="bib1" id="ref1">1</reflink>] Since dissecting a human body is an uncommon experience that a student's external support systems usually cannot relate to, a strong comradery, connection, community, and bond is forged among dissection teams.[[<reflink idref="bib2" id="ref2">2</reflink>]] Dissection thrusts students into a situation in which they are compelled to "navigate difficult emotional territory, whether it presents the first encounter with death or evokes memories of personal loss and grief (Abrams et al.[<reflink idref="bib2" id="ref3">2</reflink>], p. 664)." Several studies have identified students' reliance on religious or spiritual beliefs as a coping mechanism for students initially engaging in dissection.[[<reflink idref="bib1" id="ref4">1</reflink>], [<reflink idref="bib4" id="ref5">4</reflink>], [<reflink idref="bib6" id="ref6">6</reflink>]] Martyn et al.[<reflink idref="bib7" id="ref7">7</reflink>] qualitatively explored medical students' perceptions of a <emph>"soul</emph>,<emph>" "spirit</emph>,<emph>" or "life force"</emph> with respect to mortality and reported most students believed the soul dissociates from the body at death, and several related their concept of a soul to their own religious or spiritual beliefs.</p> <p>Despite many students believing the soul is no longer associated with the body of their donor, the act of dissection remains a formative experience. For most health profession students, dissection elicits significant emotional experiences that compel them to adopt behaviors and attitudes for interacting with donors, which can be strongly associated with their professional identity formation, from coping mechanisms to compassion and respect for patients.[[<reflink idref="bib8" id="ref8">8</reflink>]] Implementation of reflective practices regarding dissection, death, and body donation is purported to assuage students' emotional and spiritual perturbation during anatomy courses.[<reflink idref="bib8" id="ref9">8</reflink>] Whether students engage in oral or written reflections,[[<reflink idref="bib1" id="ref10">1</reflink>]] formal group discussions,[<reflink idref="bib4" id="ref11">4</reflink>] or memorial ceremonies,[[<reflink idref="bib8" id="ref12">8</reflink>], [<reflink idref="bib10" id="ref13">10</reflink>]] reflection can be a cathartic and enlightening experience as students can learn a tremendous amount from these "first patients" through death more than life.</p> <p>In recent years, a greater emphasis has been placed on the recruitment and enrollment of students from diverse backgrounds into health profession programs. Students recruited from diverse backgrounds build a more representative workforce in healthcare that can better address health disparities and serve members of the public who are members of historically marginalized and underserved communities.[[<reflink idref="bib12" id="ref14">12</reflink>]] Various Studies have shown a statistically significant negative correlation between academic performance in foundational sciences like anatomy and students identifying as Hispanic or students for whom English is a second language.[[<reflink idref="bib14" id="ref15">14</reflink>], [<reflink idref="bib16" id="ref16">16</reflink>]] Failure to adequately support the unique needs of students with underrepresented social identities has been shown to lead to diminished retention rates, particularly among students of color in health professions programs.[[<reflink idref="bib12" id="ref17">12</reflink>], [<reflink idref="bib17" id="ref18">17</reflink>]] As a foundational science course that is often heavily weighted in the initial phase of health professions' curricula, anatomy courses provide a unique opportunity to promote an inclusive learning environment, a supportive social community, and a sense of belonging between students and their educators. Therefore, the implementation of innovative educational experiences within the anatomy curriculum at the onset of a health profession program has the potential to promote diversity, equity, inclusion, and belonging among students whose social, cultural, and spiritual identities are historically marginalized in healthcare.</p> <p>Tisdell[<reflink idref="bib19" id="ref19">19</reflink>] proffers a culturally‐responsive epistemology for teaching in higher education, asserting that teaching is both an intellectual and spiritual endeavor. Furthermore, Tisdell elucidated the intersectionality between spirituality and cultural identity before arguing that in order for multicultural teaching to be transformative, it must enable students to engage in, explore, and reclaim their cultural identity, a process that is often spiritual. The employment of intentional strategies to foster a sense of belonging among underrepresented groups in academic spaces is necessary for students who identify within these groups to feel seen, heard, and valued.[<reflink idref="bib20" id="ref20">20</reflink>] With respect to cultivating a sense of belonging and inclusion for students whose identities have historically been excluded from the healthcare field, it is imperative that educators and institutions deliberately strive to create learning environments that overtly respect, value, and celebrate the cultural and spiritual identities of underrepresented minorities.[[<reflink idref="bib18" id="ref21">18</reflink>], [<reflink idref="bib20" id="ref22">20</reflink>], [<reflink idref="bib22" id="ref23">22</reflink>]]</p> <p>Regis University, with its distinctive history and unique positionality, was and is well‐positioned to engage these emerging insights. One of 27 Jesuit colleges and universities in the United States, Regis stands within a 450‐year history of holistic education. The earliest companions of Ignatius of Loyola met while studying at the University of Paris.[<reflink idref="bib23" id="ref24">23</reflink>] After receiving formal recognition for the Society of Jesus, which is the more formal name of the Roman Catholic religious order founded by Ignatius of Loyola that is commonly referred to as Jesuit, in 1540, the order proliferated. Understanding the value of a strong education, each new recruit underwent a period of formative training that typically lasted well over a decade and included multiple master's degrees and minimum. When local leaders asked the Jesuits to educate their own children as well, the Society of Jesus became the first religious order with education as a core ministry. The educational system they designed drew from what they had experienced at the University of Paris: a model that encourages active participation, experience, and reflection.</p> <p>As the first Roman Catholic religious order to make education a primary ministry, the Society of Jesus has reflected on its unique approach to education for centuries. Standing within a Catholic intellectual tradition that emphasizes the goodness of creation and education of the whole person, the Jesuits have long valued the sort of reflective practices and inclusive strategies recommended by the research on Jesuit pedagogy.[[<reflink idref="bib24" id="ref25">24</reflink>], [<reflink idref="bib26" id="ref26">26</reflink>]] In recent decades, this approach was formalized as the Ignatian Pedagogical Paradigm.[[<reflink idref="bib27" id="ref27">27</reflink>]] Drawing insights from Ignatian spirituality and contemporary social movements, at the heart of this process is a praxis model of experience, reflection, and action. It is worth noting how this cycle differs from the see‐judge‐act process of social analysis.[<reflink idref="bib29" id="ref28">29</reflink>] Here, the emphasis is on not just observing reality but experiencing it directly. Similarly, students are encouraged to not only judge from the outside but also to reflect on their own experiences and identities in conversation with the social reality.</p> <p>Bracketing these three elements, the Ignatian Pedagogical Paradigm also includes context and evaluation. Here, context refers to the educator's pause at the beginning of the process to consider the global and particular realities of the students they educate.[<reflink idref="bib30" id="ref29">30</reflink>] Then, they should ask how the process of experience, reflection, and action might be adapted to the unique identities and concerns of their students. At Regis, this includes considerations of what it means to be a Hispanic serving institution (HSI), as well as our identity as a Jesuit and Catholic university. Evaluation, conversely, can pertain to both the traditional measures of evaluating student learning as well as reflection on the effectiveness of the pedagogical strategies implemented, the latter of which is carried out within the Discussion section of this article.</p> <p>Jesuits' involvement in anatomy education traces back nearly 500 years across multiple continents. A sixteenth‐century Jesuit priest from Portugal named Pero de Castilho wished to better serve native Brazilians during Portuguese colonialization by developing a bilingual dictionary of anatomical terms so that native Brazilians could communicate with and receive medical treatment from physicians of Portuguese descent.[<reflink idref="bib31" id="ref30">31</reflink>] The Jesuit‐related document created by de Castilho is believed to be the first Nomina Anatomica (now Terminologia Anatomica) published in Brazil. Additionally, at the cusp of the seventeenth and eighteenth centuries, two French Jesuits, Joachim Bouvet and Dominique Parrenin, educated the Kangxi Emperor of China on contemporary European anatomical knowledge.[<reflink idref="bib32" id="ref31">32</reflink>] This exchange of medical knowledge between the Jesuit priests and the Kangxi Emperor led to the publication of an anatomy atlas titled the <emph>Dergici toktobuha Ge ti ciowan lu bithe</emph> in Manchu (<emph>Imperially Commissioned Complete Record on the Body</emph> in English), which was grounded in knowledge gained from human body dissections.[[<reflink idref="bib32" id="ref32">32</reflink>]] The illustrations in this anatomy atlas were pivotal in demonstrating that anatomical knowledge based on the study of European bodies was also applicable to Chinese bodies.[<reflink idref="bib32" id="ref33">32</reflink>] These are just two notable examples of Jesuits' connections to anatomy education over the centuries.</p> <p>The Society of Jesus has a long history of religious, social, economic, political, and educational activity in Central and South America, tracing back to the 1540s, with Jesuits establishing schools as early as 1555.[[<reflink idref="bib34" id="ref34">34</reflink>]] Jesuit missionary work historically emphasized social justice and the promotion of education. While Catholicism as a whole is tied to the colonization of Mesoamerica, the Jesuits preferred syncretism over conversion, the latter of which was utilized by many colonizers to strip indigenous peoples of their cultural and spiritual identities.[<reflink idref="bib35" id="ref35">35</reflink>] The saying, "We go in by their door, in order to come out by ours," is ascribed to Saint Ignatius and encapsulates this Jesuit mindset of learning about, acknowledging, and collaborating across cultural and spiritual divides to better serve a diverse array of communities.[<reflink idref="bib36" id="ref36">36</reflink>] Embracing the cultural and spiritual beliefs of others, engaging respectful discourse, and creating an inclusive sense of belonging in an educational setting began with Saint Ignatius and the early Jesuits in the 1500s and persists to this day across thousands of Jesuit institutions.[<reflink idref="bib34" id="ref37">34</reflink>]</p> <p>In recent decades, much of this unique approach to education has been characterized by the Jesuit concept of <emph>cura personalis</emph> (often translated as "care for the whole person"). Initially coined as a contra to <emph>cura apostolica</emph> (care for the work), this value emphasized the need to consider the needs and abilities of a Jesuit mission to a Jesuit apostolate.[<reflink idref="bib37" id="ref38">37</reflink>] In an educational context, <emph>cura personalis</emph> challenges an instructor to consider the student as a whole person: attending not simply to their academic growth but also to their physical, emotional, and spiritual well‐being. It also signifies a particular concern for each student in terms of their unique identities and concerns. Each student is unique, and Jesuit pedagogy challenges instructors to consider and respond to the social and personal needs of each pupil.</p> <p>Through the lens of <emph>cura personalis</emph>, Regis University is well positioned to develop innovative approaches to gross anatomy education. Regis inherits a Catholic history but is religiously diverse. Less than half of all students identify as Catholic, and most cite academic reputation as their primary reason for applying. Yet regardless of faith identity, the students demonstrate the sorts of spiritual concerns outlined above. Moreover, Regis recently applied for and received in March of 2023 the federal designation as an HSI. The term "HSI," coined by the United States Department of Education, is, in fact, a misnomer as it fails to address the nuances between the terms Hispanic and Latine, which represent two different yet partially overlapping groups.[<reflink idref="bib38" id="ref39">38</reflink>] As Latine is considered the most acceptable, gender‐inclusive term by members of this community, as opposed to Latinx which is primarily utilized by individuals outside the community, it will be used henceforth. Regis University's path toward becoming an HSI underwent an accelerated trajectory in recognition of the 28% of Hispanic and Latine identifying students already enrolled. In anticipation of this designation, Regis leadership undertook several efforts to consider how to best engage and support our students.</p> <p>Creating a culture of not just inclusion but belonging requires compassionate stakeholders willing to invest time and other resources into cultivating a supportive environment that employs culturally responsive pedagogical practices.[<reflink idref="bib39" id="ref40">39</reflink>] One of the ways in which Regis supports students of Hispanic and Latine backgrounds is by educating our faculty, staff, and administrators on the differences, drawbacks, and historical trauma entangled in these two terms. As previously alluded to, these two cultural identities are frequently used interchangeably even though they are not entirely synonymous.[<reflink idref="bib38" id="ref41">38</reflink>] The term <emph>Hispanic</emph> describes an individual with ancestry that is derived from a country whose primary language is Spanish, whereas the term <emph>Latine</emph>, or its variants (<emph>Latina</emph>, <emph>Latino</emph>, or <emph>Latinx</emph>) describes an individual whose heritage is traced back to Latin or Meso‐America, such as Mexico, South and Central America, and the Caribbean. While these definitions exhibit overlap, nuances also exist. For example, an individual from Spain could identify as Spanish but not Latine; likewise, an individual from Brazil could identify as Latine but not Spanish. To add another layer of complexity, an individual may identify as both, either, or neither Hispanic nor Latine depending on their sense of identity, especially considering the bristly and tempestuous relationship between native Mesoamerican cultures and Spanish colonization, a bellicose and antagonistic historical movement which both these terms are intimately rooted in.[<reflink idref="bib38" id="ref42">38</reflink>]</p> <p>As a HSI that strives to embody Catholic, Jesuit values, Día de Muertos (the Day of the Dead) seemed the perfect opportunity to highlight and celebrate the cultural and spiritual backgrounds of Regis University's student population within the anatomy curriculum. The relationship between dissection and spiritual reflection rendered anatomy the optimal course to commemorate a spiritual holiday like Día de Muertos. Through a collaborative effort between an anatomy educator and her students, a communal <emph>ofrenda</emph>, or altar, was assembled in a common area as a sign of cultural and spiritual recognition prior to Día de Muertos. Then, an in‐class celebration was held at the start of the anatomy lecture on Día de Muertos, and students disseminated information to contextualize the spiritual event further. Finally, the Día de Muertos festivities culminated in a reflective memorial ceremony for the donors within the anatomy laboratory. Throughout this innovative culturally responsive experience, space was created for students to contemplate the gift of body donation while members of the learning environment convene to celebrate the spiritual beliefs of an underrepresented minority within health professions to actively promote diversity, equity, inclusion, and a sense of belonging among the student population.</p> <hd id="AN0180775311-3">DESCRIPTION</hd> <p>Doctor of Physical Therapy (DPT) students at Regis University enroll in a dissection‐based course, <emph>Human Anatomy and Histology</emph>. This DPT program is eight semesters and includes four clinical education experiences, spanning 6 weeks to 6 months. Throughout their first semester, these graduate students learn anatomy through a regional approach. Learning modalities within the course include lectures, palpation laboratories, and dissection‐based laboratories utilizing 14 human body donors. Dissection‐based laboratory sessions account for 30 of the 33 laboratory sessions within the course, each lasting 3 h in length.</p> <p>The DPT cohort for the Class of 2025 was comprised of 84 students. Based on the demographic data provided by the Physical Therapy Centralized Application Service (PTCAS) during the admissions process, 22.6% of the students within this cohort self‐identified as Hispanic or Latine, which is marginally less than the undergraduate population at Regis, which consistently equaled or exceeded 25% to be designated as an HSI. Regis University's DPT program has implemented a holistic admissions process, starting with the Class of 2025. Each applicant is assessed using multiple cognitive and noncognitive variables to determine aptitude, match to the Jesuit mission of the university, and valuable contributions the individual could provide to the healthcare workforce. Application essays and interview questions for prospective DPT students were designed to highlight the identity, values, and experiences each applicant would bring to both the program and the healthcare system. Furthermore, the GRE is no longer required for admission to the DPT program due to the assessment's problematic predictive validity of graduate student success for people of color.[<reflink idref="bib40" id="ref43">40</reflink>] These efforts to implement a more holistic admissions process play a part in solving the need for diversification in the healthcare field overall.[<reflink idref="bib12" id="ref44">12</reflink>]</p> <hd id="AN0180775311-4">Regis' intersectionality</hd> <p>Similar to how some individuals identify as both Hispanic and Latine, Regis University's identity is one of duality as it is characterized as both a Catholic, Jesuit university and an HSI. The intersection between Regis' identities is exemplified by the university's emphasis on exploration, discourse, acknowledgment, and collaboration across various cultural and spiritual divides. Faculty are often encouraged by the Office of Mission to be <emph>contemplatives in action</emph>, in other words, to reflect upon and initiate innovative modalities to incorporate <emph>cura personalis</emph> into the classroom. Learning about and celebrating a spiritual holiday that honors the dead and highlights the cultural identities of our Hispanic and Latine students was one such action implemented within an anatomy course to commemorate our donors while simultaneously promoting a sense of belonging within a historically marginalized group.</p> <hd id="AN0180775311-5">Día de Muertos: Traditions and symbolism</hd> <p>The tradition of celebrating Día de Muertos, also known as Día de los Muertos, has existed for thousands of years. It is worth noting that Día de Muertos is a more gender‐inclusive term that has surfaced in recent years, although the masculine Día de <emph>los</emph> Muertos is still commonly used as well. On Día de Muertos, it is believed that the spirits of loved ones come back and visit Earth. Mesoamerican cultures believed that energy is neither created nor destroyed and, as an extension, that the souls of loved ones perpetually remain in the universe. This belief regarding energy and souls, or life forces, highlights the duality of life and death. On Earth, the families of the deceased construct <emph>ofrendas</emph>, which consist of multilayered altars filled with pictures, flowers, <emph>papel picado</emph>, and <emph>calaveras</emph>, the meaning and symbolism of which are described in Table 1.</p> <p>1 TABLE Overview of Día de Muertos terminology and symbolism.</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left"><italic>Terminology (alternatives)</italic></th><th align="left">Translation</th><th align="left">Meaning and symbolism</th></tr></thead><tbody valign="top"><tr><td align="left">Día de Muertos (Día de los Muertos)</td><td align="left">Day of the Dead</td><td align="left">A spiritual celebration honoring deceased loved ones, spanning November 1st through November 2nd.</td></tr><tr><td align="left">Ofrenda (ofrendas)</td><td align="left">Offering (offerings)</td><td align="left">These altars are adorned with fruits, incenses, pictures, favorite foods of deceased family members, and other objects representing poderíos.<xref ref-type="bibr" rid="bibr41">41</xref> In remembrance of family members, altars are built so that the souls know where to go and can use the foods and drinks as energy for travel.</td></tr><tr><td align="left">Calavera (calaveras)</td><td align="left">Skull (skulls)</td><td align="left">Artistic representations of skulls were made popular by Jose Guadalupe Posada a Mexican printmaker.<xref ref-type="bibr" rid="bibr42">42</xref> The imagery of skulls ties into the indigenous traditions of skulls being offered to the gods.</td></tr><tr><td align="left">Calaca (calacas)</td><td align="left">Skeleton (skeletons)</td><td align="left">Much like calaveras, calacas are also utilized to represent the remains of deceased loved ones.</td></tr><tr><td align="left">Cempasúchil (Aztec marigold, Mexican marigold, tagetes erecta, or cempazúchitl)</td><td align="left">Marigold flowers</td><td align="left">This flower, which is native to Mexico, is culturally perceived to be one of the most beautiful indigenous flowers. Additionally, the bright colors of the marigold are a representation of the sun that guides the souls.</td></tr><tr><td align="left">Monarch mariposas</td><td align="left">Monarch butterflies</td><td align="left">These butterflies are believed to hold the spirits of the departed. This belief stems from monarchs arriving in Mexico for winter each fall around November 1st.<xref ref-type="bibr" rid="bibr43">43</xref></td></tr><tr><td align="left">Calaveritas de azucar</td><td align="left">Sugar skulls</td><td align="left">Sugar‐based, skull shaped candies come in a variety of vibrant colors. In the Pre‐Hispanic era, real skulls were offered to the gods. After Spanish influence, the use of sugar skulls was used to represent death as part of life.</td></tr><tr><td align="left">Poderíos</td><td align="left">Power, might</td><td align="left">Four powerful elements believed to be conduits for transferring energy: water, fire, Earth, and wind.</td></tr><tr><td align="left">Agua</td><td align="left">Water</td><td align="left">Agua represents water (one of the four elements) that is offered to the souls for completing their journey to earth. Water can be represented in various ways on an altar such as a bottle of alcohol or a favorite drink.<xref ref-type="bibr" rid="bibr44">44</xref></td></tr><tr><td align="left">Veladora (veladoras)</td><td align="left">Candle (candles)</td><td align="left">The term veladoras specifically describes candles that are utilized in religious and spiritual ways. They represent fire (one of the four elements) that help guide souls to their old home. It can also be used to burn incense that is believed to purify the areas around the altars.<xref ref-type="bibr" rid="bibr45">45</xref></td></tr><tr><td align="left">Pan de Muertos</td><td align="left">Bread of the dead</td><td align="left">The use of sweet‐smelling bread signifies both the life‐death cycle and pan de Muertos represents Earth (one of the four elements) by using gifts from Earth as ingredients to make food that the souls consume for nourishment.<xref ref-type="bibr" rid="bibr46">46</xref></td></tr><tr><td align="left">Papel picado</td><td align="left">Perforated paper</td><td align="left">The papel picado is brightly colored, decorative cut paper. They represent wind (one of the four elements) that brings the souls to earth and also the fragility of life.</td></tr></tbody></table> </ephtml> </p> <p>1 <emph>Note</emph>: This table outlines common Spanish terminology associated with <emph>Día de Muertos</emph>, the English translation, as well as the symbolic meaning behind the term.</p> <p>Over time, the celebrations of loved ones who have passed have evolved. The origin of Día de Muertos predates the Spanish colonization of Mexico. These spiritual celebrations of the dead in Latin America were primarily practiced by Mesoamerican civilizations, such as the Aztecs, Toltecs, and Olmecas.[<reflink idref="bib43" id="ref45">43</reflink>] At this phase of history, historians note that the indigenous groups believed in an eternal life in which souls continued to live in an afterworld. This afterworld did not consist of heaven or hell, but the indigenous groups believed there were multiple levels of the afterlife depending on how someone passed away. As the Spanish invaded Mexico and began the process of colonization, Roman Catholicism was often used to justify the enslavement of indigenous peoples and the suppression of their cultures. Yet, even amidst forced conversions and violent repression, indigenous practices and traditions continued to be passed down from generation to generation.[<reflink idref="bib47" id="ref46">47</reflink>] In the end, Mesoamerican and Spanish cultures amalgamated into a religious syncretism and <emph>mestizo</emph> spirituality, with several indigenous customs remaining, including Día de Muertos. In ancient indigenous practices, Día de Muertos celebrations lasted roughly 1 month. However, upon colonization, the celebration was aligned with Roman Catholic practices of All Saints' Day and All Souls' Day, celebrated on November 1st and November 2nd, respectively. In the assimilation of All Saints' Day and All Souls' Day, November 1st commemorates deceased children, while November 2nd honors deceased adults.</p> <p>The contemporary celebrations of Día de Muertos are primarily held on November 1st and 2nd to honor deceased adults and children, respectively; however, these celebrations vary depending on the region.[<reflink idref="bib45" id="ref47">45</reflink>] For example, in states like Oaxaca and Michoacán, Mexico, preparation for celebrations can start a few weeks before November. In various regions of Mexico, celebrations include going to gravesites and leaving food that was enjoyed by the deceased at the cemetery, along with <emph>Cempasúchil</emph> (marigold) petals and flowers to adorn the walkways. Modern celebrations of Día de Muertos have also highlighted sociopolitical injustices, for example, in Mexico and the United States. Artists create altars or public demonstrations highlighting situations where lives were lost due to sociopolitical upheaval. In Mexico, an artist made public demonstrations on Día de Muertos that represented the 43 lives of students that were lost due to drug cartels and corruption within the Mexican government in 2014, a tragedy that remains under investigation and unresolved.[<reflink idref="bib48" id="ref48">48</reflink>] In the United States, modern celebrations of Día de Muertos transformed during the Chicano movement. The holiday of Día de Muertos was used as a tool to build identity as well as to recognize and celebrate indigenous roots, leading to individuals with Mexican American heritage creating a new Chicanx identity. In recent years, major cities in California and New York have used parades to develop new political and cultural consciousness to highlight injustices like children who pass away in Immigration and Customs Enforcement (ICE) detention centers.[<reflink idref="bib49" id="ref49">49</reflink>]</p> <p>With the various rituals and customs for celebrating Día de Muertos, commonalities exist throughout the regions. As previously mentioned, decorations have a deeper meaning than simply being used as adornments (see Table 1). In the Mesoamerican traditions, fire, wind, water, and Earth are viewed as <emph>poderíos</emph>, powerful elements of transferring energy. Traditionally, <emph>ofrendas</emph> incorporate decorations that symbolize each of these elements as well as individualized adornments specific to the deceased loved ones being remembered.</p> <p>In recent years, <emph>papel picado</emph>, which translates to perforated paper, has been used to represent the wind on <emph>ofrendas</emph>.[<reflink idref="bib45" id="ref50">45</reflink>] The <emph>papel picado</emph> usually features geometric shapes but can also be artistically cut into other shapes and designs. As the wind passes through the <emph>papel picado</emph>, these paper decorations can move along with the wind like a flag. The use of <emph>agua</emph> or other beverages is tied to the symbolism of water and the belief that water is necessary to help the souls quench their thirst from traveling. Foods like <emph>pan de Muertos</emph>, a soft and sweet bread designed to mimic the shape of a skull and cross bones, represent Earth, as gifts from the Earth are used as ingredients to make these delicious foods for the souls to eat. <emph>Pan de Muertos</emph> is also believed to motivate the souls for future travel. The use of <emph>veladoras</emph>, also known as candles, represents the final element, fire. <emph>Veladoras</emph> are lit throughout these celebrations, with the fire representing a light that souls can follow to find their way to their respective altars and offerings.[<reflink idref="bib50" id="ref51">50</reflink>] As families are reunited, Día de Muertos celebrations include storytelling in honor of the lives of loved ones, live music at cemeteries, and families coming together to embrace the cycle of life and death and to honor the generational knowledge that has been passed down.</p> <hd id="AN0180775311-6">Bringing Día de Muertos to life through anatomy</hd> <p>As a Jesuit Catholic university, Regis has recognized Dia de Muertos for several years. This has included the construction of an <emph>ofrenda</emph> in the university chapel, Catholic masses, and interfaith prayer services. Recently, Regis started hosting over 150 high school students on campus annually to learn more about the tradition.[<reflink idref="bib51" id="ref52">51</reflink>] Planning began in the Fall of 2022 for the first Día de Muertos celebration specifically connected to an anatomy class. From its inception, this spiritual activity was student‐derived, with the support of an anatomy educator willing to advocate for and sponsor the event on behalf of the students who wished to see their culture recognized within the school. In the initial planning stages, the anatomy educator facilitating this endeavor met with the student council diversity representatives of the Classes of 2024 and 2025 several times to discuss how the students envisioned a Día de Muertos celebration. It was paramount that the conception of this innovative activity be driven by the students, with the educator serving as an ally willing to sponsor and facilitate the execution of the student‐led celebration.</p> <p>The most meaningful modalities to encompass an authentic Día de Muertos celebration in the eyes of these students was through a series of activities spanning the course of a week, in which individuals of any ethnicity were welcome to participate, beginning with the building of an <emph>ofrenda</emph>. The <emph>ofrenda</emph> had traditional adornments and accompanying pamphlets describing the significance of Día de Muertos and outlining additional celebratory events scheduled for November 1st and 2nd for all individuals who came across the <emph>ofrenda</emph>. The scheduled events included an in‐class celebration during the anatomy lecture on November 1st, a reflective donor memorial ceremony in the anatomy laboratory on November 2nd, and a screening of the film Coco for all who wished to attend. The movie Coco was selected for our screening due to the portrayal of celebrations during Dia De Muertos and was used as a visual representation of the cultural significance of Dia De Muertos for the attendees who had minimal prior knowledge of Dia De Muertos.</p> <p>Prior to Día de Muertos and the contemplative donor ceremony, it was essential to create a spiritually‐inclusive environment that promoted a sense of belonging. Creating a culturally welcoming environment commenced with the construction of an <emph>ofrenda</emph> to be publicly displayed and interacted with by anyone in the School of Physical Therapy, not just those currently enrolled in the anatomy course. The optimal location to house this <emph>ofrenda</emph> was directly across the hall from the entrance to a frequently utilized classroom, just down the hall from the School of Physical Therapy faculty and staff offices. By setting up the <emph>ofrenda</emph> here, it received maximal traffic from physical therapy students, faculty, and staff. The anatomy educator and student council diversity representatives assembled the <emph>ofrenda</emph> 1 week prior to Día de Muertos by decorating a table with brightly colored <emph>papel picado</emph> around the edges, a vase with fresh cut marigolds from a student's garden, another vase of <emph>agua</emph>, and a dozen electric candles in place of <emph>veladoras</emph> to represent the four elements, or <emph>poderios</emph>. Vibrantly colored handouts on the <emph>ofrenda</emph> described the spiritual significance of Día de Muertos, advertised the screening of the film Coco, which all students were welcome to attend, as well as the in‐class celebrations incorporated into the first‐year anatomy course, and featured an interactive word search for the terms defined by Table 1. Additionally, at the bottom of this handout was a QR code for any member of the community to upload images of their departed loved ones. Shared photos of community members' loved ones were then printed out by the anatomy educator and displayed on the <emph>ofrenda</emph> so that students, faculty, and staff could honor each other's loved ones in a communal manner.</p> <p>In addition to decorating a common space with an <emph>ofrenda</emph> and information, announcements were made during anatomy lectures leading up to Día de Muertos. One of the fundamental components in establishing a culturally inclusive learning environment is allyship on the part of faculty.[[<reflink idref="bib13" id="ref53">13</reflink>], [<reflink idref="bib20" id="ref54">20</reflink>], [<reflink idref="bib22" id="ref55">22</reflink>]] Based upon that rationale, it was essential for the anatomy educator to vocally support the various Día de Muertos activities, both within and outside of the anatomy course, to demonstrate to students a commitment toward making space for their identities to be celebrated. Thus, multiple announcements were made at the start of anatomy lectures, acknowledging the <emph>ofrenda</emph>, movie screening, and course‐related activities commemorating this spiritual holiday to reinforce that Hispanic and Latine students' identities were accepted, included, and valued by faculty. Finally, at the commencement of the last anatomy lecture prior to Día de Muertos, the anatomy educator announced once more that celebrations would be held in class and the anatomy laboratory in honor of Día de Muertos so that students could prepare ahead of time if they wished.</p> <p>On the day of the in‐class celebration, students and faculty were encouraged to wear vibrantly colored, white, or black clothing in honor of the festivities. Figure 1 illustrates the symbolism behind the seven colors often associated with and worn on Día de Muertos.[<reflink idref="bib52" id="ref56">52</reflink>] Although Dia de Muertos is not a recognized federal holiday in the United States of America, there are various ways to celebrate. Some students opted to wear <emph>guayabera</emph> shirts, <emph>campesina</emph> dresses, or <emph>puebla</emph> dresses to commemorate this ethnic holiday which is tied to their own cultural and spiritual identity. Their classmates and educators chose to wear outfits that visually conveyed various symbols related to Día de Muertos, with their Catholic anatomy professor wearing a vivid red and pink dress to symbolize both the sacrifice of Jesus Christ and the happiness associated with this spiritual celebration. During that anatomy lecture, time was reserved to acknowledge Día de Muertos and recognize the ways in which members of the community were observing the spiritual holiday. Additionally, time was taken to express appreciation for those who contributed to building the <emph>ofrenda</emph>, including the students and faculty who provided photographs of deceased loved ones, those who dressed up to commemorate the ethnic holiday, and those who planned to attend a screening of the film Coco later that evening.</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/8Z8K/01nov24/ase2490-fig-0001.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="ase2490-fig-0001.jpg" title="1 Symbolic colors associated with Día de Muertos. The symbolic meanings associated with yellow, orange, red, pink, purple, white, and black with respect to Día de Muertos." /> </p> <p></p> <p>Another way in which students wished to celebrate Día de Muertos in class was through sharing traditional foods with their peers. Unfortunately, due to the COVID‐19 pandemic and its lasting impact on social gatherings, breaking bread like <emph>pan de Muertos</emph> to share among several peers was deemed ill‐advised in 2022. In 2023, COVID‐19 rates in the community were low, and <emph>pan de Muertos</emph> was shared in class. The anatomy educator prudently distributed <emph>calaveritas de azucar</emph> in small <emph>calavera</emph>‐themed gift bags to each student while explaining that these colorful candies signify the vitality of life and the diversity of individual identities.[<reflink idref="bib53" id="ref57">53</reflink>] Overall, the in‐class celebration held on the first day of Día de Muertos embodied the exuberant and celebratory tone of the spiritual holiday. In contrast, the ceremony in the anatomy laboratory on the subsequent day emoted a more reverential tenor.</p> <p>On the second day of Día de Muertos, a contemplative ceremony commemorating the body donors and their loved ones was held at the start of a laboratory session. Prior to students entering the anatomy laboratory, the anatomy educator set out 14 electric candles, one for each donor, along with anatomical skull models on the table at the front of the laboratory. Brightly colored paper and writing utensils were distributed to each dissection group before the laboratory session commenced with a presentation on Día de Muertos. To amplify students' voices and support their expression of their own authentic identities, the anatomy educator felt the most appropriate way to formally disseminate information about this spiritual holiday was through the promotion of a student‐led presentation, followed by a question‐and‐answer session. The student council diversity representative who developed a brief presentation on the cultural significance and spiritual meaning behind Día de Muertos consulted peers who also identified as Hispanic or Latine along with the literature to ensure various nuances in how different Central and South American communities celebrate this occasion were touched upon.</p> <p>Once the question‐and‐answer portion was wrapped up, students were asked to reflect individually and then within their dissection groups on the benevolent gift of body donation. The anatomy educator further prompted students to ponder how their donors had shaped their anatomy education experience and contemplate what this experience made them thankful for. Each dissection group elected a scribe and a speaker to write down notes on their discussions and summarize their sentiments in front of the class, respectively. Beginning with the second iteration of this Día de Muertos ceremony in 2023, dissection groups were encouraged to plan one or more contributions of their choosing for the ceremony in advance; however, they were still afforded time for silent and group reflection prior to engaging in the class‐wide reflection. A retrospective study on this educational initiative was approved by the Regis University Institution Review Board (approval no. 2141809‐1). All students were encouraged to engage in individual reflection, and each had the agency to decide their level of involvement in their groups' contributions to the ceremony as well as what aspects of their personal reflection they wished to share publicly.</p> <p>Following individual and small group reflections, each dissection group was asked to contribute to the class‐wide portion of the reflection ceremony in some form or another. In 2022, groups selected excerpts of their small group reflection to share aloud. In 2023, in addition to reflections, some opted to share poems, letters to either their donor or their donor's loved ones, and artistic contributions, including a colorful floral wreath as well as a playlist dedicated to their donor, which was played during the dissection portion of that day's laboratory session. At the end of the ceremony, individuals and groups could share a written document on their reflections or contributions, either anonymously or identifiably, which were recorded and explored through inductive thematic analysis. In both years, every dissection group chose to share at least one document, with some sharing as many as three.</p> <p>Every dissection group expressed gratitude toward the donors for donating their bodies for medical education purposes. Many also recognized the donors' loved ones who supported this generous gift and entrusted their loved one's bodies to students to be cared for with respect, compassion, and empathy. A desire to optimize the donor's gift, learn as much as they can through this experience, and never take for granted the donors and their loved ones for making this educational experience possible. Several students reflected upon how dissection enriched their learning by providing a deeper understanding of and appreciation for: anatomical relationships and the interconnectedness between structures, anatomical variation and how variations of form affect function, as well as the opportunity to see firsthand how various health conditions can directly and indirectly impact a variety of systems within the body. A handful of students divulged their own private ways of acknowledging the gift of body donation throughout the course, from engaging in moments of silence before entering the laboratory, to contemplating the generosity of their donors and how to honor their gift, to praying for both the donors and their loved ones.</p> <p>Finally, the second most prominent theme in these reflections, following gratitude, was recognition that each donor had thoughtfully contemplated their own mortality and chose to pass on one final gift, that of education, after their souls had left their bodies. While each activity throughout the week was meaningful, the denouement of these Día de Muertos activities was an emotional and spiritual reflection, individually and as a class, which many students found profoundly moving and worthwhile.</p> <hd id="AN0180775311-8">DISCUSSION</hd> <p>Latine students are the fastest‐growing demographic among institutions of higher education, yet colleges and universities across the United States have significantly lower retention and graduation rates for Latine students compared to other groups.[[<reflink idref="bib54" id="ref58">54</reflink>], [<reflink idref="bib56" id="ref59">56</reflink>]] Multiple studies examining students enrolled in health profession programs have identified a statistically significant negative correlation between either Hispanic ethnicity or students for whom English is a second language and academic performance in foundational sciences courses like anatomy.[[<reflink idref="bib14" id="ref60">14</reflink>], [<reflink idref="bib16" id="ref61">16</reflink>]] Bains and Kaliski[<reflink idref="bib14" id="ref62">14</reflink>] purported ethnicity as a significant predictor of DPT students' performance on anatomy practical examinations, with Hispanic ethnicity identified as the only demographic factor with a negative relationship to anatomy performance.</p> <p>While there is a notable academic achievement gap concerning Latine students, several studies have identified external factors that are positively associated with academic success with respect to both academic marks and retention rates of Latine students, such as Latine representation across the institution's students, faculty, and staff,[<reflink idref="bib56" id="ref63">56</reflink>] positive campus climate,[[<reflink idref="bib54" id="ref64">54</reflink>], [<reflink idref="bib57" id="ref65">57</reflink>]] connections with supportive members of the institution,[[<reflink idref="bib58" id="ref66">58</reflink>]] and environmental support systems.[<reflink idref="bib55" id="ref67">55</reflink>] These institutional practices exemplify the Jesuit value of <emph>cura personalis</emph> by supporting Latine students holistically to help bridge the systemic academic achievement gap they face. Implementation of culturally‐responsive teaching practices and community events within an institution, such as the Día de Muertos activities described in this paper, has the potential to improve academic achievement and retention for Latine students by demonstrating <emph>cura personalis</emph> while simultaneously addressing several factors shown to positively impact academic performance.</p> <p>As institutions strive to enroll and retain more diverse student bodies, with students from historically marginalized social, economic, cultural, and spiritual backgrounds entering higher education at higher rates,[<reflink idref="bib12" id="ref68">12</reflink>] it is crucial for these students to feel they belong.[<reflink idref="bib22" id="ref69">22</reflink>] Historically, people of color are minorities in higher education, especially in health profession programs.[<reflink idref="bib12" id="ref70">12</reflink>] As members of a social minority in health professions, these students report additional personal and professional hindrances stemming from deficient social support from individuals of similar backgrounds, which can negatively affect these students' feelings of belonging, sense of self and identity, as well as their academic achievement.[[<reflink idref="bib60" id="ref71">60</reflink>]] Students who identify as members of an underrepresented group are severely and disproportionately affected by concerns of not belonging in health profession programs and fields, particularly if they are the first in their family to attain entrance into higher education.[[<reflink idref="bib13" id="ref72">13</reflink>], [<reflink idref="bib60" id="ref73">60</reflink>]] Thus, understanding the unique social, cultural, economic, language, and academic barriers faced by students within underrepresented social groups, especially students of color, and enacting strategies to support these students better both academically and socially is crucial to their success and retention in health profession programs.[[<reflink idref="bib22" id="ref74">22</reflink>], [<reflink idref="bib61" id="ref75">61</reflink>]]</p> <p>The purposeful incorporation of spiritual rituals and signs of cultural recognition of underrepresented minorities within a learning environment is associated with a positive sense of belonging for students within historically excluded groups.[[<reflink idref="bib13" id="ref76">13</reflink>], [<reflink idref="bib57" id="ref77">57</reflink>]] In addition to the acknowledgment of multiple cultural identities, the demonstration of inclusive teaching practices and the facilitation of discussions about the relevance of personal identity are positive modalities for educators to promote belonging among a diverse student population.[[<reflink idref="bib20" id="ref78">20</reflink>], [<reflink idref="bib62" id="ref79">62</reflink>]] Studies have suggested that interactions with educators who acknowledge Latine students' identities and are willing to provide mentorship are positively associated with student's academic success.[[<reflink idref="bib58" id="ref80">58</reflink>]] Youmans et al.[<reflink idref="bib22" id="ref81">22</reflink>] take this notion a step further by recommending that educators should mentor and sponsor underrepresented minority students by providing regular check‐ins, creating individual development plans, connecting mentees with scholars within and outside of campus, and assisting with student‐led activities. Student‐led opportunities aim to counteract their historical exclusion by allowing students to celebrate their own backgrounds and reflect on their intersectional identities, enabling learning environments to successfully shift from inclusion to belonging. The approach suggested by Youmans et al.[<reflink idref="bib22" id="ref82">22</reflink>] was implemented within this anatomy course as students led the planning and execution of these Día de Muertos activities with the support and mentorship of an anatomy educator.</p> <p>Educators that co‐construct supportive and collaborative learning environments with their students to highlight and celebrate various cultural backgrounds and beliefs can have a positive impact on racially and ethnically diverse students' sense of belonging within their learning environment as well as their academic achievements.[[<reflink idref="bib54" id="ref83">54</reflink>], [<reflink idref="bib60" id="ref84">60</reflink>]] Día de Muertos served as an opportune occasion to not only highlight but celebrate the cultural and spiritual beliefs of Latine students. Incorporating this spiritual holiday into the anatomy curriculum was an intentional strategy aimed at cultivating a more profound sense of inclusion and belonging among underrepresented groups within an academic space. By providing students with an opportunity to share, express, and discuss their social and spiritual identities, this innovative activity enabled students from underrepresented groups to feel acknowledged, accepted, and valued within their academic environment.[[<reflink idref="bib13" id="ref85">13</reflink>], [<reflink idref="bib22" id="ref86">22</reflink>]] Furthermore, this innovative educational experience promotes social comradery among students as well as mentorship and allyship between the students leading this endeavor and their educators. These strides toward cultivating a genuine sense of belonging for students who identify as members of underrepresented minorities are purported to enhance the recruitment and retention of more diverse student populations.[[<reflink idref="bib56" id="ref87">56</reflink>], [<reflink idref="bib61" id="ref88">61</reflink>]]</p> <p>While motivated anatomy educators that are willing to support and facilitate innovative culturally and spiritually inclusive activities such as the Día de Muertos festivities described in this paper are crucial, collaboration with students who identify as members of the social, cultural, or spiritual minorities the activity is aimed at highlighting are vital. Usoro et al.[<reflink idref="bib61" id="ref89">61</reflink>] and Youmans et al.[<reflink idref="bib22" id="ref90">22</reflink>] suggest health profession programs support students within underrepresented social groups by advocating for and facilitating activities that the students have envisioned to build a sense of community and cultivate underrepresented minority engagement. This approach relies heavily on student input in order to authentically incorporate their backgrounds, beliefs, and cultural experiences into the learning environment. By seeking student insight, educators are providing students from historically excluded social identities a seat at the table while simultaneously affirming to the students that their personal identities are considered appurtenant to the learning environment, program, and profession.[[<reflink idref="bib20" id="ref91">20</reflink>], [<reflink idref="bib22" id="ref92">22</reflink>]]</p> <p>This appears to be the first instance of traditions grounded in Día de Muertos being incorporated into a gratitude ceremony for donors. However, spiritual rituals are incorporated into anatomy curricula around the world, with many cultures believing that "when [deceased body donors] are given special religious accommodations, their values, and therefore human identity, are being honored (Yousman[<reflink idref="bib63" id="ref93">63</reflink>], p. 18)." For example, gross anatomy courses taught across several Asian countries honor their donors at the commencement and conclusion of each dissection session through silent prayer and deep bows of gratitude, respectively.[[<reflink idref="bib64" id="ref94">64</reflink>]] Additionally, when the semester ends at Tzu Chi University in Taiwan, students reposition all of their donors' tissues, suture their bodies back into their natural form, and then dress their donors for coffining and cremation rites rooted in their specific religious practices.[[<reflink idref="bib64" id="ref95">64</reflink>], [<reflink idref="bib66" id="ref96">66</reflink>]] Anatomy courses in Sri Lanka honor donors through a <emph>pirith</emph> ceremony grounded in principles of Theravada Buddhism.[<reflink idref="bib67" id="ref97">67</reflink>] Buddhist monks, anatomy educators, students, and donors' families come together to attend Thai <emph>ajarn yai</emph> ceremonies, in which ritual bouquets of flowers are offered to donors as their names are read aloud, and they are given the title of "great teacher."[<reflink idref="bib68" id="ref98">68</reflink>] In South Korea, Protestant‐associated institutions like Yonsei University College of Medicine conduct Christian‐based memorial services for donors with a strong religious tone, while public institutions like Pusan National University hold donor ceremonies that are more spiritually driven.[<reflink idref="bib69" id="ref99">69</reflink>] At the University of Otago in New Zealand, a <emph>whakawatea</emph> ("clearing the way") ceremony, steeped in the spiritual beliefs of the Indigenous Māori people, is held prior to the start of their medical anatomy course.[<reflink idref="bib7" id="ref100">7</reflink>] Israel's Sackler Medical School recognizes Judaic traditions such as <emph>tuma</emph> (ritual impurity) laws by physically separating dissection rooms, which are classified as cemeteries, from the rest of the medical school, as well as ensuring all bodily tissues from a donor, including blood, are kept together prior to performing Jewish burial practices.[<reflink idref="bib70" id="ref101">70</reflink>] Thus, Día de Muertos is one of many examples of how to incorporate a spiritual ceremony into a gross anatomy course in a culturally meaningful manner based on local cultures, religions, and beliefs regarding death.</p> <p>While many Judeo‐Christian traditions revolving around death are solemn and mournful in nature,[<reflink idref="bib71" id="ref102">71</reflink>] some are more exuberant, such as Catholic feast days, which commemorate the dates of saints' deaths and ascensions through celebration (feast is derived from the Latin term <emph>festes</emph>, meaning "joy"[<reflink idref="bib72" id="ref103">72</reflink>]). Día de Muertos coincides with All Saint's Day, or the Feast of All Saints, in the Catholic church due to the melding of Latin American and Christian cultures centuries ago. Since many Latine and Caribbean societies embrace death in a more celebratory manner, similar to Catholic saints' feast days, believing jovial ceremonies surrounding death are the most respectful means of remembering and honoring the deceased,[<reflink idref="bib71" id="ref104">71</reflink>] a Día de Muertos celebration was the optimal method of incorporating a donor ceremony into this anatomy course at an HSI.</p> <p>Finally, the success of this initiative also offers a response to some of the pressures faced by dissection‐based anatomy curricula as well as those faced by faith‐based institutions. In recent years, the contact hours devoted to the foundational sciences in health professional curricula have dwindled, leading some to rely on prosection, model, or virtual means to teach anatomy despite these curricular alterations' association with impairments to student learning and professional development.[[<reflink idref="bib73" id="ref105">73</reflink>]] However, Bekele et al.[<reflink idref="bib75" id="ref106">75</reflink>] found that students who participate in ceremonies honoring their donors are far more likely to view the act of dissection as an irreplaceable aspect of their education that cannot be replicated through models or virtual means. Thus, the implementation of spiritual ceremonies like this one can drastically increase student buy‐in to dissection, which may encourage institutions to reconsider removing dissection from their curricula.</p> <p>While facing increased enrollment challenges, Jesuit institutions have struggled to remain viable while also staying true to their history and spiritually grounded mission, often opting to eliminate humanities programs and core requirements aimed at promoting Jesuit values.[[<reflink idref="bib76" id="ref107">76</reflink>]] This Día de Muertos celebration offers an alternative approach to embedding mission into the curriculum. Rather than grounding institutional identity in the proliferation of humanities programs or core requirements, it is possible to practice care for the whole person and attend to the spiritual dimensions of the Jesuit mission in even the most rigorous of STEM courses. Of course, such an approach requires faculty who are properly encouraged, trained, and resourced to incorporate such elements into their courses.</p> <hd id="AN0180775311-9">Considerations</hd> <p>First and foremost, institutions and educators must delineate if a Día de Muertos celebration is the optimal way to incorporate spirituality and reflection into their anatomy courses based on their student population and the spiritual and cultural backgrounds of their historically underrepresented social identities. The next consideration is identifying students who are willing and able to take the lead or help facilitate activities that promote their own cultural or spiritual beliefs.[<reflink idref="bib61" id="ref108">61</reflink>] Time and financial constraints are another set of factors worth considering. In addition to creating time within the anatomy curriculum for these Día de Muertos activities, the time required to meet with students to plan, organize, and implement these activities must be considered. Budgeting funds for activities such as the <emph>ofrenda</emph> and in‐class celebration, which are conducive to creating a safe environment where students feel comfortable expressing their authentic identities,[<reflink idref="bib22" id="ref109">22</reflink>] should be accounted for. The School of Physical Therapy's Community of Belonging (formerly DEI) committee allocated funds from the university to procure necessary elements for the celebration and replenish perishable items annually. Collaborating with other departments across the university or consulting entities, such as an office of diversity, equity, and inclusion, could help to offset these limitations.[<reflink idref="bib56" id="ref110">56</reflink>] Furthermore, as the contemplative donor ceremony was a spiritually and emotionally charged activity for some students, the region of the body being dissected that day should be thoughtfully considered. Educators should be willing to adapt their course schedule slightly if regions that are more likely to be emotionally triggering, such as the face, hands, and perineum,[<reflink idref="bib78" id="ref111">78</reflink>] are scheduled to coincide with Día de Muertos.</p> <hd id="AN0180775311-10">CONCLUSION</hd> <p>Anatomy courses are uniquely situated within health profession programs to foster various nontechnical, discipline‐independent skills and attributes in no small part due to their early placement in the curriculum coupled with the sense of community cultivated by a common, emotionally charged experience like engaging in dissection is not easily replicated by other courses. The act of dissection requires students to demonstrate teamwork, respect for donors, compassion, and empathy while they contemplate their cultural, social, and even spiritual beliefs regarding dead bodies.[<reflink idref="bib73" id="ref112">73</reflink>] Due to the inherent relationship between anatomy and mortality, anatomical sciences education is the optimal component of a health profession program's curriculum to incorporate spiritual reflection. Furthermore, anatomy courses can promote diversity, equity, inclusion, and belonging by constructing a culturally inclusive educational experience for students to ponder and discuss their cultural and spiritual beliefs. Celebrating Día de Muertos at a university that prioritizes recruitment and retention of Hispanic and Latine students by incorporating the holiday into a contemplative ceremony commemorating body donors within an anatomy course enabled students to explore, express, and discuss their cultural as well as their spiritual identities in an inclusive manner. Implementing spiritually and culturally relevant activities into the anatomy curriculum can allow students from historically underrepresented groups to recognize that they belong in those institutions and health professions, which can, in turn, positively impact their social, academic, and professional success.</p> <hd id="AN0180775311-11">CONFLICT OF INTEREST STATEMENT</hd> <p>The authors have no conflicts of interest to disclose.</p> <ref id="AN0180775311-12"> <title> REFERENCES </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> Shiozawa T, Glauben M, Banzhaf M, Griewatz J, Hirt B, Zipfel S, et al. 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Herriott, Ph.D., is an assistant professor in the School of Physical Therapy at Regis University in Denver, Colorado with a Ph.D. in Anatomy, Cell Biology, and Physiology—Education from Indiana University School of Medicine. Her research includes anatomical curriculum development and interprofessional education.</p> <p>Neftali R. Del Rio, B.S., is a doctor of physical therapy student in the School of Physical Therapy at Regis University in Denver, Colorado. His research interests involve Diversity Equity and Inclusion, as well as sports rehabilitation.</p> <p>Daniel P. Justin, Ph.D., is an assistant director of the Office of Mission at Regis University in Denver, Colorado. 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  Label: Title
  Group: Ti
  Data: Día de Muertos: A Confluence of Gross Anatomy, Culture, and Spirituality
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Hannah+L%2E+Herriott%22">Hannah L. Herriott</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-5410-0360">0000-0002-5410-0360</externalLink>)<br /><searchLink fieldCode="AR" term="%22Neftali+R%2E+Del+Rio%22">Neftali R. Del Rio</searchLink><br /><searchLink fieldCode="AR" term="%22Daniel+P%2E+Justin%22">Daniel P. Justin</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Anatomical+Sciences+Education%22"><i>Anatomical Sciences Education</i></searchLink>. 2024 17(8):1606-1617.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 12
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2024
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Descriptive
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Religious+Factors%22">Religious Factors</searchLink><br /><searchLink fieldCode="DE" term="%22Religion%22">Religion</searchLink><br /><searchLink fieldCode="DE" term="%22Reflection%22">Reflection</searchLink><br /><searchLink fieldCode="DE" term="%22Anatomy%22">Anatomy</searchLink><br /><searchLink fieldCode="DE" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="DE" term="%22Catholic+Schools%22">Catholic Schools</searchLink><br /><searchLink fieldCode="DE" term="%22Catholics%22">Catholics</searchLink><br /><searchLink fieldCode="DE" term="%22Hispanic+American+Students%22">Hispanic American Students</searchLink><br /><searchLink fieldCode="DE" term="%22Minority+Serving+Institutions%22">Minority Serving Institutions</searchLink><br /><searchLink fieldCode="DE" term="%22Cultural+Influences%22">Cultural Influences</searchLink><br /><searchLink fieldCode="DE" term="%22Holidays%22">Holidays</searchLink><br /><searchLink fieldCode="DE" term="%22Graduate+Study%22">Graduate Study</searchLink><br /><searchLink fieldCode="DE" term="%22Doctoral+Students%22">Doctoral Students</searchLink><br /><searchLink fieldCode="DE" term="%22Allied+Health+Occupations+Education%22">Allied Health Occupations Education</searchLink><br /><searchLink fieldCode="DE" term="%22Physical+Therapy%22">Physical Therapy</searchLink><br /><searchLink fieldCode="DE" term="%22Culturally+Relevant+Education%22">Culturally Relevant Education</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1002/ase.2490
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1935-9772<br />1935-9780
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: "Is there room for spirituality and reflection in gross anatomy?" While Jesuit institutions have incorporated contemplation and reflection into their curricula for centuries; the integration of reflective practices into the gross anatomy curriculum has gained traction in recent years. Additionally, more emphasis has been placed on diversity, equity, inclusion, and belonging within health professions education. As a Jesuit, Catholic university that is simultaneously classified as a Hispanic-Serving Institute (HSI), Regis University was well-positioned to integrate reflective and celebratory activities in honor of Día de Muertos (the Day of the Dead) into a graduate level anatomy course for Doctor of Physical Therapy students. From a communal "ofrenda" (altar) to a celebration during a lecture to a reflective ceremony honoring body donors in the laboratory, students and faculty constructed a learning environment that incorporated spirituality and culture into anatomy in a thoughtful manner. Furthermore, by seeking student input on the design of this innovative educational experience, each of these activities aided in fostering a sense of cultural and spiritual belonging for Hispanic and Latine students who are historically marginalized in health professions, thereby promoting diversity, equity, inclusion, and belonging through a gross anatomy course.
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  Data: As Provided
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  Data: 2024
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  Label: Accession Number
  Group: ID
  Data: EJ1447793
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        Value: 10.1002/ase.2490
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 12
        StartPage: 1606
    Subjects:
      – SubjectFull: Religious Factors
        Type: general
      – SubjectFull: Religion
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      – SubjectFull: Reflection
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      – SubjectFull: Higher Education
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      – SubjectFull: Catholic Schools
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