Anticipatory Stress in Medical Students Before Their First Cadaver Experience: A Physiological Component of Cadaver‐Based Anatomy Education

Cadaver-based anatomy education represents a unique biological and sensory experience that may elicit significant physiological responses. However, little is known about the anticipatory phase prior to initial exposure, particularly when evaluated using objective biomarkers. This study aimed to assess anticipatory physiological responses in first-year medical students before their initial cadaver exposure. Ninety students were evaluated using a within-subject design comparing physiological measures obtained under standardized conditions at baseline (before a routine anatomy session without cadaver exposure) and immediately prior to their first entry into the dissection room (anticipatory condition), before any direct contact. Measures included systolic and diastolic blood pressure, heart rate, and salivary cortisol. Compared with baseline, the anticipatory phase was associated with significant increases in systolic blood pressure (116.9 ± 13.6 vs. 123.8 ± 13.4 mmHg, p < 0.001), heart rate (74.6 ± 13.1 vs. 82.9 ± 15.2 bpm, p < 0.001), and salivary cortisol levels (4.2 ± 2.1 vs. 5.3 ± 3.2 ng/mL, p < 0.001), indicating activation of both sympathetic and hypothalamic-pituitary-adrenal pathways. No significant changes were observed in diastolic blood pressure. These changes were associated with moderate effect sizes for systolic blood pressure (d = 0.51), heart rate (d = 0.58), and salivary cortisol (d = 0.41). Physiological responses were not influenced by sex or sociocultural factors. These findings indicate that physiological stress activation is already present during the anticipatory phase preceding first cadaver exposure, supporting the existence of a distinct anticipatory component of cadaver-based anatomy education characterized by coordinated autonomic and endocrine responses. This anticipatory phase represents a distinct physiological component of cadaver-based anatomy education and provides objective evidence of biological activation occurring before first cadaver exposure. Recognizing this early physiological response may contribute to a better understanding of students' initial adaptation to cadaver-based learning experiences.