Learning anatomy via mobile augmented reality: Effects on achievement and cognitive load

Cognitive load classification of mixed reality human computer interaction tasks based on multimodal sensor signals

Evaluating cognitive load in mixed reality (MR) has become a significant challenge in human-computer interaction (HCI). To address this, we established an MR multimodal experimental platform with three distinct environments to induce varying levels of cognitive load. Participants engaged in MR-based CNC machine tool interaction tasks within these environments. Using the built-in sensors of the HoloLens 2 mixed reality head-mounted display (MR-HMD) and wearable heart rate sensors, we collected device and physiological data from participants wearing the MR-HMD while performing these tasks. The cognitive load of participants was assessed by using the NASA-TLX questionnaire. Experimental results indicated that the operation time required in the MR environment increased by 49% under high cognitive load compared to low-load conditions. High-load environments also led to increased anxiety, frustration, and decreased performance among participants. Through comparative experiments, we identified suitable sensor data streams and algorithms for cognitive load classification and designed an MR digital twin factory cognitive load warning prototype system. This system utilizes an improved Transformer-CL algorithm, achieving a cognitive load classification accuracy of 95.83%. The system provides high cognitive load warnings, reducing the risks associated with high cognitive load tasks in MR work environments.

Immersive Extended Reality (I-XR) in Medical and Nursing for Skill Competency and Knowledge Acquisition: A Systematic Review and Implications for Pedagogical Practices

Simulation has evolved from basic practice to Immersive Extended Reality (I-XR). This systematic review examined 56 published studies on the impact of I-XR, including virtual reality (VR), augmented reality (AR), and mixed reality (MR), on the education of medical and nursing students, specifically their skill competency, and knowledge acquisition. The results demonstrate the significant potential of I-XR in healthcare education, with 42.5% of VR studies, 42.9% of AR studies, and the single MR study also demonstrating greater improvements in clinical skills and knowledge acquisition compared to non-immersive (non-I-XR) training conditions. In contrast, only 2.5% of VR studies and 7.14% of AR studies favored non-I-XR methods. It is important, however, to acknowledge the 26.8% of studies that showed mixed results (some evidence for the I-XR methods on some outcomes, but also some evidence for the non-I-XR methods, on other outcomes). Notably, the review also identified a critical gap in the theoretical foundations of I-XR learning, highlighting the urgent need for research to inform the effective pedagogical implementation of these powerful tools. We offer a preliminary framework to address the lack of learning theory in healthcare I-XR training, with implications for pedagogical practices.

Design of an interactive brain model for neuroanatomy education and MRI training

In this article, we introduce a new virtual application that offers an interactive model of the brain for neuroanatomy education. Through a dual-platform architecture, the application can be downloaded on both desktop and mobile devices, with the mobile app leveraging unique capacities of modern handheld systems to deploy the brain model in augmented reality. In addition to illustrating complex spatial relationships between internal brain structures, vasculature, and cranial nerves, the application integrates magnetic resonance imaging (MRI) data into the user interface. MRI series in the coronal, sagittal, and axial planes can be superimposed directly onto the brain model, allowing students to engage with two-dimensional MRI slices in three-dimensional space. While previous virtual tools have offered a similar superimposition, none have done so through a mobile app, downloadable on handheld devices and suited to the modern student. The benefits of this function on students' spatial understanding and identification of neural structures on MRI slices remain understudied. The aim of this article is to describe the functionality of our dual-platform application, to outline its potential strengths as an educational tool, and to address possible directions for improvement following future assessments of the app's utility. Our ultimate goal is to offer a preliminary introduction to a new system that seeks to support users' understanding of three-dimensional neuroanatomy and aims to enhance their ability to read an MRI of the brain.

Creating augmented reality-based experiences for aviation weather training: Challenges, opportunities, and design implications for 3D authoring

This paper examines opportunities and challenges of integrating augmented reality (AR) into education and investigates requirements to enable instructors to author AR educational experiences. Although AR technology is recognised for its potential in educational enhancement, it poses challenges for instructors creating AR-based experiences due to their limited digital skills and the complexity of 3D authoring tools. Semi-structured interviews with 17 aviation instructors identified current pedagogical approaches, gaps, and potential applications of AR in aviation weather education. Additionally, results highlighted the benefits of AR and obstacles to its integration into education, followed by outlining design priorities and user needs for educational AR authoring. For AR authoring toolkit development, this study recommended incorporating interactive AR lesson modules, early development of user requirements, and prebuilt AR modules. Findings will guide the development of a 3D authoring toolkit for non-technologist instructors, enabling wider AR use in aviation weather education and other educational fields.

Reviewing Mobile Apps for Teaching Human Anatomy: Search and Quality Evaluation Study

BACKGROUND

Mobile apps designed for teaching human anatomy offer a flexible, interactive, and personalized learning platform, enriching the educational experience for both students and health care professionals.

OBJECTIVE

This study aimed to conduct a systematic review of the human anatomy mobile apps available on Google Play, evaluate their quality, highlight the highest scoring apps, and determine the relationship between objective quality ratings and subjective star ratings.

METHODS

The Mobile App Rating Scale (MARS) was used to evaluate the apps. The intraclass correlation coefficient was calculated using a consistency-type 2-factor random model to measure the reliability of the evaluations made by the experts. In addition, Pearson correlations were used to analyze the relationship between MARS quality scores and subjective evaluations of MARS quality item 23.

RESULTS

The mobile apps with the highest overall quality scores according to the MARS (ie, sections A, B, C, and D) were Organos internos 3D (anatomía) (version 4.34), Sistema óseo en 3D (Anatomía) (version 4.32), and VOKA Anatomy Pro (version 4.29). To measure the reliability of the MARS quality evaluations (sections A, B, C, and D), the intraclass correlation coefficient was used, and the result was "excellent." Finally, Pearson correlation results revealed a significant relationship (r=0.989; P<.001) between the quality assessments conducted by health care professionals and the subjective evaluations of item 23.

CONCLUSIONS

The average evaluation results of the selected apps indicated a "good" level of quality, and those with the highest ratings could be recommended. However, the lack of scientific backing for these technological tools is evident. It is crucial that research centers and higher education institutions commit to the active development of new mobile health apps, ensuring their accessibility and validation for the general public.

A novel augmented reality-based simulator for enhancing orthopedic surgical training

BACKGROUND

Total Hip Arthroplasty (THA) is a well-established and common orthopedic surgery. Due to the complexity involved in THA, orthopedic surgeons require rigorous training. However, the current gold standard, the tutor-guided and -evaluated apprenticeship model is time-consuming, costly, and poses risks to patients. There is a pressing need for additional training resources to enhance the efficiency and safety of the training process. In this work, we present a novel Augmented Reality (AR)-based simulator designed for THA that helps enable a new self-paced training and learning paradigm without the need for instructors.

METHODS

The simulator reduces the need for instructors by integrating an AR guidance module and an automated performance evaluation module. Three types of AR guidance were developed: Overlay, Virtual Twin, and Sectional Views. A feasibility study was conducted with five resident surgeons and two senior surgeons to compare these guidance methods quantitatively and qualitatively. The automated performance evaluation module was assessed against manual performance evaluation using Bland-Altman analysis with limits of agreement (LoA) and Mann-Whitney U tests.

RESULTS

The quantitative feasibility results indicate the efficacy of the developed AR guidance, characterized by mean transitional and rotational deviation errors below 3 mm and 3 degrees. Based on the qualitative results, we provide recommendations for efficient AR guidance designs. The Bland-Altman analysis results (0.22±1.32mm with LoA -2.37 to 2.81 mm for distance deviation, 0.94±2.41 degrees with LoA -3.78 to 5.66 degrees for yaw deviation, -0.34±1.30 degrees with LoA -2.90 to 2.22 degrees for pitch deviation) and p-values of Mann-Whitney U tests (0.64 for distance deviation, 0.12 for yaw deviation, 0.11 for pitch deviation) indicate no statistically significant differences between the automated and manual performance evaluation at a significance level of 0.05.

CONCLUSION

This work shows the potential of AR-based simulators in introducing a novel, data-driven approach to open surgery training in orthopedics, enabling surgeons to individually assess and improve their progress.

Measuring Bound Attention During Complex Liver Surgery Planning: Feasibility Study

BACKGROUND

The integration of advanced technologies such as augmented reality (AR) and virtual reality (VR) into surgical procedures has garnered significant attention. However, the introduction of these innovations requires thorough evaluation in the context of human-machine interaction. Despite their potential benefits, new technologies can complicate surgical tasks and increase the cognitive load on surgeons, potentially offsetting their intended advantages. It is crucial to evaluate these technologies not only for their functional improvements but also for their impact on the surgeon's workload in clinical settings. A surgical team today must increasingly navigate advanced technologies such as AR and VR, aiming to reduce surgical trauma and enhance patient safety. However, each innovation needs to be evaluated in terms of human-machine interaction. Even if an innovation appears to bring advancements to the field it is applied in, it may complicate the work and increase the surgeon's workload rather than benefiting the surgeon.

OBJECTIVE

This study aims to establish a method for objectively determining the additional workload generated using AR or VR glasses in a clinical context for the first time.

METHODS

Electroencephalography (EEG) signals were recorded using a passive auditory oddball paradigm while 9 participants performed surgical planning for liver resection across 3 different conditions: (1) using AR glasses, (2) VR glasses, and (3) the conventional planning software on a computer.

RESULTS

The electrophysiological results, that is, the potentials evoked by the auditory stimulus, were compared with the subjectively perceived stress of the participants, as determined by the National Aeronautics and Space Administration-Task Load Index (NASA-TLX) questionnaire. The AR condition had the highest scores for mental demand (median 75, IQR 70-85), effort (median 55, IQR 30-65), and frustration (median 40, IQR 15-75) compared with the VR and PC conditions. The analysis of the EEG revealed a trend toward a lower amplitude of the N1 component as well as for the P3 component at the central electrodes in the AR condition, suggesting a higher workload for participants when using AR glasses. In addition, EEG components in the VR condition did not reveal any noticeable differences compared with the EEG components in the conventional planning condition. For the P1 component, the VR condition elicited significantly earlier latencies at the Fz electrode (mean 75.3 ms, SD 25.8 ms) compared with the PC condition (mean 99.4 ms, SD 28.6 ms).

CONCLUSIONS

The results suggest a lower stress level when using VR glasses compared with AR glasses, likely due to the 3D visualization of the liver model. Additionally, the alignment between subjectively determined results and objectively determined results confirms the validity of the study design applied in this research.

Implementing 3D printing and extended reality in anatomy education: Organization, evolution, and assessment of an innovative teaching program in an undergraduate medical school in the Netherlands

BACKGROUND

A knowledge gap exists on how to implement three dimensional (3D) printing and extended reality (XR) technologies in anatomy education. Also, it remains unclear how students experience the implementation of these new technologies in anatomy education,. This report describes the result of an elective course on the use of 3D prints and XR at our Faculty of Medical Sciences.

METHODS

A 10-week elective course on the use of 3D prints and XR was organized for undergraduate students studying Medicine and Biomedical Sciences. Students were trained on how to construct 3D models and/or XR models from radiological data. Students received further education on the strengths and limitations of each technique and on how to evaluate scientific literature on this topic. Also, students received training on providing anatomy education using 3D models and/or XR models. The course was evaluated using a specifically designed survey containing twelve questions. Questions needed to be answered using a 5-point Likert scale to rate several topics concerning the course itself, educational elements and perceived study load.

RESULTS

An extensive course description is provided to help other anatomy educators to adopt 3D prints and/or XR models in the curriculum at their institution. Student evaluations indicated that learners found the constructed (virtual) models insightful and highly motivating, which helped them to actively engage in (future) anatomy education.

DISCUSSION

Here presented results encourage the further implementation of 3D models and/or XR models based on radiological data in anatomy education. However, future research on educational effectiveness are needed.

[Digitally based clinically oriented anatomy: the future of teaching]

University teaching is undergoing radical changes. Rising student numbers and the progressive digitalization of routine daily life are also leading to the testing of various new teaching and learning formats. This article provides an overview of the reasons for and approaches used to effectively and efficiently organize teaching of anatomy using digital learning methods and to fulfil the expectations of students.

Efficacy of virtual reality and augmented reality in anatomy education: A systematic review and meta-analysis

Anatomy is the cornerstone of medical education. Virtual reality (VR) and augmented reality (AR) technologies are becoming increasingly popular in the development of anatomy education. Various studies have evaluated VR and AR in anatomy education. This meta-analysis aims to evaluate the effectiveness of VR and AR in anatomical education. The protocol was registered in Prospero. Scopus, PubMed, Web of Science, and Cochrane Library databases were searched. From the 4487 articles gathered, 24 randomized controlled trials were finally selected according to inclusion criteria. According to the results of the meta-analysis, VR had a moderate and significant effect on the improvement of knowledge scores in comparison with other methods (standardized mean difference = 0.58; 95% CI = 0.22, 0.95; p < 0.01). Due to the high degree of heterogeneity (I 2 = 87.44%), subgroup analyses and meta-regression were performed on eight variables. In enhancing the "attitude," VR was found to be more "useful" than other methods (p = 0.01); however, no significant difference was found for "enjoyable" and "easy to use" statements. Compared with other methods, the effect of AR on knowledge scores was non-significant (SMD = -0.02; 95% CI = -0.39, 0.34; p = 0.90); also, in subgroup analyses and meta-regression, the results were non-significant. The results indicate that, unlike AR, VR could be used as an effective tool for teaching anatomy in medical education. Given the observed heterogeneity across the included studies, further research is warranted to identify those variables that may impact the efficacy of VR and AR in anatomy education.

The Effect of Concept Map Technique on Students' Cognitive Load and Academic Success in Anatomy Course

Introduction

Anatomy has too many details to memorize. Therefore, students need alternative means of education. The aim of this research was to investigate the effect of concept mapping techniques on anatomy learning.

Methods

The participants consisted of two groups: control and experimental. Before the training, the student introduction form and pretest were applied to both groups. The theoretical course was taught to the control group using classical methods and to the experimental group using a concept map. At the end of the lesson, the experimental group was asked to study with concept maps and the control group with textbooks and atlases for 3 days. Posttest and cognitive load scales were applied to both groups, and an attitude scale towards the concept map was applied to the experimental group.

Results

Both groups were more successful in the posttest than in the pretest. Posttest success was higher in the experimental group than in the control group. The cognitive load of the control group was significantly higher than the experimental group's. It was observed that the attitude scale towards the concept map does not change according to gender, prior hearing about this technique, or its prior use.

Conclusion

This study showed that concept maps reduce cognitive load and increase academic achievement.

Technologies for Studying and Teaching Human Anatomy: Implications in Academic Education

The teaching of human anatomy (HA) constitutes one of the fundamental pillars of the curriculum in biological and healthcare-related programs. Therefore, it is imperative that the methodology and didactics employed in this discipline equip students in the best possible way. The traditional method of teaching HA involves lectures and practical classes with previously dissected cadaveric specimens and dissection activities. Concurrently, the present era is witnessing the emergence and popularization of new digital technologies connected to the internet, among which we can highlight smartphones, quick response codes, and virtual reality devices, along with the dissemination of complementary imaging methods, such as radiography, ultrasonography, magnetic resonance imaging, and computerized tomography. From this perspective, the objective of this review is to analyze how each of these new tools integrates into the academic context, in order to diversify the teaching of HA and contribute to better understanding of the HA content during academic training, as well as the clinical applications.

Theoretical foundations and implications of augmented reality, virtual reality, and mixed reality for immersive learning in health professions education

BACKGROUND

Augmented Reality (AR), Virtual Reality (VR) and Mixed Reality (MR) are emerging technologies that can create immersive learning environments for health professions education. However, there is a lack of systematic reviews on how these technologies are used, what benefits they offer, and what instructional design models or theories guide their use.

AIM

This scoping review aims to provide a global overview of the usage and potential benefits of AR/VR/MR tools for education and training of students and professionals in the healthcare domain, and to investigate whether any instructional design models or theories have been applied when using these tools.

METHODOLOGY

A systematic search was conducted in several electronic databases to identify peer-reviewed studies published between and including 2015 and 2020 that reported on the use of AR/VR/MR in health professions education. The selected studies were coded and analyzed according to various criteria, such as domains of healthcare, types of participants, types of study design and methodologies, rationales behind the use of AR/VR/MR, types of learning and behavioral outcomes, and findings of the studies. The (Morrison et al. John Wiley & Sons, 2010) model was used as a reference to map the instructional design aspects of the studies.

RESULTS

A total of 184 studies were included in the review. The majority of studies focused on the use of VR, followed by AR and MR. The predominant domains of healthcare using these technologies were surgery and anatomy, and the most common types of participants were medical and nursing students. The most frequent types of study design and methodologies were usability studies and randomized controlled trials. The most typical rationales behind the use of AR/VR/MR were to overcome limitations of traditional methods, to provide immersive and realistic training, and to improve students' motivations and engagements. The most standard types of learning and behavioral outcomes were cognitive and psychomotor skills. The majority of studies reported positive or partially positive effects of AR/VR/MR on learning outcomes. Only a few studies explicitly mentioned the use of instructional design models or theories to guide the design and implementation of AR/VR/MR interventions.

DISCUSSION AND CONCLUSION

The review revealed that AR/VR/MR are promising tools for enhancing health professions education, especially for training surgical and anatomical skills. However, there is a need for more rigorous and theory-based research to investigate the optimal design and integration of these technologies in the curriculum, and to explore their impact on other domains of healthcare and other types of learning outcomes, such as affective and collaborative skills. The review also suggested that the (Morrison et al. John Wiley & Sons, 2010) model can be a useful framework to inform the instructional design of AR/VR/MR interventions, as it covers various elements and factors that need to be considered in the design process.

An Overview of Enhancing Distance Learning Through Emerging Augmented and Virtual Reality Technologies

Although distance learning presents a number of interesting educational advantages as compared to in-person instruction, it is not without its downsides. We first assess the educational challenges presented by distance learning as a whole and identify 4 main challenges that distance learning currently presents as compared to in-person instruction: the lack of social interaction, reduced student engagement and focus, reduced comprehension and information retention, and the lack of flexible and customizable instructor resources. After assessing each of these challenges in-depth, we examine how AR/VR technologies might serve to address each challenge along with their current shortcomings, and finally outline the further research that is required to fully understand the potential of AR/VR technologies as they apply to distance learning.

Exploration of the application of augmented reality technology for teaching spinal tumor's anatomy and surgical techniques

Background

Augmented reality (AR) technology is gradually being applied in surgical teaching as an innovative teaching method. Developing innovative teaching methods to replicate clinical theory and practical teaching scenarios, simulate preoperative planning and training for bone tumor surgery, and offer enhanced training opportunities for young physicians to acquire and apply clinical knowledge is a crucial concern that impacts the advancement of the discipline and the educational standards for young orthopedic physicians.

Objective

This study explores the application effect of augmented reality technology in anatomy teaching and surgical clinical teaching for spinal tumor.

Methods

The method utilizes virtual reality and augmented reality technology to present a spinal tumor model and the surgical process of percutaneous vertebroplasty. We conducted a random selection of 12 students forming into the augmented reality teaching group and 13 students forming into the traditional teaching group among the 8-year medical students from Peking Union Medical College and Tsinghua University, ensuring that the age and learning stage of the students in both groups were similar. Two groups of students were taught using traditional teaching methods and augmented reality technology-assisted teaching methods, respectively. A questionnaire survey was conducted after class to assess the quality of course instruction, student motivation in learning, their proficiency in anatomical structures, their comprehension of spinal tumor growth and metastasis, and their understanding and proficiency in percutaneous vertebroplasty.

Results

This study was the first to apply augmented reality technology in teaching, using spinal tumors and percutaneous vertebroplasty as examples, a head-mounted augmented reality device was used to create learning scenarios, presenting the complex three-dimensional spatial structure intuitively. The two groups of students differ significantly in their rating of teaching quality, enthusiasm for learning, knowledge of anatomical features, understanding of spinal trabecular structure, and understanding of steps in percutaneous vertebroplasty. The augmented reality technology-assisted teaching system demonstrates outstanding advantages.

Conclusion

Augmented reality technology has great potential and broad prospects in teaching bone tumors, which can help improve the visualization, interactivity, and three-dimensional spatial sense of medical teaching in spinal tumor. The application and development prospects of using augmented reality technology for anatomy instruction, surgical teaching, and simulation training are extensive.

The rise of ChatGPT: Exploring its potential in medical education

The integration of artificial intelligence (AI) into medical education has the potential to revolutionize the way students learn about biomedical sciences. Large language models, such as ChatGPT, can serve as virtual teaching assistants, providing students with detailed and relevant information and perhaps eventually interactive simulations. ChatGPT has the potential to increase student engagement and enhance student learning, though research is needed to confirm this. The challenges and limitations of ChatGPT must also be considered, including ethical issues and potentially harmful effects. It is crucial for medical educators to keep pace with technology's rapidly changing landscape and consider the implications for curriculum design, assessment strategies, and teaching methods. Continued research and evaluation are necessary to ensure the optimal integration of AI-based learning tools into medical education.

Unveiling the Evolution of Virtual Reality in Medicine: A Bibliometric Analysis of Research Hotspots and Trends over the Past 12 Years

BACKGROUND

Virtual reality (VR), widely used in the medical field, may affect future medical training and treatment. Therefore, this study examined VR's potential uses and research directions in medicine.

METHODS

Citation data were downloaded from the Web of Science Core Collection database (WoSCC) to evaluate VR in medicine in articles published between 1 January 2012 and 31 December 2023. These data were analyzed using CiteSpace 6.2. R2 software. Present limitations and future opportunities were summarized based on the data.

RESULTS

A total of 2143 related publications from 86 countries and regions were analyzed. The country with the highest number of publications is the USA, with 461 articles. The University of London has the most publications among institutions, with 43 articles. The burst keywords represent the research frontier from 2020 to 2023, such as "task analysis", "deep learning", and "machine learning".

CONCLUSION

The number of publications on VR applications in the medical field has been steadily increasing year by year. The USA is the leading country in this area, while the University of London stands out as the most published, and most influential institution. Currently, there is a strong focus on integrating VR and AI to address complex issues such as medical education and training, rehabilitation, and surgical navigation. Looking ahead, the future trend involves integrating VR, augmented reality (AR), and mixed reality (MR) with the Internet of Things (IoT), wireless sensor networks (WSNs), big data analysis (BDA), and cloud computing (CC) technologies to develop intelligent healthcare systems within hospitals or medical centers.

Comparing desktop 3D virtual reality with web 2.0 interfaces: Identifying key factors behind enhanced user capabilities

The aim of this paper is to investigate how commonly used 2D digital layouts can be transformed into 3-dimensional dashboards with the effect of reducing cognitive load. To this end, we compared user performance metrics, pupil dilation data as well as subject-reported qualitative measures in a Web 2.0-based 2D scenario and two different versions of a desktop 3D virtual reality scenario. All three scenarios focused on a use case involving the most prevalent 2D digital formats and designs encountered in digital education, making use of e.g. textual information (PDF files, PPT files), images and videos. Based on the assumption that cognitive load differences can be validated based on pupillometry measurements, we showed that it is possible to develop 3D virtual reality scenarios where users experience less cognitive load while achieving the same performance metrics as in commonly used 2D environments. At the same time, our experiment also showed that such improvements do not come automatically; instead, 3D workflows that require less locomotion - even at the expense of increased camera rotations - seem to result in more effective cognitive load reduction.

Dissecting human anatomy learning process through anatomical education with augmented reality: AEducAR 2.0, an updated interdisciplinary study

Anatomical education is pivotal for medical students, and innovative technologies like augmented reality (AR) are transforming the field. This study aimed to enhance the interactive features of the AEducAR prototype, an AR tool developed by the University of Bologna, and explore its impact on human anatomy learning process in 130 second-year medical students at the International School of Medicine and Surgery of the University of Bologna. An interdisciplinary team of anatomists, maxillofacial surgeons, biomedical engineers, and educational scientists collaborated to ensure a comprehensive understanding of the study's objectives. Students used the updated version of AEducAR, named AEducAR 2.0, to study three anatomical topics, specifically the orbit zone, facial bones, and mimic muscles. AEducAR 2.0 offered two learning activities: one explorative and one interactive. Following each activity, students took a test to assess learning outcomes. Students also completed an anonymous questionnaire to provide background information and offer their perceptions of the activity. Additionally, 10 students participated in interviews for further insights. The results demonstrated that AEducAR 2.0 effectively facilitated learning and students' engagement. Students totalized high scores in both quizzes and declared to have appreciated the interactive features that were implemented. Moreover, interviews shed light on the interesting topic of blended learning. In particular, the present study suggests that incorporating AR into medical education alongside traditional methods might prove advantageous for students' academic and future professional endeavors. In this light, this study contributes to the growing research emphasizing the potential role of AR in shaping the future of medical education.

Immersive virtual reality and augmented reality in anatomy education: A systematic review and meta-analysis

The purpose of this review was to (1) analyze the effectiveness of immersive virtual reality (iVR) and augmented reality (AR) as teaching/learning resources (collectively called XR-technologies) for gaining anatomy knowledge compared to traditional approaches and (2) gauge students' perceptions of the usefulness of these technologies as learning tools. This meta-analysis, previously registered in PROSPERO (CRD42023423017), followed PRISMA guidelines. A systematic bibliographical search, without time parameters, was conducted through four databases until June 2023. A meta-analytic approach investigated knowledge gains and XR's usefulness for learning. Pooled effect sizes were estimated using Cohen's standardized mean difference (SMD) and 95% confidence intervals (95% CI). A single-group proportional meta-analysis was conducted to quantify the percentage of students who considered XR devices useful for their learning. Twenty-seven experimental studies, reporting data from 2199 health sciences students, were included for analysis. XR-technologies yielded higher knowledge gains than traditional approaches (SMD = 0.40; 95% CI = 0.22 to 0.60), especially when used as supplemental/complementary learning resources (SMD = 0.52; 95% CI = 0.40 to 0.63). Specifically, knowledge performance using XR devices outperformed textbooks and atlases (SMD = 0.32; 95% CI = 0.10 to 0.54) and didactic lectures (SMD = 1.00; 95% CI = 0.57 to 1.42), especially among undergraduate students (SMD = 0.41; 95% CI = 0.20 to 0.62). XR devices were perceived to be more useful for learning than traditional approaches (SMD = 0.54; 95% CI = 0.04 to 1), and 80% of all students who used XR devices reported these devices as useful for learning anatomy. Learners using XR technologies demonstrated increased anatomy knowledge gains and considered these technologies useful for learning anatomy.

Neuroanatomy in virtual reality: Development and pedagogical evaluation of photogrammetry-based 3D brain models

Anatomy studies are an essential part of medical training. The study of neuroanatomy in particular presents students with a unique challenge of three-dimensional spatial understanding. Virtual Reality (VR) has been suggested to address this challenge, yet the majority of previous reports have implemented computer-generated or imaging-based models rather than models of real brain specimens. Using photogrammetry of real human bodies and advanced editing software, we developed 3D models of a real human brain at different stages of dissection. Models were placed in a custom-built virtual laboratory, where students can walk around freely, explore, and manipulate (i.e., lift the models, rotate them for different viewpoints, etc.). Sixty participants were randomly assigned to one of three learning groups: VR, 3D printed models or read-only, and given 1 h to study the white matter tracts of the cerebrum, followed by theoretical and practical exams and a learning experience questionnaire. We show that following self-guided learning in virtual reality, students demonstrate a gain in spatial understanding and an increased satisfaction with the learning experience, compared with traditional learning approaches. We conclude that the models and virtual lab described in this work may enhance learning experience and improve learning outcomes.

Augmented Reality in Neurosurgery

Augmented Reality (AR) involves superimposing digital content onto the real environment. AR has evolved into a viable tool in neurosurgery, enhancing intraoperative navigation, medical education and surgical training by integrating anatomical data with the real world. Neurosurgical AR relies on several key techniques to be successful, which includes image segmentation, model rendering, AR projection, and image-to-patient registration. For each of these technical components, different solutions exist, with each having their own advantages and limitations.Intraoperative AR applications cover diverse neurosurgical disciplines including vascular, oncological, spinal, and functional surgeries. Preliminary studies indicate that AR may improve the understanding of complex anatomical structures and offer sufficient accuracy for use as a navigational tool. Additionally, AR shows promise in enhancing surgical training and patient education through interactive 3D models, aiding in the comprehension of intricate anatomical details. Despite its potential, the widespread adoption of AR in clinical settings depends on overcoming technical limitations and validating its clinical efficacy.

What Faculty and Students Value When Evaluating Human Digital Anatomy Platforms: A Mixed-Methods Study

OBJECTIVES

There is an increasing availability of digital technologies for teaching and learning of human anatomy. Studies have shown that such applications allow for better spatial awareness than traditional methods. These digital human anatomy platforms offer users myriad features, such as the ability to manipulate 3D models, conduct prosection, investigate anatomical regions through virtual reality, or perform knowledge tests on themselves. This study examined what faculty members' value when using digital human anatomy platforms for teaching and what students value when using these platforms for learning.

METHODS

Six anatomy faculty members and 21 students were selected to participate in this study. After using the three digital anatomy platforms for at least 1 week, a survey was conducted to record their feedback in 4 categories: usability, interactive features, level of detail, and learning support. Respondents' Qualitative feedback within each category was also analyzed to strengthen the study's findings.

RESULTS

The study's findings showed that faculty members and students have different priorities when evaluating digital anatomy platforms. Faculty members valued platforms that provided better accuracy and detailed anatomical structures, while students prioritized usability above the rest of the features.

CONCLUSION

Given that faculty and students have different preferences when selecting digital anatomy platforms, this article proposed that educators maximize the specific affordances offered by the technology by having a clear pedagogy and strategy on how the technology will be incorporated into the curriculum to help students achieve the desired learning outcomes.

Learning technology in health professions education: Realising an (un)imagined future

CONTEXT

Technology is being introduced, used and studied in almost all areas of health professions education (HPE), often with a claim of making HPE better in one way or another. However, it remains unclear if technology has driven real change in HPE. In this article, we seek to develop an understanding of the transformative capacity of learning technology in HPE.

METHODS AND OUTCOMES

We first consider the wider scholarship highlighting the intersection between technology and pedagogy, articulating what is meant by transformation and the role of learning technology in driving educational transformation. We then undertake a synthesis of the current high visibility HPE-focused research. We sampled the literature in two ways-for the five highest impact factor health professional education journals over the past decade and for all PubMed indexed journals for the last 3 years-and categorised the extant research against the Substitution, Augmentation, Modification, Redefinition model. We found that the majority of research we sampled focussed on substituting or augmenting learning through technology, with relatively few studies using technology to modify or redefine what HPE is through the use of technology. Of more concern was the lack of theoretical justification for pedagogical improvement, including transformation, underpinning the majority of studies.

CONCLUSIONS

While all kinds of technology use in learning have their place, the next step for HPE is the robust use of technology aiming to lead transformation. This should be guided by transformational educational theory and aligned with pedagogical context. We challenge HPE practitioners and scholars to work thoughtfully and with intent to enable transformation in education for future health professionals.

Durable Learning Strategies in Nursing Education: State-of-the-Evidence Review

BACKGROUND

Health professions (HP) students must achieve durable learning (DL) to transfer and apply knowledge from the classroom to the clinical setting. This review examines the state of the science of classroom-based DL in HP.

METHOD

The Joanna Briggs Systematic Review Methodology was used. MEDLINE, CINAHL, PsycINFO, and ERIC databases were searched for articles published from 2006 to 2022. A total of 2,000 titles were identified for review, with 51 studies being selected for inclusion.

RESULTS

Multiple classroom-based learning strategies generally reported as being effective were identified, including flipped classroom, educational technology, spaced learning, team-based learning, concept mapping and schema, testing, and case study and problem-based learning.

CONCLUSION

Although DL has been proven to be effective in the classroom setting for HP, no one type has been shown to be more effective than others. Additional research is needed within the context of transferring knowledge to clinical settings and in nursing education. [J Nurs Educ. 2024;63(1):24-31.].

Student Critical Self-Reflection and Perceptions of Video-Based Pro-Section Computer-Assisted Instruction

Introduction

The cost, high resource demands, and psychological significance of in-person cadaveric labs are barriers to their use. Computer-assisted instruction (CAI) of gross anatomy is widely available as an alternative option. However, student engagement, reflections, and expectations of learning anatomy with CAI instead of in-person labs may influence their learning experience and outcomes.

Purpose

To evaluate students' critical self-reflection and perceptions of learning using online self-guided anatomy modules with video-based pro-section CAI.

Methods

A prospective observational cross-sectional study was conducted with first-year occupational therapy students who received anatomy education using CAI involving online self-guided anatomy modules with video-based pro-section instruction. Critical self-reflection was measured using Kember's Critical Self-Reflection Questionnaire scores and open-ended comments. Paired analysis of self-reported Kember nonreflective and reflective actions was conducted followed by quantitative (correlation, Student t-tests) and qualitative (directed content analysis) exploration of factors associated with critical self-reflection.

Results

Of the 126 students enrolled in the study, 97 consented and completed the study. The students' Kember Understanding (U) subscale mean score was significantly higher than the Habitual Action (HA), Reflection, and Critical Self-Reflection subscales. The largest effect size was found between the U and HA subscales (ds  = 1.3, 95% CI [1.0, 1.5]). Academic outcomes (anatomy quiz sum score, term grade) did not correlate with the Kember scores. Overall, students felt that video-based anatomy pro-section CAI was best used in a supplementary manner and opportunities for hands-on learning of anatomy were needed.

Conclusion

Video-based anatomy pro-section CAI helped students understand anatomy but did not readily engage students in critical self-reflection. Strategic course and curriculum design with integrated and hands-on learning opportunities are needed to optimize student anatomy learning experience and academic outcomes while using this type of CAI.

Virtual Reality for Patient Education about Hypertension: A Randomized Pilot Study

BACKGROUND

Hypertension challenges arise in part from poor adherence due to inadequate patient education. VR offers immersive learning to improve hypertension knowledge.

OBJECTIVE

To compare VR education with traditional verbal education to improve hypertension knowledge.

METHODS

In this randomised trial, 182 patients with hypertension were assigned to receive either traditional physician-led education (n = 88) or VR education (n = 94) with equivalent content. The VR group experienced a 3D video using Oculus Quest 2 headsets. Knowledge was assessed post-intervention using a 29-item questionnaire. The primary outcome was the objective score. Subjective satisfaction and responder characteristics were secondary outcomes.

RESULTS

Median objective scores were significantly higher for VR (14, IQR 3) versus traditional education (10, IQR 5), p < 0.001, indicating superior hypertension knowledge acquisition with VR. Subjective satisfaction was high in both groups. Participants were categorized into low (first quartile) and medium-high (second to fourth quartiles) responders based on their scores. Low responders had a significantly higher prevalence of older women than medium-high responders (57% vs. 40% female, p = 0.024; 68 vs. 65 years), p = 0.036).

CONCLUSIONS

VR outperforms traditional education. Tailoring to groups such as older women can optimise learning.

Augmented reality-The way forward in patient education for intracranial aneurysms? A qualitative exploration of views, expectations and preferences of patients suffering from an unruptured intracranial aneurysm regarding augmented reality in patient education

Objectives: The goal of this project is to explore the views, expectations and preferences of patients with an unruptured intracranial aneurysm regarding the use of AR in patient education. Methods: To gain an in-depth understanding of the patients' perspective, a face-to-face interview study was conducted using an interview protocol with a predefined topic list. All interviews were audio-recorded and transcribed verbatim afterwards. Transcripts were analyzed using thematic content analyses. Coding was performed using Atlas.ti software. Results: Seventeen interviews were conducted. The views, expectations and preferences of patients regarding patient education with AR could be subdivided into 15 categories, which could be grouped into 4 general themes: 1) experiences with current patient education, 2) expectations of AR in patient education, 3) opportunities and limitations of AR, and 4) out-of-hospital use of an AR application. Patients' expectations were predominantly positive regarding improving patients' understanding of their medical situation and doctor-patient communication. Discusssion: This study suggests that patients with unruptured intracranial aneurysms are open to receive patient education regarding their disease with AR. Patients expect that AR models can help patients with intra-cranial aneurysms better understand their disease, treatment options and risks. Additionally, patients expect AR could improve doctor-patient communication.

Creation of 21st century anatomy facilities: designing facilities for integrated preclinical education in the Middle East

BACKGROUND

The establishment of new anatomy facilities needs to accommodate a combination of modern teaching modalities that best align with evidence-based best teaching practices. This article describes the process in which our state-of-the-art anatomy laboratories were designed and implemented, and how these facilities support aspects of modern anatomy education.

METHODS

A list of best practices for anatomy education in a modern medical curriculum was summarized from the literature. To assess student satisfaction, a survey related to student perception of the anatomy facilities (5-point Likert scale) was conducted.

RESULTS

Our educational modalities include a broad range of teaching approaches. The Instructional Studio houses prosected and plastinated specimens, and cadaveric dissections are performed. Each of our three Dry Laboratories allow for active learning and interaction between small student groups. The Webinar Room acts as a conference room for departmental and online meetings, discussions with students, and dialogues with affiliated hospitals via the internet. The Imaging Center is equipped with a Sectra® medical educational platform, CAE Vimedix® Virtual Medical Imaging Ultrasound Training System, and Philipps Lumify® Ultrasound devices to train students to conduct and interpret sonographic images. Moreover, the Complete Anatomy® program is made available to all our students.

CONCLUSION

The layout of our newly created Anatomy Facilities allows for all aspects of modern medical education mentioned in the literature. These educational modalities and teaching approaches are highly appreciated by our faculty and students. Moreover, these technologies allowed for a smooth transition from on-site anatomy teaching to online education during the COVID pandemic.

The Effect of Mobile Applied Anatomy Learning on Students' Academic Success, Cognitive Loads, and Attitudes

Purpose/Objectives

Anatomy has always been one of the most important components of Health Science education. Worldwide, anatomy education is given in an environment based on cadaver, touch and 3D designs. However, this process has become quite difficult as the pandemic restricted use of laboratory procedures, models, and other learning materials. Therefore, education with mobile applications has become much more important. The aim of this study was to measure the effect of mobile applications used in anatomy course, which is one of the courses that form the basis of medical science, on the success levels of students, and to evaluate their perspectives on this method.

Methods

In this study, a real experimental research model with pretest-posttest control group was used in order to determine the difference that may occur between academic achievement and cognitive load when anatomy course students use traditional method or mobile application technology learning method.

Results

The findings of the study showed that the students in the experimental group, in which mobile applications were used in the anatomy course, had higher achievement levels and lower cognitive loads than the students in the control group. Another point that was determined was that the students in the experimental group were satisfied with the fact that the use of the mobile application facilitated learning, and they learned better as the ease of use in the mobile application increased.

A scoping review on the trends of digital anatomy education

Digital technologies are changing the landscape of anatomy education. To reveal the trend of digital anatomy education across medical science disciplines, searches were performed using PubMed, EMBASE, and MEDLINE bibliographic databases for research articles published from January 2010 to June 2021 (inclusive). The search was restricted to publications written in English language and to articles describing teaching tools in undergraduate and postgraduate anatomy and pre-vocational clinical anatomy training courses. Among 156 included studies across six health disciplines, 35% used three-dimensional (3D) digital printing tools, 24.2% augmented reality (AR), 22.3% virtual reality (VR), 11.5% web-based programs, and 4.5% tablet-based apps. There was a clear discipline-dependent preference in the choice and employment of digital anatomy education. AR and VR were the more commonly adopted digital tools for medical and surgical anatomy education, while 3D printing is more broadly used for nursing, allied health and dental health education compared to other digital resources. Digital modalities were predominantly adopted for applied interactive anatomy education and primarily in advanced anatomy curricula such as regional anatomy and neuroanatomy. Moreover, there was a steep increase in VR anatomy combining digital simulation for surgical anatomy training. There is a consistent increase in the adoption of digital modalities in anatomy education across all included health disciplines. AR and VR anatomy incorporating digital simulation will play a more prominent role in medical education of the future. Combining multimodal digital resources that supports blended and interactive learning will further modernize anatomy education, moving medical education further away from its didactic history.

Use of the Anatomage Virtual Table in Medical Education and as a Diagnostic Tool: An Integrative Review

Studies on human anatomy mainly depend on cadaver dissection. New technology devices have progressed to improve anatomy teaching, such as the 3D Anatomage virtual dissection table. There is a shortage and deficiency in information about the uses and benefits of the Anatomage table. The aim of this article was to review and assess the current evidence about the advantages of the Anatomage virtual table in medical education and curricula of medical courses, and its utility in diagnosis. The current study is a comprehensive systematic review. A search was conducted on online medical and scientific databases. Twenty-nine articles relevant to the content of the current research topic were selected. Based on this review, the use of the Anatomage table is valuable for anatomy learning outcomes, and most of the research supported it as an important anatomy tool in addition to cadaveric dissection. The Anatomage table in association with human dissection can improve knowledge retention of anatomy. It is an important tool for understanding organ variation. Anatomage is now considered an important tool for the educational training programs of medical students and residents and for disease diagnosis and prognosis. Anatomage can make the curriculum more interesting and valuable. Utilizing the Anatomage table can help medical and paramedical students and residents by assisting them to understand anatomy in a better way. It will also improve radiological knowledge and facilitate pre-planning for surgeries. Finally, it has a crucial role during exceptional circumstances such as pandemics.

Evaluating the integration of body donor imaging into anatomical dissection using augmented reality

Augmented reality (AR) has recently been utilized as an integrative teaching tool in medical curricula given its ability to view virtual objects while interacting with the physical environment. The evidence for AR in medical training, however, is limited. For this reason, the purpose of this mixed method study was to evaluate the implementation of overlaying donor-specific diagnostic imaging (DSDI) onto corresponding body donors in a fourth-year, dissection-based, medical elective course entitled anatomy for surgeons (AFS). Students registered in AFS course were separated into groups, receiving either DSDI displayed on Microsoft HoloLens AR head-mounted display (n = 12) or DSDI displayed on iPad (n = 15). To test for the change in spatial ability, students completed an anatomical mental rotation test (AMRT) prior to and following the AFS course. Students also participated in a focus group discussion and completed a survey at the end of AFS, analyzed through thematic triangulation and an unpaired, Mann Whitney U test respectively, both addressing dissection experience, DSDI relevancy to dissection, and use of AR in anatomical education. Although statistically significant differences were not found when comparing student group AMRT scores, survey and discussion data suggest that the HoloLens had improved the students' understanding of, and their spatial orientation of, anatomical relationships. Trunk dissection quality grades were significantly higher with students using the HoloLens. Although students mentioned difficulties with HoloLens software, with faculty assistance, training, and enhanced software development, there is potential for this AR tool to contribute to improved dissection quality and an immersive learning experience.

Technology-Enhanced Preclinical Medical Education (Anatomy, Histology and Occasionally, Biochemistry): A Practical Guide

The recent explosion of technological innovations in mobile technology, virtual reality (VR), digital dissection, online learning platform, 3D printing, and augmented reality (AR) has provided new avenues for improving preclinical education, particularly in anatomy and histology education. Anatomy and histology are fundamental components of medical education that teach students the essential knowledge of human body structure and organization. However, these subjects are widely considered to be some of the most difficult disciplines for healthcare students. Students often face challenges in areas such as the complexity and overwhelming volume of knowledge, difficulties in visualizing body structures, navigating and identifying tissue specimens, limited exposure to learning materials, and lack of clinical relevance. The COVID-19 pandemic has further exacerbated the situation by reducing face-to-face teaching opportunities and affecting the availability of body donations for medical education.To overcome these challenges, educators have integrated various educational technologies, such as virtual reality, digital 3D anatomy apps, 3D printing, and AI chatbots, into preclinical education. These technologies have effectively improved students' learning experiences and knowledge retention. However, the integration of technologies into preclinical education requires appropriate pedagogical approaches and logistics to align with educational theories and achieve the intended learning outcomes.The chapter provides practical guidance and examples for integrating technologies into anatomy, histology, and biochemistry preclinical education. The author emphasizes that every technology has its own benefits and limitations and is best suited to specific learning scenarios. Therefore, it is recommended that educators and students should utilize multiple modalities for teaching and learning to achieve the best outcomes. The chapter also acknowledges that cadaver-based anatomy education is essential and proposes that educational technologies can serve as a crucial complement for promoting active learning, problem solving, knowledge application, and enhancing conventional cadaver-based education.

Evaluating augmented reality for 'real life' teaching of food portion concepts

BACKGROUND

Estimation of food portions is a vital skill for dietitians, which is developed during formal nutrition training. Skill development is often accomplished by training with food portion estimation tools. These tools can vary in design but evaluations often reveal them to be limited in their effectiveness and generally impractical for everyday use. The aim of this study was to develop and evaluate an augmented reality (AR) tool for the estimation food portions.

METHODS

An online, quasi-experimental, randomised pre-test post-test study was conducted to evaluate the effectiveness of three food portion tools with nutrition students. These tools consisted of an online, AR, and an infographic tool (control). Students tested 10 different food images and were asked to estimate food portion sizes with and without assistance of a portion tool to determine absolute error, relative error, and overall improvement in estimation.

RESULTS

A total of 33 participants enrolled in the study with 26 (72.0%) completing the study. The mean absolute error was lowest in the online group (53.0%), followed by AR (59.5%) and control (64.0%). Relative error scores revealed higher accuracy for the AR group (45.5%) followed by online (43.5%), and control group (29.0%). Overall improvement in estimation was highest in the AR group (+12.2%) followed by the online (+11.6%) tool with a decrease seen for the infographic (-1.7%) tool.

CONCLUSIONS

The use of technology, notably AR technology, may provide some advantage when training nutrition students in food portion estimation, although further investigation is advised.

Effectiveness of augmented reality in learning about leg ulcer care: A quasi-experimental study in nursing students

BACKGROUND

Chronic wounds are a serious public health problem worldwide. Providing optimal treatment to patients suffering from leg ulcers is a priority for nursing. Therefore, nursing students need to acquire the necessary competencies to provide evidence-based care. Augmented Reality (AR) is an emerging technology in health science education which can help nursing students achieve these skills if it is promoted by both institutions and educationalists.

OBJECTIVES

To test the effectiveness of an AR-based methodology for teaching-learning aspects of the nursing curriculum (leg ulcer care), as well as to describe how AR influences different learning determinants of nursing students.

DESIGN

A quasi-experimental study was carried out.

PARTICIPANTS/SETTINGS

The participants of the study were 137 s-year nursing students from the School of Nursing of the University of Santiago de Compostela (Spain) (average age = 21.59 years, 80.29 % females). Of them, 65 comprised the control group (Non-AR-based teaching) and 72 comprised the experimental group (AR-based teaching).

METHODS

Pre-post tests were used to measure knowledge and skills about leg ulcer care in both groups. Additionally, two validated questionnaires were selected to identify the influence of AR on learning determinants in the experimental group. The study took place during the 2018/2019 academic year.

RESULTS

Significantly higher scores (7.68 vs. 6.14) were found in the knowledge post-test in the experimental group (p ≤ 0.001), while the pre-test did not show differences between groups (4.43 vs. 4.32). Also, nursing students indicated high scores in attention, autonomous learning, understanding and motivation to carry out learning objectives using AR.

CONCLUSIONS

AR is a tool that improves performance related to the specific aspects of the nursing academic curriculum (leg ulcer care), while encouraging positive attitudes towards the teaching-learning process. These findings reinforce the need to include innovative methodologies in nursing classrooms.

The blacksmith approach: a strategy for teaching and learning in the medical anatomy course (a qualitative study)

BACKGROUND

Anatomy is a symbolic, essential core topic and one of the fundamental pillars of medical and paramedical knowledge. Nevertheless, few exploratory data analyses have focused on how students approach learning anatomy. This study examined how students perceive their learning experience during anatomy lessons and how to make a model which promotes their meaningful learning and professional identity.

METHODS

Using purposive sampling with maximum variation, we conducted a qualitative content analysis at the Shiraz University of Medical Sciences in Iran (2020 to 2021). Twenty-four medical students and twelve faculty members of Iran's medical science universities were enrolled in the study. The data were collected through semi-structured interviews and analyzed according to the theme.

RESULTS

A conceptual model emerged from the data analysis with the main theme called the blacksmith approach, which included Three sub-themes: (1) making a new forge (adequate preparation and mindful beginning), (2) heating the students' hearts (considering supporting systems that learners need) and (3) using Sledgehammer's approach (teaching anatomy by using more active methods and engaging all neuroanatomical regions) and (Using fun for enjoyable learning). All the concepts were related to each other.

CONCLUSION

Medical students experience a challenging fundamental evolution into professional doctors. Educational systems focus primarily on teaching and learning, while students' transition can be facilitated by a three-step model called the Blacksmith Approach. It best serves as an educational framework for any pivotal, preclinical course capable of helping students acquire new roles and tackle challenges. Further research should be conducted to confirm how hard work leads to satisfying results with the opportunity to create enjoyable learning.

Enhanced Visualisation of Normal Anatomy with Potential Use of Augmented Reality Superimposed on Three-Dimensional Printed Models

Anatomical knowledge underpins the practice of many healthcare professions. While cadaveric specimens are generally used to demonstrate realistic anatomy, high cost, ethical considerations and limited accessibility can often impede their suitability for use as teaching tools. This study aimed to develop an alternative to traditional teaching methods; a novel teaching tool using augmented reality (AR) and three-dimensional (3D) printed models to accurately demonstrate normal ankle and foot anatomy. An open-source software (3D Slicer) was used to segment a high-resolution magnetic resonance imaging (MRI) dataset of a healthy volunteer ankle and produce virtual bone and musculature objects. Bone and musculature were segmented using seed-planting and interpolation functions, respectively. Virtual models were imported into Unity 3D, which was used to develop user interface and achieve interactability prior to export to the Microsoft HoloLens 2. Three life-size models of bony anatomy were printed in yellow polylactic acid and thermoplastic polyurethane, with another model printed in white Visijet SL Flex with a supporting base attached to its plantar aspect. Interactive user interface with functional toggle switches was developed. Object recognition did not function as intended, with adequate tracking and AR superimposition not achieved. The models accurately demonstrate bony foot and ankle anatomy in relation to the associated musculature. Although segmentation outcomes were sufficient, the process was highly time consuming, with effective object recognition tools relatively inaccessible. This may limit the reproducibility of augmented reality learning tools on a larger scale. Research is required to determine the extent to which this tool accurately demonstrates anatomy and ascertain whether use of this tool improves learning outcomes and is effective for teaching anatomy.

Technology enhanced neuroanatomy teaching techniques: A focused BEME systematic review of current evidence: BEME Guide No. 75

BACKGROUND

In response to growing curriculum pressures and reduced time dedicated to teaching anatomy, research has been conducted into developing innovative teaching techniques. This raises important questions for neuroanatomy education regarding which teaching techniques are most beneficial for knowledge acquisition and long-term retention, and how they are best implemented. This focused systematic review aims to provide a review of technology-enhanced teaching methods available to neuroanatomy educators, particularly in knowledge acquisition and long-term retention, compared to traditional didactic techniques, and proposes reasons for why they work in some contexts.

METHODS

Electronic databases were searched from January 2015 to June 2020 with keywords that included combinations of 'neuroanatomy,' 'technology,' 'teaching,' and 'effectiveness' combined with Boolean phrases 'AND' and 'OR.' The contexts and outcomes for all studies were summarised while coding, and theories for why particular interventions worked were discussed.

RESULTS

There were 4287 articles identified for screening, with 13 studies included for final analysis. There were four technologies of interest: stereoscopic views of videos, stereoscopic views of images, augmented reality (AR), and virtual reality (VR). No recommendation for a particular teaching method was made in six studies (46%) while recommendations (from weak to moderate) were made in seven studies (54%). There was weak to moderate evidence for the efficacy of stereoscopic images and AR, and no difference in the use of stereoscopic videos or VR compared to controls.

CONCLUSIONS

To date, technology-enhanced teaching is not inferior to teaching by conventional didactic methods. There are promising results for these methods in complex spatial anatomy and reducing cognitive load. Possible reasons for why interventions worked were described including students' engagement with the object, cognitive load theory, complex spatial relationships, and the technology learning curve. Future research may build on the theorised explanations proposed here and develop and test innovative technologies that build on prior research.

Mixed-methods exploration of students' motivation in using augmented reality in neuroanatomy education with prosected specimens

The use of augmented reality (AR) in teaching and studying neuroanatomy has been well researched. Previous research showed that AR-based learning of neuroanatomy has both alleviated cognitive load and was attractive to young learners. However, how the attractiveness of AR effects student motivation has not been discovered. Therefore, the motivational effects of AR were investigated in this research by the use of quantitative and qualitative methods. Motivation elicited by the GreyMapp-AR, an AR application, was investigated in medical and biomedical sciences students (n = 222; mean age: 19.7 ± 1.4 years) using the instructional measure of motivation survey (IMMS). Additional components (i.e., attention, relevance, confidence, and satisfaction) were also evaluated with motivation as measured by IMMS. Additionally, 19 students underwent audio-recorded individual interviews which were transcribed for qualitative analysis. Males regarded the relevance of AR significantly higher than females (P < 0.024). Appreciation of the GreyMapp-AR program was found to be significantly higher in students studying biomedical sciences as compared to students studying medicine (P < 0.011). Other components and scores did not show significant differences between student groups. Students expressed that AR was beneficial in increasing their motivation to study subcortical structures, and that AR could be helpful and motivating for preparing an anatomy examination. This study suggests that students are motivated to study neuroanatomy by the use of AR, although the components that make up their individual motivation can differ significantly between groups of students.

A validated instrument measuring students' perceptions on plastinated and three-dimensional printed anatomy tools

Due to the modernization of the medical curriculum and technological advancements, anatomy education has evolved beyond cadaveric dissection alone. Plastination techniques, three-dimensional (3D) modeling, and 3D printing technologies have progressively gained importance. However, there are limited valid and reliable surveys to evaluate students' perceptions of these new anatomy tools. Hence, this study aimed to develop a validated instrument to measure students' learning satisfaction, self-efficacy, humanistic values, and perceived limitations of plastinated and 3D printed models. A 41-item survey (five-point Likert scale, 1 = strongly disagree to 5 = strongly agree) was administered to Year 1 undergraduate medical students following a randomized controlled crossover study that evaluated plastinated and 3D printed cardiac and neck models. Ninety-six responses were received, and a factor analysis was performed with the Kaiser-Meyer-Olkin sampling adequacy of 0.878. The confirmatory factor analysis yielded a 4-factor, 19 items model that had a good fit with the latent constructs of x ² (147) = 211.568, P < 0.001, root mean square error of approximation = 0.068, root mean square residual = 0.064, comparative fit index = 0.946, and Tucker Lewis index = 0.937. The Cronbach's alpha for the individual factors ranged from 0.74 to 0.95, indicating good internal consistency. This demonstrated a psychometrically valid and reliable instrument to measure students' perceptions toward plastinated and 3D printed models.

Self-Regulated Learning Strategies for Nursing Students: A Pilot Randomized Controlled Trial

Distance learning (DL) based on information and communication technologies is gaining importance due to its convenience and cost savings. However, there is not enough evidence to identify the effect of DL on students requiring a high level of self-regulated learning (SRL). Therefore, this study aims to compare the effects of the use of augmented reality (AR) as an innovative learning method and the use of a textbook as a conventional learning method. Both methods were based on SRL strategies. In this pilot randomized controlled trial (RCT), SRL using an AR group (n = 31) and a textbook group (n = 31) was performed. Perceived learning (PL) competency, knowledge, SRL competency, academic stress, and learning flow were measured to evaluate the effect of intervention. Although, there was not significant interaction between the effects of time and the intervention in PL competency, knowledge, academic stress, and learning flow. In the subdomains of SRL competency, environmental structuring, task strategies, time management, help seeking, and self-evaluation were significantly improved after intervention. SRL using innovative methods is more important after COVID 19. Therefore, well-designed larger RCTs are required to identify the effect of SRL strategy using innovative method.

Scoping review: The use of augmented reality in clinical anatomical education and its assessment tools

The purpose of this review was to identify the different augmented reality (AR) modalities used to teach anatomy to students, health professional trainees, and surgeons, and to examine the assessment tools used to evaluate the performance of various AR modalities. A scoping review of four databases was performed using variations of: (1) AR, (2) medical or anatomical teaching/education/training, and (3) anatomy or radiology or cadaver. Scientific articles were identified and screened for the inclusion and exclusion criteria as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses with extension for scoping reviews guidelines. Virtual reality was an exclusion criterion. From this scoping review, data were extracted from a total of 54 articles and the following four AR modalities were identified: head-mounted display, projection, instrument and screen, and mobile device. The usability, feasibility, and acceptability of these AR modalities were evaluated using a variety of quantitative and qualitative assessment tools. Within more recent years of AR integration into anatomy education, the assessment of visuospatial ability, cognitive load, time on task, and increasing academic achievement outcomes are variables of interest, which continue to warrant more exploration. Sufficiently powered studies using validated assessment tools must be conducted to better understand the role of AR in anatomical education.

The role and effectiveness of augmented reality in patient education: A systematic review of the literature

OBJECTIVES

To provide an overview of the existing research concerning the use and effects of AR in patient education.

METHODS

Following PRISMA guidelines four electronic databases were systematically searched.

INCLUSION CRITERIA

empirical studies using any type of AR intervention in patient education across all medical specialties. Quality assessment of the retrieved literature was carried out.

RESULTS

Ten papers, comprising 788 patients, were identified and included (Randomized controlled trial (RCT)(n = 3), non-randomized controlled trial (n = 3), before-and-after study (n = 3), and qualitative survey (n = 1)). Retrieved literature showed itself to be highly heterogeneous. The studied population included patients suffering from a diverse spectrum of chronic diseases (e.g., prostate cancer, diabetes mellitus, multiple sclerosis, epilepsy). Quantitative results indicated that the use of AR had a positive effect on knowledge retention and patient satisfaction. Qualitative findings suggested that patients liked the technology and felt comfortable with its use for educational purposes. The quality of the retrieved results was shown to be moderate to low.

CONCLUSION

The limited evidence of this topic suggests the possible potential of AR in patient education.

PRACTICE IMPLICATION

More research, using high-quality study designs and more evidence-based interventions, is needed to fully appreciate the value of AR on patient education.