Analysis of traditional versus three-dimensional augmented curriculum on anatomical learning outcome measures

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.

Evaluating virtual reality anatomy training for novice anesthesiologists in performing ultrasound-guided brachial plexus blocks: a pilot study

BACKGROUND

Developing proficiency in ultrasound-guided nerve block (UGNB) demands an intricate understanding of cross-sectional anatomy as well as spatial reasoning, which is a big challenge for beginners. The aim of this pilot study was to evaluate the feasibility of virtual reality (VR)-facilitated anatomy education in the first performance of ultrasound-guided interscalene brachial plexus blockade among novice anesthesiologists. We carried out pilot testing of this hypothesis using a prospective, single blind, randomized controlled trial.

METHODS

Twenty-one anesthesia trainees with no prior ultrasonography or nerve block training were included in this study. All participants underwent a training program encompassing theory and hands-on practice. Trainees were randomized into one of two groups: one received VR-assisted anatomy course while the other did not. Subsequently, both groups completed identical practical modules on ultrasound scanning and needle insertion. The primary end point was defined as the evaluation of trainees' performance during their initial ultrasound-guided interscalene brachial plexus block, assessed using both the Global Rating Scale (GRS) and a task-specific Checklist. The secondary end point included the improvement in scores for written multiple-choice questions (MCQs).

RESULTS

In evaluating practical ultrasound-guided nerve block skills, the VR group significantly outperformed the control group on the task-specific Checklist (29.23 ± 3.91 vs. 24.85 ± 5.13; P < 0.05), while both groups showed comparable performance on the GRS. Additionally, post-theoretical course MCQ scores increased substantially, with post-test results significantly surpassing pre-test scores in both groups (P < 0.001). However, intergroup analysis indicated no significant difference in score improvements between the VR and control groups (21.82 ± 12.30 vs. 18.33 ± 9.68, P > 0.05).

CONCLUSIONS

Overall, the findings of this pilot study suggest that immersive virtual reality training in anatomy may contribute to improving the proficiency of ultrasound-guided brachial plexus blocks among novice anesthesiologists. Incorporating VR into future anesthesia technique training programs should be considered.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: ChiCTR2300067437. Date of Registration Jan 9, 2023.

Community college student perceptions of digital anatomy models as a curricular resource

Digital model platforms and applications are common in anatomy education and continue to grow in number, which suggests that educators and students find use for these tools despite the lack of widely accepted best practices. Consequently, it is a challenge for educators to mindfully integrate digital models into curriculum. This short-term, longitudinal study investigated the effects of integrating a monoscopic digital model as a teaching tool during lectures on reproductive and endocrine anatomy as an intervention in a community college human anatomy and physiology course. Student use and perceptions of digital models were analyzed for correlation with the nature of the course content and the intervention (n = 92). Academic content significantly affected self-reported student use (p < 0.001) as well as student perceived usefulness of the model (p = 0.02). These findings support the conjecture that digital anatomy models may be better for achieving certain specific learning goals opposed to all learning goals. Integration of digital models as an instructional method did not consistently influence student behavior but it made a difference in participant ability to recognize this technology outside of the lecture. Overall, participants had a positive perception of digital models, although they were not perceived as more important than all other curricular resources. Inclusion of monoscopic digital models for teaching anatomy should be considered by educators since teaching with digital models can demonstrate strengths and weaknesses for students within the context the of learning objectives, assisting students to make more informed decisions about effective learning tools.

Comparing the effectiveness of augmented reality and anatomical atlases in student preparation for neuroanatomy dissection

Anatomy teachers urge students to come to education sessions at the dissection rooms as well-prepared as possible. To effectuate optimal preparation, assignments are designed to guide the students' learning processes. These assignment often include the use of anatomical figures in atlases. The role of augmented reality (AR) applications in helping students prepare for body donor-based teaching sessions at the dissection rooms remains quite elusive. Therefore, this study examines the effects of the use of an AR application compared to the use of anatomical atlases in helping students (n = 28) prepare for a neuroanatomy session at the dissection rooms with prosections. The study shows that students from both groups showed a similar improvement in anatomy test scores. The amount of experienced cognitive engagement, however, is higher in the experimental AR group. Based on these results, it can be suggested that an AR application is a valid method to help students prepare and could be an alternative to the use of anatomical atlases. Nevertheless, future studies should re-investigate this research question in larger cohorts. Also, it remains unknown whether cognitive engaged students are indeed the students who are better prepared for educational sessions at the dissection rooms.

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.

Perspective or Spectacle? Teaching thoracic aortic anatomy in a mixed reality assisted educational approach- a two-armed randomized pilot study

PURPOSE

Anatomical understanding is an important basis for medical teaching, especially in a surgical context. The interpretation of complex vascular structures via two-dimensional visualization can yet be difficult, particularly for students. The objective of this study was to investigate the feasibility of an MxR-assisted educational approach in vascular surgery undergraduate education, comparing an MxR-based teaching-intervention with CT-based material for learning and understanding the vascular morphology of the thoracic aorta.

METHODS

In a prospective randomized controlled trial learning success and diagnostic skills following an MxR- vs. a CT-based intervention was investigated in 120 thoracic aortic visualizations. Secondary outcomes were motivation, system-usability as well as workload/satisfaction. Motivational factors and training-experience were also assessed. Twelve students (7 females; mean age: 23 years) were randomized into two groups undergoing educational intervention with MxR or CT.

RESULTS

Evaluation of learning success showed a mean improvement of 1.17 points (max.score: 10; 95%CI: 0.36-1.97). The MxR-group has improved by a mean of 1.33 [95% CI: 0.16-2.51], against 1.0 points [95% CI: -0.71- 2.71] in the CT-group. Regarding diagnostic skills, both groups performed equally (CT-group: 58.25 ± 7.86 vs. MxR-group:58.5 ± 6.60; max. score 92.0). 11/12 participants were convinced that MxR facilitated learning of vascular morphologies. The usability of the MxR-system was rated positively, and the perceived workload was low.

CONCLUSION

MxR-systems can be a valuable addition to vascular surgery education. Further evaluation of the technology in larger teaching situations are required. Especially regarding the acquisition of practical skills, the use of MxR-systems offers interesting application possibilities in surgical education.

The evolution of simulation-based medical education research: From traditional to virtual simulations

Background

Simulation-based medical education (SBME) is a widely used method in medical education. This study aims to analyze publications on SBME in terms of countries, institutions, journals, authors, and keyword co-occurrence, as well as to identify trends in SBME research.

Methods

We retrieved the Publications on SBME from the Web of Science Core Collection (WoSCC) database from its inception to January 27, 2024. Microsoft Excel 2019, CiteSpace, and VOSviewer were used to identify the distribution of countries, journals, and authors, as well as to determine the research hotspots.

Results

We retrieved a total of 11272 publications from WoSCC. The number of documents published in 2022 was the highest in the last few decades. The USA, the UK, and Canada were three key contributors to this field. The University of Toronto, Stanford University, and Harvard Medical School were the top major institutions with a larger number of publications. Konge, Lars was the most productive author, while McGaghie, William C was the highest cited author. BMC Medical Education has the highest number of publications among journals. The foundational themes of SBME are "Patient simulation," "extending reality," and "surgical skills."

Conclusions

SBME has attracted considerable attention in medical education. The research hotspot is gradually shifting from traditional simulations with real people or mannequins to virtual, digitally-based simulations and online education. Further studies will be conducted to elucidate the mechanisms of SBME. The utilization of SBME will be more rationalized.

Effects of 3D Scans on Veterinary Students' Learning Outcomes Compared to Traditional 2D Images in Anatomy Classes

Students often struggle with interpreting traditional textbook images and translating them to anatomical structures. This study aimed to compare the impact of 3D scans versus 2D images on students' learning outcomes when learning anatomical structures on skulls from horses and pigs. Furthermore, the correlation between spatial ability and learning outcomes using 3D scans or 2D images was examined. Second-year veterinary medicine students either used 3D scans or 2D images, annotated with arrows or numbers as learning material. Students' anatomical knowledge was tested before and after the learning session, and spatial ability was assessed using the mental rotation test. All groups improved significantly in the post-test. However, the differences between groups were not significant, suggesting that 3D scans do not necessarily lead to higher learning outcomes. The analysis of the correlation between spatial ability and learning outcomes did not prove that students with weaker spatial ability benefit from 3D scans. Students preferred 3D scans over 2D images despite similar outcomes, suggesting they are valuable for learning. However, results show that the introduction of novel learning materials likely amplified the impact of reduced learning time on the 3D group, as these materials necessitated additional time for effective comprehension and integration.

Effectiveness and satisfaction with virtual and donor dissections: A randomized controlled trial

In recent years, human anatomy education has faced challenges with traditional donor dissection, leading to the emergence of virtual dissection as an alternative. This study aims to investigate the academic performance and satisfaction of medical students by comparing the virtual and donor dissections. An open-labeled crossover randomized controlled trial was conducted with 154 first-year medical students in Human Anatomy and Neuroanatomy laboratories, which were divided into three classes. Students were randomly assigned to either the virtual (virtual dissection followed by donor dissection) or donor (donor dissection followed by virtual dissection) groups in each class. A curriculum, incorporating head-mounted displays (HMDs), a life-sized touchscreen, and tablets, was developed. Data was evaluated through quizzes and surveys. In the Human Anatomy laboratory, each class of the donor group conducted heart extraction, dissection and observation. In observation class, the virtual group had a significantly higher mean quiz score than the donor group (p < 0.05). Compared to the donor, satisfaction was significantly higher for the HMD (understanding of concept and immersion), life-size touchscreen (esthetics, understanding of the concept, and spatial ability), and tablet (esthetics, understanding of the concept, spatial ability, and continuous use intention). In the Neuroanatomy laboratory, the virtual group showed significantly higher mean quiz scores than the donor group (p < 0.05), and tablet showed a significantly higher satisfaction than donor in terms of esthetics, understanding of the concept, and spatial ability. These results suggest that virtual dissection has the potential to supplement or replace donor dissection in anatomy education. This study is innovative in that it successfully delivered scenario-based virtual content and validated the efficacy in academic performance and satisfaction when using virtual devices compared to donor.Trial registration: This research has been registered in the Clinical Research Information Service (CRIS, https://cris.nih.go.kr/cris/search/detailSearch.do?search_lang=E&focus=reset_12&search_page=L&pageSize=10&page=undefined&seq=26002&status=5&seq_group=26002 ) with registration number "KCT0009075" and registration date "27/12/2023".

The effect of pre-body donor quizzes on student performance in a hybrid anatomy course

Learning human anatomy is essential for Doctor of Physical Therapy (DPT) education. Body donors are traditionally utilized to understand content, but in a hybrid learning environment, students have limited time to use body donors. To improve body donor access and learning, we created online synchronous pre-body donor activities. The impact of these online strategies on students' subsequent exams and final grade were investigated in a non-randomized, observational study. These activities were hypothesized to positively influence students' anatomy performance. In a 16-week semester, DPT students (case [n = 91], control [n = 22]) participated in a hybrid program of asynchronous/synchronous online learning and two in-person immersions. Measures included student course grades and teaching surveys. Spearman's rho correlations analyzed the relationship between four pre-body donor quizzes to body donor exams, written exams, and final course grade. Mann-Whitney U tests assessed differences in grades between cohorts. A linear regression model examined the influence of pre-body donor quizzing on exams/final grades. Correlation tests revealed a strong relationship between the average pre-body donor quiz score and both the first written exam and final course grade (p = 0.0001). The case group achieved significantly higher scores than the control group on the first in-person body donor exam (p = 0.011), the second written exam (p = 0.0001), and the final grade (p = 0.004). The pre-body donor quizzes predicted performance on the subsequent in-person body donor exams, written exams, and the final grade. Implementation of online pre-body donor learning activities was associated with increased academic performance among hybrid DPT students and may aid in learning anatomy concepts for clinical practice.

Impact of gross anatomy laboratory on student written examination performance: A 3-year study of a large-enrollment undergraduate anatomy course

The efficacy of the various pedagogies that are used in human anatomy laboratories has been extensively debated. Nevertheless, an important question remains relatively unexamined-how the learning experience in the anatomy laboratory impacts students' mastery and application of anatomical knowledge beyond the laboratory setting. In this study, the effect of a prosection-based anatomy laboratory on overall comprehension and mastery of anatomical knowledge was evaluated in an upper division undergraduate anatomy curriculum that consists of a mandatory lecture course and an optional laboratory course. This flexible curricular structure permitted assessing the merit of laboratory learning on the written examination performance of the lecture course. In 2019 and 2022, the anatomy laboratory was taught in-person using prosections, while in 2021 due to the Covid-19 pandemic related regulations, it was taught remotely with live-streaming of prosections using document cameras. In both in-person and remote instructive formats, written examination scores of the lecture course were compared between two cohorts of students: Those enrolled in lecture only and those enrolled in both lecture and laboratory. Results showed that the cohort enrolled in both lecture and laboratory courses consistently outperformed the lecture-only cohort by one full letter grade. Furthermore, when the degrees of improvement on written examination scores were compared between the two instructive formats, in-person laboratory had a greater increase compared to remote laboratory. Altogether this study demonstrates that the prosection-based anatomy laboratory enhances students' mastery of anatomical knowledge beyond the laboratory setting by promoting comprehension of spatial relationships of anatomical structures.

Comparing the emotional experiences of students in similar dissection- and prosection-based medical gross anatomy courses: A mixed-methods study

The anatomy laboratory can incite strong emotional reactions in students, which can in turn facilitate growth in empathy, care for vulnerable others, and professionalism. Despite this, little is known about the relative emotional impacts of different laboratory modalities. The response to the COVID-19 pandemic created an opportunity to compare the emotional experiences of students in similar courses in which one group of students dissected donors and the other group learned from prosected donors. The courses were otherwise the same in content, length, instructional design, and assessment. Students in the dissection-based (Fall 2019) and prosection-based (Fall 2020) courses completed a previously validated survey that used quantitative and qualitative questions to assess their feelings about the donors and the anatomy laboratory experience. Students in both cohorts reported overall appreciation for having had the experience. Negative themes experienced by both groups included feeling anxiety, worries about depersonalizing donors, and physical discomfort in the laboratory. Students in the dissection course reported stronger connections with the donors and the donors' families but also more frequently felt negative feelings such as disgust, anxiety, and feeling alone. Students in the prosection course reported more consistently positive responses but worried about not using the donors to the fullest extent possible. Regardless of pedagogical design, students have complex emotional experiences in the anatomy laboratory and our results indicate that these feelings may be more intense in the context of dissection. Anatomists should foster educational settings that enable students to learn to process complex or challenging emotions.

3D-Printing-Based Fluoroscopic Coronary Angiography Simulator Improves Learning Capability Among Cardiology Trainees

Aim

One of the essential competencies of cardiology trainees is the ability to perform coronary angiography with good projection.

Purpose

This study is a research and development study aimed at testing the effectiveness of 3D-printing-based fluoroscopic coronary angiography simulator as a learning medium for diagnostic coronary angiogram.

Methods

Thirty-four cardiology trainees randomly were divided into two groups. Both groups took a pretest before the intervention. The first group (group A) studied using conventional learning media and underwent the first post-test. Afterward, they switched to a 3D-printing-based fluoroscopic coronary angiography simulator and underwent a second post-test. The second group (group B) studied using a 3D-printing-based fluoroscopic coronary angiography simulator, underwent the first post-test, switched to the conventional learning media, and underwent a second post-test.

Results

The delta between the post-test I and the pretest of group B was 8.53, higher than the delta between the post-test I and the pretest of group A (5.21) with a significant difference (p = 0.003). In group A, the delta between post-test II and pretest was 9.65, higher than the delta between post-test I and pretest (5.21) with a significant difference (p < 0.001).

Conclusion

3D-printing-based fluoroscopic coronary angiography simulator is effective as a learning medium for coronary angiogram diagnostics.

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 impact of enhancing publicity and commemoration of body donors at Zhengzhou University, China

As a fundamental subject of medical education, human anatomy plays a critical role in the development of medical science. However, because of multiple factors including cultural conservativism and limited social understanding, China is facing a particularly severe shortage of bodies donated for anatomy education. Zhengzhou University (ZZU) has continued to uphold whole-body dissection as the preferred method for medical students to learn anatomy. For this study, records of registered individuals (who have signed a body donation agreement) and donors (whose bodies have been received) from 2001 to 2020 were collected and analyzed. The aim of this study was to explore the factors influencing the body donation program (BDP) at ZZU, and then reinforce the social understanding for the BDP. The results showed a significant increase in the numbers of both registered individuals and donors since 2015, which is the year the publicity and commemoration in honor of donors were increased. There were no significant differences between the biological male and female sexes in the registered individuals, but the number of male donors (12.85 ± 10.86, per year) was significantly higher than that of female donors (4.75 ± 4.53, per year). The current donor profile at ZZU is male in his 60/70s, while the profile of registered individuals is male or female in their 60s. Strengthening the publicity and commemoration in honor of donors may contribute to the implementation of BDPs.

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.

Determinants of Learning Anatomy in an Immersive Virtual Reality Environment - A Scoping Review

Given the decline of cadavers as anatomy teaching tools, immersive virtual reality (VR) technology has gained popularity as a potential alternative. To better understand how to maximize the educational potential of VR, this scoping review aimed to identify potential determinants of learning anatomy in an immersive VR environment. A literature search yielded 4523 studies, 25 of which were included after screening. Six common factors were derived from secondary outcomes in these papers: cognitive load, cybersickness, student perceptions, stereopsis, spatial understanding, and interactivity. Further objective research investigating the impact of these factors on anatomy examination performance is required.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-022-01701-y.

Effect of binocular disparity on learning anatomy with stereoscopic augmented reality visualization: A double center randomized controlled trial

Binocular disparity provides one of the important depth cues within stereoscopic three-dimensional (3D) visualization technology. However, there is limited research on its effect on learning within a 3D augmented reality (AR) environment. This study evaluated the effect of binocular disparity on the acquisition of anatomical knowledge and perceived cognitive load in relation to visual-spatial abilities. In a double-center randomized controlled trial, first-year (bio)medical undergraduates studied lower extremity anatomy in an interactive 3D AR environment either with a stereoscopic 3D view (n = 32) or monoscopic 3D view (n = 34). Visual-spatial abilities were tested with a mental rotation test. Anatomical knowledge was assessed by a validated 30-item written test and 30-item specimen test. Cognitive load was measured by the NASA-TLX questionnaire. Students in the stereoscopic 3D and monoscopic 3D groups performed equally well in terms of percentage correct answers (written test: 47.9 ± 15.8 vs. 49.1 ± 18.3; P = 0.635; specimen test: 43.0 ± 17.9 vs. 46.3 ± 15.1; P = 0.429), and perceived cognitive load scores (6.2 ± 1.0 vs. 6.2 ± 1.3; P = 0.992). Regardless of intervention, visual-spatial abilities were positively associated with the specimen test scores (η² = 0.13, P = 0.003), perceived representativeness of the anatomy test questions (P = 0.010) and subjective improvement in anatomy knowledge (P < 0.001). In conclusion, binocular disparity does not improve learning anatomy. Motion parallax should be considered as another important depth cue that contributes to depth perception during learning in a stereoscopic 3D AR environment.

Extended reality veterinary medicine case studies for diagnostic veterinary imaging instruction: Assessing student perceptions and examination performance

Educational technologies in veterinary medicine aim to train veterinarians faster and improve clinical outcomes. COVID-19 pandemic, shifted face-to-face teaching to online, thus, the need to provide effective education remotely was exacerbated. Among recent technology advances for veterinary medical education, extended reality (XR) is a promising teaching tool. This study aimed to develop a case resolution approach for radiographic anatomy studies using XR technology and assess students' achievement of differential diagnostic skills. Learning objectives based on Bloom's taxonomy keywords were used to develop four clinical cases (3 dogs/1 cat) of spinal injuries utilizing CT scans and XR models and presented to 22 third-year veterinary medicine students. Quantitative assessment (ASMT) of 7 questions probing 'memorization', 'understanding and application', 'analysis' and 'evaluation' was given before and after contact with XR technology as well as qualitative feedback via a survey. Mean ASMT scores increased during case resolution (pre 51.6% (±37%)/post 60.1% (± 34%); p < 0.01), but without significant difference between cases (Kruskal-Wallis H = 2.18, NS). Learning objectives were examined for six questions (Q1-Q6) across cases (C1-4): Memorization improved sequentially (Q1, 2 8/8), while Understanding and Application (Q3,4) showed the greatest improvement (26.7%-76.9%). Evaluation and Analysis (Q5,6) was somewhat mixed, improving (5/8), no change (3/8) and declining (1/8).Positive student perceptions suggest that case studies' online delivery was well received stimulating learning in diagnostic imaging and anatomy while developing visual-spatial skills that aid understanding cross-sectional images. Therefore, XR technology could be a useful approach to complement radiological instruction in veterinary medicine.

Virtual reality in midwifery education: A mixed methods study to assess learning and understanding

BACKGROUND

Virtual reality learning environments (VRLEs) are a potentially valuable learning tool that have recently increased in popularity due to widespread availability and decreased cost. VRLEs can provide an immersive learning environment that increases the understanding of three-dimensional relationships between anatomical structures. However, there is a paucity of evidence in the literature supporting its use within Midwifery education.

OBJECTIVES

To explore the effectiveness of a VRLE as an educational tool in midwifery education.

SETTING

A large University in Ireland, with institutional ethical approval.

PARTICIPANTS

Undergraduate and graduate degree midwifery students.

DESIGN

A descriptive qualitative and quantitative study was carried out. Data collection was carried out between September 2020 and March 2021.

METHODS

Participants underwent a VRLE lesson based on the topic of fetal lie, position, and presentation in pregnancy. A multiple-choice questionnaire was used to quantitatively evaluate knowledge before and immediately after the intervention, and knowledge retention after one week. Qualitative data was collected using open-ended questions in the questionnaire. The primary outcome was a difference in pre- and post-intervention knowledge scores. Data was analysed using repeated measures one-way ANOVA. Qualitative data was analysed using thematic analysis and simple content analysis. All students participated in the quantitative and qualitative components of the study. Secondary outcomes included participant satisfaction and self-confidence in learning which were analysed using thematic analysis. The side effect profile of the virtual reality device was also explored using open-ended questions in the questionnaire.

RESULTS

Forty-one midwifery students participated in the study, with a 100 % participation and response rate. Repeated measures one-way ANOVA revealed no statistically significant differences in knowledge scores pre- and post-intervention. Participants rated high satisfaction and self-confidence scores with regard to the VRLE as a learning modality. Side effects most commonly experienced by participants included dizziness (49 %), disorientation (30 %) and symptoms similar to motion sickness (32 %). The following themes were identified: "Learning in 3D", "The Power of Visual Learning", "The value of Educational Technology", "Learning can be fun and enjoyable".

CONCLUSIONS

This study showed that the VRLE had no impact on knowledge gain, though high levels of satisfaction and self-confidence indicate a positive response to the VRLE. VRLEs are a potentially valuable learning tool to help enhance the student learning experience, promoting increased engagement, satisfaction, and self-confidence with the learning material.

The Anatomy Course During COVID-19: The Impact of Cadaver-Based Learning on the Initiation of Reflection on Death

BACKGROUND

During the COVID-19 pandemic, in-person cadaveric dissection laboratories for teaching anatomy were omitted by many schools around the world. While knowledge domains can be easily evaluated via remote exams, non-traditional discipline-independent skills such as those encouraged through reflection on the topic of death are often overlooked. This study investigated how different anatomy course formats played a role in initiating students' reflections on death during the COVID-19 pandemic.

METHOD

In fall 2020, 217 medical, dental, premedical, and health sciences students from 13 international universities discussed differences in their anatomy courses online. Formats of anatomy courses ranged from dissection-based, prosection-based, hybrid (combination of dissection and prosection) to no laboratory exposure at all. Students' responses to the question, "Did/does your anatomy course initiate your thinking about life's passing?" were collected, and they self-reported themes that were present in their reflections on death using a multiple-choice prompt. Statistical analyses to detect differences between students with and without exposure to cadavers were performed using the chi-squared test.

RESULTS

When comparing students who had exposure to human anatomical specimens to those who had no exposure, the majority of students with exposure thought that the course did initiate thoughts about life's passing, compared to students without exposure (P < 0.05). Reflection themes were consistent across groups.

DISCUSSION

These findings indicate that anatomy dissection courses are important for the initiation of students' feelings about the topic of death. Omission of cadaveric dissection- or prosection-based laboratories will decrease the likelihood that students initiate reflection on this topic and gain important transferable skills.

Visual-spatial dimension integration in digital pathology education enhances anatomical pathology learning

Literature review demonstrated a surprising lack of publications on digital e-learning pathology resources for senior medical undergraduates and interns. An interactive Digital Pathology Repository (iDPR) integrating two- and three-dimensional (2D, 3D) high-resolution anatomical pathology images with correlated digital histopathology was developed. The novel iDPR was rigorously evaluated using mixed methods to assess pathology knowledge gains (pre- and post-tests), quality impact analysis (questionnaire), user feedback (focus group discussions) and user visual behaviour (eye gaze tracking analysis of 2D/ 3D images).Exposure to iDPR appeared to improve user pathology knowledge, as observed by significantly increased test scores on topic-related quizzes (n = 69, p < 0.001). In addition, most users were highly satisfied with the key design elements of the iDPR tool. Focus group discussion revealed the iDPR was regarded as a relevant online learning resource, although some minor technical issues were also noted. Interestingly, visual behaviour trends indicated that specific diagnostic pathological lesions could be correctly identified faster in 3D images, when compared to 2D images.The iDPR offers promise and potential in pathology education for senior clinical students and interns, gauging from both qualitative and quantitative positive user feedback. With incorporation of image annotations and interactive functionality, and with further technology development, this would prove a useful tool for diagnostic pathology and telepathology. As images with added visual-spatial dimension can provide enhanced detail and aid more rapid diagnosis, future applications of the iDPR could include virtual reality or holographic images of anatomical pathology specimens.

Evaluation of an Augmented Reality Application for Learning Neuroanatomy in Psychology

Neuroanatomy is difficult for psychology students because of spatial visualization and the relationship among brain structures. Some technologies have been implemented to facilitate the learning of anatomy using three-dimensional (3D) visualization of anatomy contents. Augmented reality (AR) is a promising technology in this field. A mobile AR application to provide the visualization of morphological and functional information of the brain was developed. A sample of 67 students of neuropsychology completed tests for visuospatial ability, anatomical knowledge, learning goals, and experience with technologies. Subsequently, they performed a learning activity using one of the visualization methods considered: a 3D method using the AR application and a two-dimensional (2D) method using a textbook to color, followed by questions concerning their satisfaction and knowledge. After using the alternative method, the students expressed their preference. The two methods improved knowledge equally, but the 3D method obtained higher satisfaction scores and was more preferred by students. The 3D method was also more preferred by the students who used this method during the activity. After controlling for the method used in the activity, associations were found between the preference of the 3D method because of its usability and experience with technologies. These results found that the AR application was highly valued by students to learn and was as effective as the textbook for this purpose.

Three-Dimensional Tooth Models with Pulp Cavity Enhance Dental Anatomy Education

Dental anatomy is an integrated, core fundamental dental course, which prepares students for all future clinical dental courses. This study aimed to build up an online dental learning platform of micro-computed tomography-based three-dimensional (3D) tooth models with pulp cavity, and to further evaluate its effectiveness for dental anatomy education using a cohort study. First, ninety-six extracted permanent teeth were scanned by micro-computed tomography and the enamel, dentine, and pulp cavity of each was distinguished by different grey-scale intensities using Mimics software. Three-dimensional images allowed further discrimination and insights into permanent three-rooted premolars, central tip, and dental diseases including deep caries and wedge-shaped defects. Furthermore, a second mesiobuccal canal (MB2) in maxillary permanent molar teeth and Vertucci type III root canal configuration in mandibular anterior teeth could be detected using the 3D analytical tool. A digitized 3D tooth model learning platform was implemented. Last, two groups of dental students were assessed to evaluate the effect of 3D models on dental anatomy education. Participants in the Digital group were allowed to use the online dental learning platform freely after class, while the participants in the Traditional group were not. Assessment quizzes showed that participants' scores improved in the Digital group with the use of the learning platform compared with scores in the Traditional group. A questionnaire survey indicated that the participants had a positive attitude toward the 3D models. Thus, adding digital 3D resources to a traditional curriculum may have a positive effect on academic achievements.

Augmented Reality and Virtual Reality in Dentistry: Highlights from the Current Research

Many modern advancements have taken place in dentistry that have exponentially impacted the progress and practice of dentistry. Augmented reality (AR) and virtual reality (VR) are becoming the trend in the practice of modern dentistry because of their impact on changing the patient’s experience. The use of AR and VR has been beneficial in different fields of science, but their use in dentistry is yet to be thoroughly explored, and conventional ways of dentistry are still practiced at large. Over the past few years, dental treatment has been significantly reshaped by technological advancements. In dentistry, the use of AR and VR systems has not become widespread, but their different uses should be explored. Therefore, the aim of this review was to provide an update on the contemporary knowledge, to report on the ongoing progress of AR and VR in various fields of dental medicine and education, and to identify the further research required to achieve their translation into clinical practice. A literature search was performed in PubMed, Scopus, Web of Science, and Google Scholar for articles in peer-reviewed English-language journals published in the last 10 years up to 31 March 2021, with the help of specific keywords related to AR and VR in various dental fields. Of the total of 101 articles found in the literature search, 68 abstracts were considered suitable and further evaluated, and consequently, 33 full-texts were identified. Finally, a total of 13 full-texts were excluded from further analysis, resulting in 20 articles for final inclusion. The overall number of studies included in this review was low; thus, at this point in time, scientifically-proven recommendations could not be stated. AR and VR have been found to be beneficial tools for clinical practice and for enhancing the learning experiences of students during their pre-clinical education and training sessions. Clinicians can use VR technology to show their patients the expected outcomes before the undergo dental procedures. Additionally, AR and VR can be implemented to overcome dental phobia, which is commonly experienced by pediatric patients. Future studies should focus on forming technological standards with high-quality data and developing scientifically-proven AR/VR gadgets for dental practice.

Anatomical self-efficacy of undergraduate students improves during a fully online biology course with at-home dissections

Student enrollments in online college courses have grown steadily over the past decade, and college administrators expect this trend to continue or accelerate. Despite the growing popularity of online education, one major critique in the sciences is that students are not trained in the hands-on skills they may need for the workforce, graduate school, or professional school. For example, the Association of American Medical Colleges has recommended that medical schools evaluate applicants on their motor skills and observation skills, yet many online biology programs do not offer opportunities for students to develop these skills. In on-campus biology programs, students commonly develop these skills through hands-on animal dissections, but educators have struggled with how to teach dissections in an online environment. We designed a fully online undergraduate biology course that includes at-home, hands-on dissections of eight vertebrate specimens. Over three course offerings, we evaluated changes in four student outcomes: anatomical self-efficacy, confidence in laboratory skills, perceptions of support, and concerns about dissections. Here, we describe how we implemented at-home dissections in the online course and show that students taking the course gained anatomical self-efficacy and confidence in multiple laboratory skills. Based on open-ended responses, the students perceived that their experiences with the at-home dissections facilitated these gains. These results demonstrate that at-home, hands-on laboratories are a viable approach for teaching practical skills to students in fully online courses. We encourage science instructors to introduce at-home laboratories into their online courses, and we provide recommendations for instructors interested in implementing at-home laboratories.

Learning in Stereo: The Relationship Between Spatial Ability and 3D Digital Anatomy Models

Three-dimensional (3D) digital anatomical models show potential to demonstrate complex anatomical relationships; however, the literature is inconsistent as to whether they are effective in improving the anatomy performance, particularly for students with low spatial visualization ability (Vz). This study investigated the educational effectiveness of a 3D stereoscopic model of the pelvis, and the relationship between learning with 3D models and Vz. It was hypothesized that participants learning with a 3D pelvis model would outperform participants learning with a two-dimensional (2D) visualization or cadaveric specimen on a spatial anatomy test, particularly when comparing those with low Vz. Participants (n = 64) were stratified into three experimental groups, who each attended a learning session with either a 3D stereoscopic model (n = 21), 2D visualization (n = 21), or cadaveric specimen (n = 22) of the pelvis. Medical and pre-medical student participants completed a multiple-choice pre-test and post-test during their respective learning session, and a long-term retention (LTR) test 2 months later. Results showed no difference in anatomy test improvement or LTR performance between the experimental groups. A simple linear regression analysis showed that within the 3D group, participants with high Vz tended to retain more than those with low Vz on the LTR test (R²  = 0.31, P = 0.01). The low Vz participants may be cognitively overloaded by the complex spatial cues from the 3D stereoscopic model. Results of this study should inform resource selection and curriculum design for health professional students, with attention to the impact of Vz on learning.

Digital anatomy table in teaching-learning process of the temporomandibular joint anatomy

INTRODUCTION

The use of teaching resources and digital objects has gradually been incorporated into dental schools. This study aimed to evaluate the digital anatomy table in teaching-learning process of the temporomandibular joint (TMJ) anatomy and the student's perception regarding this resource.

MATERIALS AND METHODS

A cross-sectional study was conducted on 41 undergraduate dental students. Knowledge assessment tests were applied at different time intervals: before and after the TMJ theoretical class, after the practical class on prosected specimens and after the use of digital anatomy table. The medians of the scores obtained in the three groups (theoretical class, practical class and digital table) were descriptively analysed and submitted to Wilcoxon, Kruskal-Wallis and Student-Newman-Keuls statistical tests. The perception survey was conducted at the end of the study.

RESULTS

When the teaching strategies were compared amongst each other, the medians of the scores with the digital anatomy table were significantly higher than after the theoretical and practical classes. At the end of the research, there were no differences amongst the three groups (theoretical class, practical class and digital table). Regarding the perception, the majority of the students reported that the digital anatomy table helped them to understand the content of the theoretical class.

CONCLUSION

It was concluded that learning with the use of the digital anatomy table did not increase the knowledge of dental students with respect to the TMJ anatomy. The students' perceptions of the digital anatomy table were positive and that it could be used as an additional resource in the teaching-learning process.

Learning Outcomes of Immersive Technologies in Health Care Student Education: Systematic Review of the Literature

BACKGROUND

There is a lack of evidence in the literature regarding the learning outcomes of immersive technologies as educational tools for teaching university-level health care students.

OBJECTIVE

The aim of this review is to assess the learning outcomes of immersive technologies compared with traditional learning modalities with regard to knowledge and the participants' learning experience in medical, midwifery, and nursing preclinical university education.

METHODS

A systematic review was conducted according to the Cochrane Collaboration guidelines. Randomized controlled trials comparing traditional learning methods with virtual, augmented, or mixed reality for the education of medicine, nursing, or midwifery students were evaluated. The identified studies were screened by 2 authors independently. Disagreements were discussed with a third reviewer. The quality of evidence was assessed using the Medical Education Research Study Quality Instrument (MERSQI). The review protocol was registered with PROSPERO (International Prospective Register of Systematic Reviews) in April 2020.

RESULTS

Of 15,627 studies, 29 (0.19%) randomized controlled trials (N=2722 students) were included and evaluated using the MERSQI tool. Knowledge gain was found to be equal when immersive technologies were compared with traditional learning modalities; however, the learning experience increased with immersive technologies. The mean MERSQI score was 12.64 (SD 1.6), the median was 12.50, and the mode was 13.50. Immersive technology was predominantly used to teach clinical skills (15/29, 52%), and virtual reality (22/29, 76%) was the most commonly used form of immersive technology. Knowledge was the primary outcome in 97% (28/29) of studies. Approximately 66% (19/29) of studies used validated instruments and scales to assess secondary learning outcomes, including satisfaction, self-efficacy, engagement, and perceptions of the learning experience. Of the 29 studies, 19 (66%) included medical students (1706/2722, 62.67%), 8 (28%) included nursing students (727/2722, 26.71%), and 2 (7%) included both medical and nursing students (289/2722, 10.62%). There were no studies involving midwifery students. The studies were based on the following disciplines: anatomy, basic clinical skills and history-taking skills, neurology, respiratory medicine, acute medicine, dermatology, communication skills, internal medicine, and emergency medicine.

CONCLUSIONS

Virtual, augmented, and mixed reality play an important role in the education of preclinical medical and nursing university students. When compared with traditional educational modalities, the learning gain is equal with immersive technologies. Learning outcomes such as student satisfaction, self-efficacy, and engagement all increase with the use of immersive technology, suggesting that it is an optimal tool for education.

Measuring the value of a digital supplemental resource

Supplemental resources in science education are made available to students based on the belief that they will improve course-based student learning. This belief is ubiquitous, with supplemental resources being a traditional component of physiology education. In addition, the recent large-scale transition to remote learning caused by the Covid-19 pandemic suggests an increased relevance and necessity of digital versions of supplemental resources. However, the use of a supplemental resource is entirely dependent on whether students view it as beneficial. If students in a specific course do not perceive a supplemental resource as useful, there is little reason to believe the resources will be used and are worthy of investment. Consequently, measurement of student perception regarding the effectiveness of any digital learning tool is essential for educators and institutions in order to prioritize resources and make meaningful recommendations to students. In this study, a survey was used to determine student perceptions of a digital, supplemental resource. Quantitative methods, including exploratory factor analysis, were performed on data collected from the survey to examine the dimensionality and functionality of this survey. The findings from this study were used to devise an improved, standardized (i.e., reliable and valid) survey that can be used and adapted by physi3ology researchers and educators to determine student perception of a digital supplemental resource. The survey, with known construct validity and internal reliability, can provide useful information for administrators, instructors, and designers of digital supplemental resources.

Virtual Dissection: An Interactive Anatomy Learning Tool

The novelty of three-dimensional visualization technology (3DVT), such as virtual reality (VR), has captured the interest of many educational institutions. This study's objectives were to (1) assess how VR and physical models impact anatomy learning, (2) determine the effect of visuospatial ability on anatomy learning from VR and physical models, and (3) evaluate the impact of a VR familiarization phase on learning. This within-subjects, crossover study recruited 78 undergraduate students who studied anatomical structures at both physical and VR models and were tested on their knowledge immediately and 48 hours after learning. There were no significant differences in test scores between the two modalities on both testing days. After grouping participants on visuospatial ability, low visuospatial ability learners performed significantly worse on anatomy knowledge tests compared to their high visuospatial ability counterparts when learning from VR immediately (P = 0.001, d = 1.515) and over the long-term (P = 0.003, d = 1.279). In contrast, both low and high visuospatial ability groups performed similarly well when learning from the physical model and tested immediately after learning (P = 0.067) and over the long-term (P = 0.107). These results differ from current literature which indicates that learners with low visuospatial ability are aided by 3DVT. Familiarizing participants with VR before the learning phase had no impact on learning (P = 0.967). This study demonstrated that VR may be detrimental to low visuospatial ability students, whereas physical models may allow all students, regardless of their visuospatial abilities, to learn similarly well.

Lessons from Cadaver Dissection during the COVID-19 Pandemic

The rapid increase of the coronavirus disease 2019 pandemic from mid-February 2020 has led the anatomy department of the Korea University College of Medicine to cease the dissection laboratory. However, the hands-on anatomy laboratory experience is paramount to maximizing learning outcomes. In this paper, we share the experiences and lessons learned through the face-to-face cadaveric dissection experience during this disruptive situation. To minimize infection risks, the following strategies were applied: first, students' on-campus attendance was reduced; second, body temperatures and symptoms were checked before entering the laboratory, and personal protective equipment was provided to all participants; and third, a negative pressure air circulation system was used in the dissection room. We suggest that conducting face-to-face cadaveric anatomy dissection is feasible when the daily count of newly infected cases stabilizes, and there is ample provision of safety measures to facilitate hands-on education.

Digital Feast and Physical Famine: The Altered Ecosystem of Anatomy Education due to the Covid-19 Pandemic

This article explores the effects of the coronavirus disease 2019 (Covid-19) pandemic on the evolution of both physical and digital cadavers within the unique ecosystem of the anatomy laboratory. A physical cadaver is a traditional and established learning tool in anatomy education, whereas a digital cadaver is a relatively recent phenomenon. The Covid-19 pandemic presented a major disturbance and disruption to all levels and types of education, including anatomy education. This article constructs a conceptual metaphor between a typical anatomy laboratory and an ecosystem, and considers the affordances, constraints, and changing roles of physical and digital cadavers within anatomy education through an ecological lens. Adaptation of physical and digital cadavers during the disturbance is analyzed, and the resiliency of digital cadaver technology is recognized. The evolving role of the digital cadaver is considered in terms of increasing accessibility and inclusivity within the anatomy laboratory ecosystem of the future.

Use of a 3D virtual app and academic performance in the study of the anatomy of the musculoskeletal system among Peruvian medical students

OBJECTIVE

To evaluate the association between the use of a 3D virtual App and academic performance among Peruvian medical students. In addition, factors associated with academic performance were also assessed.

METHODS

We conducted an analytical cross-sectional study in students enrolled in the Musculoskeletal System course during the first semester of 2019. Students filled out a data collection form and the "Self-directed learning readiness scale" (SDLRS) questionnaire adapted by Fisher, King, and Tangle. Linear regression models were carried out to assess the association between the appropriate use of the application and academic performance. Additionally, the factors associated with academic performance were evaluated using nested models, and β coefficients were calculated by manual forward selection.

RESULTS

A total of 187 medical students were included. The 61% were female and the median age was 21 [20-22] years. The average grade was 13.5 ± 2 and 21% reported an adequate use of a 3D App. No association was found between the use of the 3D App and academic performance in the adjusted model (aβ = 0.17; 95% CI: -0.45 to 0.80). We found that age (aβ = -0.22; 95% CI: -0.39 to -0.06), performing extracurricular activities (aβ = 0.75, 95% CI: 0.25 to 1.24) and having failed an anatomy/physiology course before (aβ = -2.11 to 95% CI: -2.9 to -1.8) were factors associated with academic performance.

CONCLUSION

The adequate use of a 3D application to study the anatomy of the musculoskeletal system was not significantly associated with better academic performance.

Harnessing Augmented Reality and CT to Teach First-Year Medical Students Head and Neck Anatomy

RATIONALE AND OBJECTIVES

Three-dimensional (3D) visualization has been shown to benefit new generations of medical students and physicians-in-training in a variety of contexts. However, there is limited research directly comparing student performance after using 3D tools to those using two-dimensional (2D) screens.

MATERIALS AND METHODS

A CT was performed on a donated cadaver and a 3D CT hologram was created. A total of 30 first-year medical students were randomly assigned into two groups to review head and neck anatomy in a teaching session that incorporated CT. The first group used an augmented reality headset, while the second group used a laptop screen. The students were administered a five-question anatomy test before and after the session. Two-tailed t-tests were used for statistical comparison of pretest and posttest performance within and between groups. A feedback survey was distributed for qualitative data.

RESULTS

Pretest vs. posttest comparison of average percentage of questions answered correctly demonstrated both groups showing significant in-group improvement (p < 0.05), from 59% to 95% in the augmented reality group, and from 57% to 80% in the screen group. Between-group analysis indicated that posttest performance was significantly better in the augmented reality group (p = 0.022, effect size = 0.73).

CONCLUSION

Immersive 3D visualization has the potential to improve short-term anatomic recall in the head and neck compared to traditional 2D screen-based review, as well as engage millennial learners to learn better in anatomy laboratory. Our findings may reflect additional benefit gained from the stereoscopic depth cues present in augmented reality-based visualization.

The Cadaver Conundrum: Sourcing and Anatomical Embalming of Human Dead Bodies by Medical Schools during and after COVID-19 Pandemic: Review and Recommendations

COVID-19 pandemic has posed a new challenge for medical schools across the world regarding the acceptance of donated and unclaimed dead bodies for academic purpose. Uncertainty of the COVID-19 status among the donated bodies poses a health risk for embalming personnel and medical students who handle the embalmed cadavers. There is a paucity of literature delineating the criteria for accepting or rejecting the bodies during COVID-19 pandemic. Similarly, there is no recommended standard operating procedure for anatomical embalming during COVID-19. We propose certain criteria for accepting and rejecting the human dead bodies for anatomical embalming. And we propose some technical modifications to the conventional procedure of formalin-based anatomical embalming. A guarded approach and diligent screening of donated bodies is the way forward during the COVID-19 pandemic.

The use of photogrammetric fossil models in palaeontology education

Photogrammetry allows overlapping photographs of fossils to be taken and converted into photo-realistic three-dimensional (3-D) digital models. These models offer potential advantages in teaching palaeontology: they are cheap to produce, can be easily shared and allow the study of rare and delicate specimens. Here I describe approaches for using photogrammetric models in the teaching and learning of palaeontology. Little is known about how students perceive these models and whether they find them valuable in their learning. To address this, first-year university students taught using both fossil specimens and digital models were surveyed about their experience through an anonymous online survey. Most students found that the digital models were easy to use, helped them understand anatomy and were more useful than studying photographs. However, most did not see the models as a substitute for studying real fossils and felt they could learn more from physical models. Digital models are a useful addition to palaeontological education that can supplement real fossils and allow palaeontological education to take place in circumstances where handling of specimens is not possible.

A review of anatomy education during and after the COVID-19 pandemic: Revisiting traditional and modern methods to achieve future innovation

The coronavirus disease 2019 (COVID-19) pandemic has had enormous effects on anatomy education. During the pandemic, students have had no access to cadavers, which has been the principal way to learn anatomy since the 17th century. As it is difficult to predict future access to cadavers for students or in-person classes, anatomy educators are encouraged to revisit all possible teaching methods in order to develop innovations. Here, we review anatomy education methods to apply to current and future education.

Virtual Dissection with Clinical Radiology Cases Provides Educational Value to First Year Medical Students

RATIONALE AND AIM

In virtual dissection, three-dimensional computed tomography scans are viewed on a near-life size virtual dissection table and through touchscreen technology, students work together to manipulate the data to perform their dissection. The purpose of this study was to develop a Virtual Dissection Curriculum for first year medical students and to assess its educational value as well as students' preferred pedagogy for learning with this new technology.

METHODS

One hundred and five first-year medical students participated in a case-based virtual dissection curriculum and were invited to complete a theory-based post experience survey. Eight unique clinical cases were selected based on the first-year curricular objectives and divided into four 30-minute sessions. In groups of 6-8, students reviewed the cases with a radiologist. First, students' reactions to virtual dissection were measured by three constructs using a 5-point Likert scale: quality of curriculum design (11 questions), impact on learning (7 questions), and comfort with technology (3 questions). Second, students ranked the usefulness of six pedagogical approaches for this technology. Responses were tabulated and rank order item lists were generated statistically using the Schulze method where appropriate.

RESULTS

The survey response rate was 83% (87/105). Overall, students' reactions to virtual dissection were positive across all three measured constructs. Most students indicated that the cases were of an appropriate level of difficulty (90%) and that virtual dissection improved their understanding of disease and pathology (89%), the clinical relevance of anatomy (77%), and visuospatial relationships (64%). Almost all students (94%) reported that the curriculum improved understanding of the role of the radiologist in patient care. Students felt that the "very useful" pedagogical approaches were small group demonstration (68%) and problem-based learning (51%).

CONCLUSION

First-year medical students perceive the use of virtual dissection as a valuable tool for learning anatomy and radiology. This technology enables the integration of clinical cases and radiology content into preclinical learning.

The influence of online review videos on gross anatomy course performance among doctor of chiropractic students

OBJECTIVE

Technology-enhanced learning is on the rise within healthcare education. This pilot study evaluated the relationship between the use of online review videos and students' performance and satisfaction in gross anatomy.

METHODS

For this quasi-experimental study, we developed a series of online gross anatomy review videos, and surveyed students enrolled in a doctor of chiropractic program regarding use of the videos and their attitudes towards using the videos. Ordinal regression was used to evaluate the relationship between students' video use and course performance and the Mann-Whitney U test was used to determine whether there was a difference in course performance between students who did and did not report using the review videos.

RESULTS

We received 143 responses to our survey, resulting in a 73.3% response rate. Most students (71%) had engaged with the online review videos. No significant differences in course performance were detected between students who did and did not report using the videos. Many students (82%) reported the review videos as being "helpful" and 73% perceived them as "an enjoyable way to study."

CONCLUSION

While chiropractic students perceived a series of online gross anatomy review videos as being an enjoyable and helpful way to study, engagement with this form of technology-enhanced learning did not have an impact on their overall gross anatomy course performance.

Creating a Human Gross Anatomy Laboratory: The Experience at a Primarily Undergraduate Institution

This paper details the creation of a human gross anatomy laboratory from a defunct chemistry laboratory at West Liberty University, a small primarily undergraduate institution in West Virginia. The article highlights important considerations with regard to the development of a human gross anatomy laboratory including access to human gifts; assessment of the space for size, security, and privacy; assessment of the utilities; acquisition of a dissection table; ventilation; aesthetics in functional design; expenses; and sustainability. The report also identifies favorable conditions and potential pitfalls regarding the creation of a human gross anatomy laboratory. This paper demonstrates that a human gross anatomy laboratory can be created quickly and at little expense.

The Critical Role of Stereopsis in Virtual and Mixed Reality Learning Environments

Anatomy education has been revolutionized through digital media, resulting in major advances in realism, portability, scalability, and user satisfaction. However, while such approaches may well be more portable, realistic, or satisfying than traditional photographic presentations, it is less clear that they have any superiority in terms of student learning. In this study, it was hypothesized that virtual and mixed reality presentations of pelvic anatomy will have an advantage over two-dimensional (2D) presentations and perform approximately equal to physical models and that this advantage over 2D presentations will be reduced when stereopsis is decreased by covering the non-dominant eye. Groups of 20 undergraduate students learned pelvic anatomy under seven conditions: physical model with and without stereo vision, mixed reality with and without stereo vision, virtual reality with and without stereo vision, and key views on a computer monitor. All were tested with a cadaveric pelvis and a 15-item, short-answer recognition test. Compared to the key views, the physical model had a 70% increase in accuracy in structure identification; the virtual reality a 25% increase, and the mixed reality a non-significant 2.5% change. Blocking stereopsis reduced performance on the physical model by 15%, on virtual reality by 60%, but by only 2.5% on the mixed reality technology. The data show that virtual and mixed reality technologies tested are inferior to physical models and that true stereopsis is critical in learning anatomy.

Cadaveric Simulation Training in Cardiothoracic Surgery: A Systematic Review

Simulation training has become increasingly relevant in the educational curriculum of surgical trainees. The types of simulation models used, goals of simulation training, and an objective assessment of its utility and effectiveness are highly variable. The role and effectiveness of cadaveric simulation in cardiothoracic surgical training has not been well established. The objective of this study was to evaluate the current medical literature available on the utility and the effectiveness of cadaveric simulation in cardiothoracic surgical residency training. A literature search was performed using PubMed, Cochrane Library, Embase, Scopus, and CINAHL from inception to February 2019. Of the 362 citations obtained, 23 articles were identified and retrieved for full review, yielding ten eligible articles that were included for analysis. One additional study was identified and included in the analysis. Extraction of data from the selected articles was performed using predetermined data fields, including study design, study participants, simulation task, performance metrics, and costs. Most of these studies were only descriptive of a cadaveric or perfused cadaveric simulation model that could be used to augment clinical operative training in cardiothoracic surgery. There is a paucity of evidence in the literature that specifically evaluates the utility and the efficacy of cadavers in cardiothoracic surgery training. Of the few studies that have been published in the literature, cadaveric simulation does seem to have a role in cardiothoracic surgery training beyond simply learning basic skills. Additional research in this area is needed.

Dissection in the Modern Medical Curriculum: An Exploration into Student Perception and Adaptions for the Future

For centuries cadaveric dissection has been a cornerstone of medical anatomy education. However, time and financial limitations in modern, compressed medical curricula, coupled with the abundance of alternate modalities, have raised questions about the role of dissection. This study was designed to explore student perceptions of the efficacy of a dissection program for learning musculoskeletal anatomy, and possible adaptations for appropriate inclusion of dissection in the modern medical curricula. A paper-based questionnaire was used to collect data from 174 medical students after completion of cadaveric dissections. Data were analyzed using both quantitative and qualitative methods. Students strongly believed that cadaver-based learning is essential to anatomy education and modern teaching modalities only complement this. Moreover, most students reported that dissection provided an additional, immersive learning experience that facilitated active learning and helped in developing manual competencies. Students with previous dissection experience or an interest in anatomy-related specialties were significantly more likely to attend dissection sessions. Students found that the procedural dissection components enhanced the knowledge of applied anatomy and is beneficial for the development of clinical skills. They welcomed the idea of implementing more procedure-based dissections alongside lectures and prosections-based practical (PBP) sessions. Cadaveric dissection plays an integral role in medical anatomy education. Time restraints and an increased focus on clinical significance, however, demand carefully considered adaptations of existing dissection protocols. The introduction of procedure-based dissection offers an innovative, highly engaging and clinically relevant package that would amalgamate skills essential to medical practice while retaining the benefits that have allowed dissection to stand the test of time.

A case report about anatomy applications for a physical therapy hybrid online curriculum

Background

Three-dimensional digital anatomy applications can provide a powerful supplement to more traditional learning modalities. The challenge for medical libraries and educators is to select an app that best supports anatomical learning objectives and then effectively integrate it into health sciences curricula. App selection is particularly important when traditional learning modalities, such as cadaver dissection, are not feasible. Selection was a challenge at the authors' university, as the doctor of physical therapy (DPT) program expanded into a hybrid online environment.

Case Presentation

Reported here are our: (1) analysis and identification of an anatomy app to supplement cadaver lab instruction for DPT students who were enrolled in a hybrid program, where the majority of instruction took place online; (2) description of the implementation process; and (3) discussion of student feedback and the library's perspective. Features and shortcomings of two anatomy apps, Complete Anatomy (CA) 2019 by 3D4 Medical and Human Anatomy Atlas (HAA) 2019 by Visible Body, were reviewed. CA was selected based on smoother navigation, visually appealing graphics, and user customization tools. The library purchased 1,000 CA redemption codes as a pilot program. Video recordings and live demonstrations of the app were used for instruction. Student feedback indicated extensive use. Based on success of the pilot, the library will purchase additional licenses.

Conclusions

Medical libraries can use our experience as an example to help select anatomy resources that would be useful when considering the conversion of health sciences programs into online environments and further guide app integration to supplement other anatomical models.