Mixed reality as a time-efficient alternative to cadaveric dissection

Metaverse-powered basic sciences medical education: bridging the gaps for lower middle-income countries

BACKGROUND

Traditional medical education often lacks contextual experience, hindering students' ability to effectively apply theoretical knowledge in real-world scenarios. The integration of the metaverse into medical education holds great enormous promise for addressing educational disparities, particularly in lower-middle-income countries (LMICs) accompanied by rapid technological advancements. This commentary paper aimed to address the potential of the metaverse in enhancing basic sciences education within the constraints faced by universities in LMICs. We also addressed learning design challenges by proposing fundamental design elements and a suggested conceptual framework for developing metaverse-based teaching methods.The goal is to assist educators and medical practitioners in comprehensivley understanding key factors in immersive teaching and learning.

DISCUSSION

By immersing medical students in virtual scenarios mimicking real medical settings and patient interactions, the metaverse enables practice in clinical decision-making, interpersonal skills, and exposure to complex medical situations in a controlled environment. These simulations can be customized to reflect local healthcare challenges, preparing medical students to tackle specific community needs. Various disciplines, including anatomy, physiology, pharmacy, dentistry, and pathology, have begun leveraging the metaverse to offer immersive learning experiences, foster interdisciplinary collaborations, and facilitate authentic assessments. However, financial constraints pose a significant barrier to widespread adoption, particularly in resource-limited settings like LMICs. Addressing these challenges is crucial to realizing the full potential of metaverse technology in medical education.

CONCLUSION

The metaverse offers a promising solution for enhancing medical education by providing immersive, context-rich learning experiences. This paper proposes a conceptual framework and fundamental design elements to aid faculty educators and medical practitioners in effectively incorporating metaverse technology into their teaching methods, thus improving educational outcomes in LMICs.

Evaluation of the (clinical) relevance of gross anatomical teaching for dental students and practicing oral surgeons in Berlin

Knowledge of human anatomy is an important scientific basis for every dentist, and the adequacy of its provision by anatomy faculties is therefore constantly being adapted. Students' motivation to comprehend knowledge is a fundamental prerequisite and has been shown to increase when the relevance of the subject is clear. This study examines dental students' perceptions of the relevance of the anatomy curriculum, with particular reference to clinical practice and the dissection course, in conjunction with the perceptions of surgically specialized dentists. The distinctions between the participating groups concerning their perceived relevance are being discussed particularly regarding their applicability to improve the anatomical education of dental students. The overall aim is to find and highlight aspects of the clinical use of anatomical knowledge towards students, which they are unable to apprehend yet. A questionnaire consisting of information on demographics and professional competence as well as a Likert-style section was administered to dental students at Charité Universitätsmedizin in 2019/2020 (n = 322, 84.96%) and a modified version with congruent questions was administered retrospectively to oral surgeons practicing in Berlin in 2020 (n = 81, 63.3%). A Wilcoxon rank-sum test was used to examine differences in responses between the cohorts. Demographic data and professional competence were correlated with the participants' ratings of the given statements using Spearman's rank correlation coefficient. Both groups of respondents expressed a high level of appreciation of the overall relevance of anatomical knowledge, valued the teaching of all human anatomy for dental education, and recognized the relevance of anatomical knowledge for clinical practice. The importance of the dissection course was also rated relatively high by both groups of respondents. The overall appreciation of anatomical knowledge was more prevalent among oral surgeons. There were few correlations between demographics in our findings, showing slightly higher motivation in female students and a growing appreciation of anatomical knowledge as students qualification progressed. The demographics and post-qualification experience of the participating oral surgeons did not influence their perceptions. The results of this survey suggest that there is potential to increase the motivation of dental students to learn anatomy by emphasizing clinical relevance, as perceived by experienced practitioners, during the anatomy curriculum.

A Comparative Analysis of Physical Therapy Anatomical Knowledge and Retention: Human Donor Dissection Versus Virtual Laboratory

INTRODUCTION

Despite a long history of using human donor dissection (HDD) for physical therapy (PT) anatomy education, there are no PT guidelines that require HDD. The purpose of this quantitative causal-comparative study was to determine if Doctor of Physical Therapy students who used HDD had different grades both within anatomy and within courses that require retention and application of anatomical knowledge (kinesiology and a foundational musculoskeletal course) compared with those who used virtual 3-dimensional anatomical software (VAS).

REVIEW OF LITERATURE

Numerous factors affect the decision to use HDD within PT anatomy, and few PT studies have compared the effectiveness of VAS to HDD.

SUBJECTS

All students who took anatomy in an entry-level PT program from 2018 to 2021 (232 total students, 115 who used HDD in 2018-2019 and 117 who used VAS in 2020-2021).

METHODS

Mann-Whitney tests were used to compare anatomy grades (course, written examination, and practical examination) and future grades in kinesiology and a foundational musculoskeletal course for students who used HDD or VAS.

RESULTS

Physical therapy students who used VAS had statistically significant higher anatomy course grades (VAS 93.81% ± 4.99% to HDD 92.20% ± 4.53%) and higher practical examination grades (VAS 97.43% ± 2.91% to HDD 93.55% ± 4.39%) compared with those who used HDD. However, there were no significant differences between groups on written anatomy examinations (VAS 89.42% ± 7.21% to HDD 90.40% ± 4.94%), kinesiology grades (VAS 91.86% ± 4.52% to HDD 92.80% ± 4.27%), or foundational musculoskeletal grades (VAS 89.50% ± 3.89% to HDD 89.77% ± 3.83%).

DISCUSSION AND CONCLUSION

The causal-comparative study design prevents concluding that PT student grade differences were due exclusively to either anatomy laboratory method. It does provide preliminary evidence that the PT anatomy laboratory method did not practically affect anatomy performance or long-term application of anatomy knowledge in future coursework.

Evaluation of Mixed Reality Technologies for Remote Feedback and Guidance During Transrectal Ultrasound Biopsy Simulation: A Prospective, Randomized, Crossover Study

OBJECTIVE

To compare equivalency of remote to in-person training during simulated transrectal ultrasound-guided prostate biopsy, we combined three technologies (mixed reality [MR] software, smart glasses, and hydrogel simulation model). Taken together, telemonitoring harnesses data streaming to provide real-time supervision and technical assistance for surgical procedures from an expert at a remote geographical location.

METHODS

Nineteen students were randomized into two groups (MR-first and in-person-first) and proctored to measure prostate volume and perform 14-biopsies over seven sessions: pretest, two MR/in-person-guided training sessions, mid-test, crossover into two in-person/MR-guided training sessions, and post-test. MR sessions utilized Vuzix smart glasses with MR software (HelpLightning) to share the student's first-person perspective and Zoom to project the ultrasound screen to a remote instructor. Training and test sessions utilized single-color and seven-color prostate models, respectively. Accuracy of biopsy cores from test sessions were compared. Perception of instruction following each training session using 5-point Likert scales across five domains was assessed. Preference of instruction modality was assessed qualitatively.

RESULTS

Comparison of mid-test performance following two training sessions was similar across the two groups (MR-first 63.8% vs in-person-first 57.6%, P = .340). Following crossover, difference in post-test performance of the MR-first group and the in-person-first group approached significance (MR-first 80.2% vs in-person-first 70.8%, P = .050). Student evaluation of MR and in-person instruction following training sessions was similar across the five metrics.

CONCLUSION

MR-based remote learning is equally effective when compared to traditional in-person instruction.

Recent Advances in Surgical Simulation For Resident Education

PURPOSE OF REVIEW

Surgical simulation has become a cornerstone for the training of surgical residents, especially for urology residents. Urology as a specialty bolsters a diverse range of procedures requiring a variety of technical skills ranging from open and robotic surgery to endoscopic procedures. While hands-on supervised training on patients still remains the foundation of residency training and education, it may not be sufficient to achieve proficiency for graduation even if case minimums are achieved. It has been well-established that simulation-based education (SBE) can supplement residency training and achieve the required proficiency benchmarks.

RECENT FINDINGS

Low-fidelity modules, such as benchtop suture kits or laparoscopic boxes, can establish a strong basic skills foundation. Eventually, residents progress to high-fidelity models to refine application of technical skills and improve operative performance. Human cadavers and animal models remain the gold standard for procedural SBE. Recently, given the well-recognized financial and ethical costs associated with cadaveric and animal models, residency programs have shifted their investments toward virtual and more immersive simulations. Urology as a field has pushed the boundaries of SBE and has reached a level where unexplored modalities, e.g., 3D printing, augmented reality, and polymer casting, are widely utilized for surgical training as well as preparation for challenging cases at both the residents, attending and team training level.

Mixed Reality as a Teaching Tool for Medical Students in Neurosurgery

Background and Objectives: Simulation-based learning within neurosurgery provides valuable and realistic educational experiences in a safe environment, enhancing the current teaching model. Mixed reality (MR) simulation can deliver a highly immersive experience through head-mounted displays and has become one of the most promising teaching tools in medical education. We aimed to identify whether an MR neurosurgical simulation module within the setting of an undergraduate neurosurgical hands-on course could improve the satisfaction of medical students. Materials and Methods: The quasi-experimental study with 223 medical students [120 in the conventional group (CG) and 103 in the MR-group (MRG)] was conducted at the University Hospital Münster, Münster, Germany. An MR simulation module was presented to the intervention group during an undergraduate neurosurgical hands-on course. Images of a skull fracture were reconstructed into 3D formats compatible with the MR-Viewer (Brainlab, Munich, Germany). Participants could interact virtually with the model and plan a surgical strategy using Magic Leap goggles. The experience was assessed by rating the course on a visual analog scale ranging from 1 (very poor) to 100 (very good) and an additional Likert-scale questionnaire. Results: The satisfaction score for CG and MRG were 89.3 ± 13.3 and 94.2 ± 7.5, respectively. The Wilcoxon rank-sum test showed that MR users (Mdn = 97.0, IQR = 4, n = 103) were significantly more satisfied than CG users (Mdn = 93.0, IQR = 10, n = 120; ln(W) = 8.99, p < 0.001) with moderate effect size (r^biserial = 0.30, CI95 [0.15, 0.43]), thus indicating that the utilization of MR-simulation is associated with greater satisfaction. Conclusions: This study reports a positive response from medical students towards MR as an educational tool. Feedback from the medical students encourages the adoption of disruptive technologies into medical school curricula.

The Practice of Teaching and Scientific Research on Cadaveric Material Remains Crucial for Medical Education

The practice of teaching and scientific research on cadaveric material remains crucial for medical education, especially in surgical disciplines. However, in Italy, this practice has been neglected due to legislative insufficiency and financial constraints. Although innovative methods and tools like simulators and e-learning have been adopted, direct hands-on experience with human cadavers remains irreplaceable for medical and surgical education. The absence of clear legislation governing cadaveric dissection has limited availability for teaching and research, resulting in economic burdens for universities and individuals seeking proper surgical training. To address this issue, Law No. 10/2020 and the recent implementing decree were introduced in Italy, providing detailed legislation on the donation of bodies for educational and research purposes. The law emphasizes the importance of respecting the donor's specific choices and aligns with constitutional principles promoting culture, research, and health protection. However, some critical issues related to consent procedures, duration of body availability, and preservation of anatomical parts remain. Additionally, the law's dissemination among the population needs improvement. Future optimization could include allowing donors to choose the timing of body donation and considering different timeframes for body availability. Furthermore, the implementation of consent procedures could be simplified to increase donations. The law should also address the need for appropriate reception centers and allocate resources for effective dissemination. Despite these challenges, Law No. 10/2020 represents a significant step forward in enhancing medical-surgical training, scientific research, and the overall quality of patient care in Italy.

Mixed reality for the assessment of aortoiliac anatomy in patients with abdominal aortic aneurysm prior to open and endovascular repair: Feasibility and interobserver agreement

OBJECTIVES

The objective is to evaluate the feasibility and interobserver agreement of a Mixed Reality Viewer (MRV) in the assessment of aortoiliac vascular anatomy of abdominal aortic aneurysm (AAA) patients.

METHODS

Fifty preoperative computed tomography angiographies (CTAs) of AAA patients were included. CTAs were assessed in a mixed reality (MR) environment with respect to aortoiliac anatomy according to a standardized protocol by two experienced observers (Mixed Reality Viewer, MRV, Brainlab AG, Germany). Additionally, all CTAs were independently assessed applying the same protocol by the same observers using a conventional DICOM viewer on a two-dimensional screen with multi-planar reconstructions (Conventional viewer, CV, GE Centricity PACS RA1000 Workstation, GE, United States). The protocol included four sets of items: calcification, dilatation, patency, and tortuosity as well as the number of lumbar and renal arteries. Interobserver agreement (IA, Cohen's Kappa, κ) was calculated for every item set.

RESULTS

All CTAs could successfully be displayed in the MRV (100%). The MRV demonstrated equal or better IA in the assessment of anterior and posterior calcification (κMRV: 0.68 and 0.61, κCV: 0.33 and 0.45, respectively) as well as tortuosity (κMRV: 0.60, κCV: 0.48) and dilatation (κMRV: 0.68, κCV: 0.67). The CV demonstrated better IA in the assessment of patency (κMRV: 0.74, κCV: 0.93). The CV also identified significantly more lumbar arteries (CV: 379, MRV: 239, p < 0.01).

CONCLUSIONS

The MRV is a feasible imaging viewing technology in clinical routine. Future efforts should aim at improving hologram quality and enabling accurate registration of the hologram with the physical patient.

Student Perceptions of Superimposed Mixed Reality Anatomy: A Bridge Between the Virtual and Physical

A prototype mixed reality model was developed in which three-dimensional holograms of musculoskeletal anatomy were superimposed over a physical skeleton model, conferring tactile sensation to the bony attachments of virtually observed muscles. Fifty-three second-year medical students piloted this innovative format and provided feedback on its effectiveness as a learning modality.

Evolution in Congenital Cardiology Education: The Rise of Digital-Learning Tools

Technology-enhanced learning is now an established part of medical education due to its ready availability and on-demand nature. This offers new opportunities but also challenges to both learners and teachers. This review outlines the current use of social media tools and online resources in medical education with a particular emphasis on congenital cardiology. It provides strategies to the reader on how to optimize learning in the digital environment and offers guidance on how such tools can be incorporated into routine educational practice. Suggestions for developing and assessing educational material online are discussed. Lastly, the concepts of digital professionalism and digital scholarship are explored to aid medical teachers and educators employ these technologies effectively into their teaching and career development.

The HoloLens in medicine: A systematic review and taxonomy

The HoloLens (Microsoft Corp., Redmond, WA), a head-worn, optically see-through augmented reality (AR) display, is the main player in the recent boost in medical AR research. In this systematic review, we provide a comprehensive overview of the usage of the first-generation HoloLens within the medical domain, from its release in March 2016, until the year of 2021. We identified 217 relevant publications through a systematic search of the PubMed, Scopus, IEEE Xplore and SpringerLink databases. We propose a new taxonomy including use case, technical methodology for registration and tracking, data sources, visualization as well as validation and evaluation, and analyze the retrieved publications accordingly. We find that the bulk of research focuses on supporting physicians during interventions, where the HoloLens is promising for procedures usually performed without image guidance. However, the consensus is that accuracy and reliability are still too low to replace conventional guidance systems. Medical students are the second most common target group, where AR-enhanced medical simulators emerge as a promising technology. While concerns about human-computer interactions, usability and perception are frequently mentioned, hardly any concepts to overcome these issues have been proposed. Instead, registration and tracking lie at the core of most reviewed publications, nevertheless only few of them propose innovative concepts in this direction. Finally, we find that the validation of HoloLens applications suffers from a lack of standardized and rigorous evaluation protocols. We hope that this review can advance medical AR research by identifying gaps in the current literature, to pave the way for novel, innovative directions and translation into the medical routine.

Augmented Reality in Medical Education: A Mixed Methods Feasibility Study

BACKGROUND

Augmented reality (AR) is a novel technology with many applications in medical education. Perhaps one of the most beneficial potential applications is to enable better clinical access for students; however, there is limited research into this use. The purpose of this mixed-methods feasibility study was to evaluate the applicability and acceptability of AR in undergraduate and early postgraduate medical education.

METHODS

Single-group quasi-experimental study design was developed for critical care-themed simulation teaching delivered using Microsoft HoloLens (Microsoft Corporation, Redmond, Washington, United States). Post-test questionnaires were completed including a validated adapted immersive experience questionnaire (AIEQ) and an abridged intrinsic motivation inventory (AIMI). The AIMI focused on the domains of 'interest and enjoyment', and 'value and usefulness'. Following the teaching, focus group interviews with thematic analysis were conducted to evaluate participants' experiences with AR.

RESULTS

All 15 participants (100%) completed the AIEQ and AIMI. Co-located airway teaching (i.e., the demonstrator and participants were placed in the same AR environment) was reported as having a moderate level of user immersion (median 72) and a high level of user enjoyment and value (median 52). Thematic analysis revealed four key themes: visual conceptualization for learning, accessibility, varied immersion, and future application.  Conclusions: Remote simulation for the management of airways in critical care was found to be acceptable and afforded a high level of enjoyment and value. Similarly, this was reflected in the thematic analysis. However, immersion was rated variably in both AIEQ and thematic analysis. The challenges identified with the application of AR included technical infrastructure and patient consent. AR-enabled education benefits are relevant to a number of clinical teaching areas.

Googling "Anatomy dissection": Pre-pandemic, pandemic, and current scenario

OBJECTIVES

The present study was proposed to assess if the online search behavior for Anatomy dissection was affected by actual dissection being performed in the labs. The interest in dissection was ascertained and compared between pre-pandemic, pandemic, and current times.

METHODS

Online web search behavior for key terms related to "Anatomy dissection" was noticed worldwide using Google Trends Tool. Relative search volume (RSV) was downloaded for these keywords worldwide using all categories, and web search settings during a period from January 1, 2018, to July 31, 2022.

RESULTS

There was almost a similar google trend for the first three months in years 2018 and 2020, with a slightly lower RSV in March and a noticeable RSV decrease from April onwards in 2020. During the pre-pandemic period, the peak for RSV in the month of May was noticed. These peaks were missing in 2020 and 2021. In May 2022, RSV again increased. The top five countries with the highest search hit for "Anatomy Dissection" web were the Philippines, the United States, Canada, Australia, and India.

CONCLUSIONS

There was lower search trend for "Anatomy dissection" during the pandemic period as compared to pre-pandemic period. The search trends may be associated with the closure of dissection labs and it may be concluded that Anatomy learners search for this term more often, if they are actually performing the dissections. The future integrated multi-country data and analysis from different set-ups about their ways of dissection and labs before and after the pandemic may further clarify.

Musculoskeletal education in undergraduate medical curricula-A systematic review

Rheumatic and musculoskeletal diseases encompass a vast spectrum of up to 200 conditions that are increasingly prevalent, with significant associated disability and socioeconomic burden. Their impact is pervasive, with musculoskeletal conditions being the second leading cause of years lived with disability worldwide, in addition to the 9th most common cause of disability-adjusted life years. It is therefore imperative that all graduating medical physicians are competent in their management, and that the quality of undergraduate musculoskeletal education is commensurate with patient and societal needs. A systematic literature review was conducted between April 1, 2021 and June 1, 2021 assessing the quality of undergraduate musculoskeletal education in medical schools. Educational interventions in musculoskeletal medicine were also included. Quality assessment appraisal of the studies was done using a Mixed Methods Appraisal Tool. One thousand and thirty-three titles were screened, and 44 studies were included in the final analysis. Our analysis of these studies showed that the quality of undergraduate musculoskeletal education, as determined by the cognitive mastery and clinical confidence of undergraduate medical students remains inadequate. Multiple educational interventions were assessed with mixed results. Despite the prevalence, and burden associated with rheumatic and musculoskeletal diseases, the musculoskeletal education of undergraduate medical students remains inadequate. Urgent international collaboration is required to devise teaching strategies and curriculum initiatives that are globally and reproducibly applicable and effective. Further research into educational interventions and teaching strategies is also required.

Use of Extended Reality in Medical Education: An Integrative Review

Extended reality (XR) has emerged as an innovative simulation-based learning modality. An integrative review was undertaken to explore the nature of evidence, usage, and effectiveness of XR modalities in medical education. One hundred and thirty-three (N = 133) studies and articles were reviewed. XR technologies are commonly reported in surgical and anatomical education, and the evidence suggests XR may be as effective as traditional medical education teaching methods and, potentially, a more cost-effective means of curriculum delivery. Further research to compare different variations of XR technologies and best applications in medical education and training are required to advance the field.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-022-01698-4.

Student Engagement Using HoloLens Mixed-Reality Technology in Human Anatomy Laboratories for Osteopathic Medical Students: an Instructional Model

Mixed-reality technology is a powerful tool used in healthcare and medical education to engage students in life-like scenarios. This blend of virtual and augmented reality images incorporates virtual projections with the real environment to allow real-time observation and interaction [1]. While this immersive technology offers advantages over cadaver dissections, it creates new challenges to keeping students engaged [2, 3]. Student engagement improves students' commitment to learning, critical thinking, and motivation and results in successful course outcomes [4, 5]. This paper provides an activity model using the HoloLens mixed-reality technology to deliver human gross anatomy laboratory sessions to first-year osteopathic medical students. The activity was designed using Gagne's model for instructional design and team-based learning to create an active learning model, which targets the behavioral, emotional, and cognitive dimensions of student engagement [6, 7]: behavioral engagement through autonomy and time on task, emotional engagement through providing the guiding exploration and narrative flow to accompany students' visual experience, and cognitive engagement by incorporating team-based learning (TBL) and case-based learning (CBL). The instructional model also answers the call for a new type of virtual reality instructor and pedagogical strategy that addresses the unique challenges and increases student engagement with this new technology. The effectiveness of this classroom activity was assessed by observing students for indicators or behaviors of student engagement, which are discussed. Further studies are required to measure the extent to which these indicators were exhibited and compare student engagement with this mixed-reality to didactic cadaver-based laboratory sessions.

Awareness of Universal Design for Learning among anatomy educators in higher level institutions in the Republic of Ireland and United Kingdom

There is an increasing need to facilitate enhanced student engagement in anatomy education. Higher education students differ in academic preferences and abilities and so, not all teaching strategies suit all students. Therefore, it is suggested that curricula design and delivery adapt to sustain learner engagement. Enhanced learner engagement is a fundamental feature of Universal Design for Learning (UDL). The aim of this study is to determine if anatomy educators in the Republic of Ireland (ROI) and United Kingdom (UK) are aware of UDL and to assess if, and to what extent, it has been implemented in the design and delivery of anatomy curricula for healthcare students. An anonymous online questionnaire was administered to anatomy educators in higher level institutions in the ROI and UK. Inductive content analysis was used to identify the impact of UDL on student learning, engagement, and motivation, as perceived by the participants. The response rate was 23% (n = 61). Nineteen participants stated they knew of UDL. Of these, 15 had utilized UDL in their teaching of anatomy. Analysis indicated that the perception of UDL was mixed. However, the majority of responses relating to UDL were positive. The majority of the respondents were unaware of UDL but identified the frameworks' checkpoints within their curriculum, suggesting they have unknowingly incorporated elements of UDL in their curriculum design and delivery. There is a lack of information on the benefits of explicit utilization of UDL for engagement and motivation to learn anatomy in healthcare programs in the ROI and UK.

Extended reality as a means to enhance public health education

Technology has transformed the classroom and learning environments. From electronic whiteboards to tablet computers, educators now have access to a multitude of tools that enhance the learning experience. Educational technologies that rely on extended reality (XR) such as augmented and virtual reality are being used, or suggested for use, in various settings and often focus on technical fields such as medicine, dentistry, and aviation. Here, we propose that XR can be used in public health education to better prepare both undergraduate and graduate trainees for real world, complex public health scenarios that require public engagement, investigative skills, and critical decision making. Several opportunities for XR use are outlined that provide perspective on how XR can supplement traditional classroom instruction methods by providing an immersive, participatory training environment. XR offers an opportunity for public health students to gain confidence, have repeated simulated exposures in a safe and equitable environment, and build competency in critical functions they will likely perform as future public health professionals.

The use of mixed reality technology for the objective assessment of clinical skills: a validation study

BACKGROUND

Mixed Reality technology may provide many advantages over traditional teaching methods. Despite its potential, the technology has yet to be used for the formal assessment of clinical competency. This study sought to collect validity evidence and assess the feasibility of using the HoloLens 2 mixed reality headset for the conduct and augmentation of Objective Structured Clinical Examinations (OSCEs).

METHODS

A prospective cohort study was conducted to compare the assessment of undergraduate medical students undertaking OSCEs via HoloLens 2 live (HLL) and recorded (HLR), and gold-standard in-person (IP) methods. An augmented mixed reality scenario was also assessed.

RESULTS

Thirteen undergraduate participants completed a total of 65 OSCE stations. Overall inter-modality correlation was 0.81 (p = 0.01), 0.98 (p = 0.01) and 0.82 (p = 0.01) for IP vs. HLL, HLL vs. HLR and IP vs. HLR respectively. Skill based correlations for IP vs. HLR were assessed for history taking (0.82, p = 0.01), clinical examination (0.81, p = 0.01), procedural (0.88, p = 0.01) and clinical skills (0.92, p = 0.01), and assessment of a virtual mixed reality patient (0.74, p = 0.01). The HoloLens device was deemed to be usable and practical (Standard Usability Scale (SUS) score = 51.5), and the technology was thought to deliver greater flexibility and convenience, and have the potential to expand and enhance assessment opportunities.

CONCLUSIONS

HoloLens 2 is comparable to traditional in-person examination of undergraduate medical students for both live and recorded assessments, and therefore is a valid and robust method for objectively assessing performance. The technology is in its infancy, and users need to develop confidence in its usability and reliability as an assessment tool. However, the potential to integrate additional functionality including holographic content, automated tracking and data analysis, and to facilitate remote assessment may allow the technology to enhance, expand and standardise examinations across a range of educational contexts.

Nursing students' experiences and perceptions of an anatomy laboratory session: Mixed methods study

Many nursing curricula do not offer anatomy laboratories and exposure to cadaveric material. In this mixed methods study, nursing students' perceptions and experiences from an anatomy laboratory session were examined. Students from two academic nursing programs (a four-year general baccalaureate nursing program and a two-year accelerated nursing program for non-nursing baccalaureate graduates) took part in an anatomy laboratory session (N = 223). Participants' learning experiences, emotional experiences, and satisfaction with the anatomy laboratory session were assessed by their responses to closed-ended questionnaires. Participants' reasons for participation and suggestions for improvement were examined by open-ended questions. A mixed methods analysis of the data revealed a high level of satisfaction with the anatomy laboratory experience. Positive attitudes and learning experiences correlated with a sense of identification with the nursing profession. Satisfaction was positively associated with a perceived quality of learning and negatively associated with a negative emotional experience. Curiosity and self-challenge, as well as the quest for tangible, in-depth learning, were major motivators involved in the students' desire to participate in the session. Both qualitative and quantitative analyses indicated that the educational experience was significant. Therefore, it is recommended to integrate anatomy laboratory sessions into anatomy courses for nursing students. This will help to illustrate and assimilate classroom material and strengthen nursing students' sense of identification with their profession.

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.

Comparing learning retention in medical students using mixed-reality to supplement dissection: a preliminary study

OBJECTIVES

To evaluate student impressions of learning anatomy with mixed-reality and compare long-term information retention of female breast anatomy between students who learned with a mixed-reality supplement and their classmates who dissected cadavers.

METHODS

In Part 1, 38 first-year medical student volunteers, randomly divided into two groups, completed a mixed-reality module and cadaveric dissection on the female breast in a counterbalanced design. Participants also completed post-quizzes and surveys. Part 2 was a non-randomized controlled trial, 8-months after completing Part 1 and 6-months after a final exam on this content. The performance of twenty-two Part 1 participants and 129 of their classmates, who only dissected, was compared on a delayed post-quiz. Wilcoxon signed-rank test, Mann-Whitney U test, and 95% confidence intervals were used to analyze the data.

RESULTS

In Part 1, the Wilcoxon signed-rank test determined that participants expressed significantly more positive responses to mixed-reality and found mixed-reality easier for learning and teamwork. In Part 2, the Mann-Whitney U test found mixed-reality participants scored significantly higher on a delayed-post quiz than their classmates who only dissected (U = 928, p < .009).

CONCLUSIONS

  This study suggests that medical students may prefer mixed-reality and that it may be an effective modality for learning breast anatomy while facilitating teamwork. Results also suggest that supplementing cadaveric dissection with mixed-reality may improve long-term retention for at least one anatomical topic. It is recommended that similar studies evaluate a larger sample and additional anatomical regions to determine the generalizability of these findings.

Mixed Reality: A Step Further for Planning Complex Renal Tumors(RENAL nephrometry score of 7 or higher)

OBJECTIVES

Mixed reality (MR) technology has emerged in recent years and allows three-dimensional visualization, multi-angle observation, remote vision, and virtual-real interaction. This study aims to explore the influence of MR technology on the outcomes and strategy planning of robotic surgery for complex renal tumors.

PATIENTS AND METHODS

A total of 92 patients with complex renal tumors were enrolled in this study from June 2018 to June 2020. All patients were diagnosed in our department by magnetic resonance imaging（MRI）. This trial follows CONSORT guidelines and adopts a parallel single blind design and randomizes patients with a random number table. The study was approved by the institutional review board, and written informed consent was obtained from each participant. All surgeries were performed by 3 experienced and high-volume surgeons. The demographic indicators, intraoperative and postoperative complications, renal function outcomes, pathological results, and surgical strategies were recorded. Student's t-test and Wilcoxon rank-sum were used to compare continuous variables, and Pearson's chi-squared and Fisher's exact tests were used to compare categorical variables.

RESULTS

WIT is mainly composed of tumor resection time and reconstruction time, and the reconstruction time accounts for a larger proportion. For urologists treating complex renal tumors, MR technology can help them reduce warm ischemia time (21.3±4.0 vs 23.6±5.9min, P=0.031), reconstruction time (15.4±3.8 vs 17.2±4.2min, P=0.034), estimated blood loss (P=0.044), operation time (125.7±26.3 vs 144.6±27.9min, P=0.001) and intraoperative complications (P=0.030).

CONCLUSIONS

MR assisted surgery can reduce the incidence of intraoperative complications, improve perioperative outcomes, which may be a good preoperative tool for planning complex renal tumors.

PGxKnow: a pharmacogenomics educational HoloLens application of augmented reality and artificial intelligence

Aim: To develop and assess an augmented reality tool for pharmacogenomics (PGx) education based on artificial intelligence. Materials & methods: A HoloLens application was developed using feedback from three clinical PGx-trained pharmacists. 15 Participants independently reviewed the application and assessed usability using the system usability scale (SUS). Results & conclusion: Eighteen different frames were developed. Each video module was 2-3 min for the education. The application included textual information and 3D structures of PGx concepts. The mean SUS score for 15 participants (11 pharmacy students and four pharmacists) was 83, with a standard deviation of 6.6. Results suggest that PGxKnow has the potential to bridge the gap in PGx education, further widespread utilization of PGx and boost its impact on precision medicine.

A three-arm single blind randomised control trial of naïve medical students performing a shoulder joint clinical examination

BACKGROUND

Technological advances have previously been hailed as a new dawn in Higher Education, with the advent of 'massive open online courses' (MOOCs) and online learning. Virtual platforms have potential advantages such as accessibility and availability but simply transferring educational material to the online environment may not ensure high quality learning. Clinical examination is a fundamental principle of medical assessment, and this study aimed to assess the role of technology in teaching these skills.

AIMS/OBJECTIVES

To determine whether three teaching modalities were of equal efficacy in teaching examination of the shoulder joint to naïve medical students.

METHODS

Sixty-seven pre-clinical medical students naïve to large joint examination were recruited. Participants completed a learning style questionnaire and were then block randomised to three study: textbook study, face-to-face seminar, or video tutorial via online platform. The same examination technique was taught in all groups, with the intervention being the method of delivery All second year students were eligible for inclusion. The single exclusion criteria was previous exposure to clinical examination teaching. Students were assessed using a standardised scoring system at baseline (pre-intervention), and days 5 and 19 post-intervention (maximum score 30). Assessors were blinded to group allocation. The primary outcome was assessment score at day 5 post intervention.

RESULTS

There was no difference between the three groups at baseline assessment (mean scores 2.4 for textbook, 2.8 for face-to-face, and 3.1 for video; p = 0.267). Mean post-intervention scores were 16.5 textbook, 25.5 face-to-face, and 22.4 video (p < 0.001, η2 = .449). There was no change between day 5 and day 19 post-intervention assessment scores in any group (p = 0.373), Preferred learning style did not affect scores (p = 0.543).

CONCLUSION

Face-to-face teaching was the most effective method for teaching clinical examination of the shoulder. Technology can potentially increase accessibility and remove geographic barriers, but is not as effective if teaching techniques are simply mirrored in an online format. Online platforms allow in depth data analysis of how learners interact with educational material and this may have value in improving the design of online educational materials, and is a potential area for further research.