The effectiveness of an interactive 3-dimensional computer graphics model for medical education

Collaborative use of a 3D anatomy platform to motivate and enhance anatomy learning in first-year online medical sonography students

INTRODUCTION

Sonography students require a deep understanding of structural anatomy, including where structures sit relative to one another. Additionally, they need to learn the complex task of identifying structures on medical images including X-rays, computed tomography, magnetic resonance imaging and ultrasound imaging. Anatomy can be taught online, but learning can be challenging for students. Online three-dimensional (3D) anatomy platforms aid student learning, but research investigating how to use them effectively when teaching is scarce. This project evaluated the impact of incorporating a three-dimensional (3D) online anatomy platform into teaching relative structural anatomy and assist sonography students when learning how to recognise structures on medical images.

METHODS

Sixty-one first-year sonography students within an articulated undergraduate and postgraduate medical sonography programme in Australia, studying anatomy online participated in this mixed methods study. The impact of using a 3D online anatomy platform on their conceptual 3D anatomy understanding of relative anatomy, development of medical image recognition skills and their learning experience was assessed via a Qualtrics survey.

RESULTS

Students who used this platform collaboratively enhanced their relative anatomy understanding and developed the skill of identifying structures from medical images. The scaffolded use of this platform generated enquiry discussions between teachers and students and made learning anatomy online a social and enjoyable experience.

CONCLUSION

Collaborative and interactive scaffolded use of 3D online anatomy platforms can motivate and encourage student questions and discussions, enabling social connections and enhancing their learning experience. Student enquiry skills were developed, and the more complex task of identifying structures from medical images was made achievable.

A pilot study for the evaluation of 3D anatomy application 'Complete Anatomy' as an additional non-mandatory study tool for the functional anatomy classes of first year physical therapy students

For this pilot study, the use of the digital 3D anatomy application Complete Anatomy was evaluated as a non-mandatory additional study tool throughout the semester. The aim of the study was to investigate if the Complete Anatomy usage time had an effect on final exam grades and how the app was used post-Covid19. This cross-sectional study asked first year bachelor/freshman university students of Physical Therapy and Rehabilitation Sciences to fill out a questionnaire to gauge Complete Anatomy usage time, the student's exam results, and how the app was used, for example, in relation to other study tools. A positive correlation was found between the proportion of students that passed the final exam and the number of hours of Complete Anatomy usage (rs (4) = 0.94, p = 0.016). Compared to students who didn't use Complete Anatomy, these positive effects were observed when students used Complete Anatomy for at least 10 h (p = 0.04). The app was well-used with almost half of the respondents reporting >10 h of usage time. The results from this study provide a good overview of how and how often Complete Anatomy is used. Although a positive correlation between the hours of use and the number of passing grades was found in this pilot study, a future study to prove the causality between these two factors is warranted to further investigate the effect of Complete Anatomy as an additional non-mandatory study tool.

Virtual Nephron: Evaluation of a Novel Virtual Reality Educational Tool

Introduction

Recent technological advancements allowed the development of engaging technological tools. Using ASN funding from the ASN, we developed a 3D Virtual Reality (VR) physiology course entitled DiAL-Neph (Diuretic Action and eLectrolyte transport in the Nephron). We hereby present its evaluation.

Methods

The study consisted of 2 parts: evaluation of knowledge gain, and qualitative evaluation of platform reception. Internal medicine PGY1 residents were randomly assigned into 2 groups: a VR group and a conventional group. Knowledge acquisition was assessed with a post-test administered at the end of the course and repeated within 6 to 12 weeks. Independent t-tests were used to compare the number of correct answers between the groups. A survey and focus groups composed of medicine residents evaluated the platform. Sessions were recorded and transcribed verbatim. Data was analyzed through the content analysis approach by two independent reviewers.

Results

Of 117 PGY1 resident participants, 64 were randomized to the VR group and 53 were randomized to the traditional group. Initial test results showed higher scores among VR compared to the traditional group (76.5% correct vs. 68.8%). Seventy-eight PGY1s participated in the follow up testing (46 VR group vs. 32 traditional group) and results showed no significant difference in test results. Greater than 90% of the residents rated the platform positively and 77% preferred it as a teaching method.

Conclusion

The DiAL-Neph VR platform appeared to improve short-term learning but not long-term retention. Further studies are needed to investigate the impact of such teaching platforms on overall interest in nephrology.

The Status of Cadaver-Based Anatomy Instruction in Missouri Medical Schools

Cadaveric dissection has been a foundational principle of medical anatomic education for the last 400 years, yet medical anatomy course hours have been drastically reduced in the last decades. With this course reduction and the availability of other modalities for anatomic instruction, the physician may question the current role of cadavers in medical anatomy courses. This study aims to evaluate the role cadaveric dissection plays in anatomy programs in allopathic and osteopathic medical schools in Missouri and compare course hours to the national trend. Ongoing challenges are reviewed, including the international shortage of qualified cadaveric anatomists.

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.

Serious game for radiotherapy training

BACKGROUND

Cancer patients are often treated with radiation, therefore increasing their exposure to high energy emissions. In such cases, medical errors may be threatening or fatal, inducing the need to innovate new methods for maximum reduction of irreversible events. Training is an efficient and methodical tool to subject professionals to the real world and heavily educate them on how to perform with minimal errors. An evolving technique for this is Serious Gaming that can fulfill this purpose, especially with the rise of COVID-19 and the shift to the online world, by realistic and visual simulations built to present engaging scenarios. This paper presents the first Serious Game for Lung Cancer Radiotherapy training that embodies Biomedical Engineering principles and clinical experience to create a realistic and precise platform for coherent training.

METHODS

To develop the game, thorough 3D modeling, animation, and gaming fundamentals were utilized to represent the whole clinical process of treatment, along with the scores and progress of every player. The model's goal is to output coherency and organization for students' ease of use and progress tracking, and to provide a beneficial educational experience supplementary to the users' training. It aims to also expand their knowledge and use of skills in critical cases where they must perform crucial decision-making and procedures on patients of different cases.

RESULTS

At the end of this research, one of the accomplished goals consists of building a realistic model of the different equipment and tools accompanied with the radiotherapy process received by the patient on Maya 2018, including the true beam table, gantry, X-ray tube, CT Scanner, and so on. The serious game itself was then implemented on Unity Scenes with the built models to create a gamified authentic environment that incorporates the 5 main series of steps; Screening, Contouring, External Beam Planning, Plan Evaluation, Treatment, to simulate the practical workflow of an actual Oncology treatment delivery for lung cancer patients.

CONCLUSION

This serious game provides an educational and empirical space for training and practice that can be used by students, trainees, and professionals to expand their knowledge and skills in the aim of reducing potential errors.

Face-to-face versus 360° VR video: a comparative study of two teaching methods in nursing education

BACKGROUND

The practical sessions during skills laboratory simulation or clinical simulation are cores of nursing education. For this, different modalities have been devised to facilitate psychomotor skills learning. One of the commonly used educational material or instructional method to supplement skills learning across various disciplines is video-based teaching method. The opportunities of traditional two-dimensional video might be limitless and maximized with 360º virtual reality (VR) video, which offers immersive experience. This study incorporates 360º VR video into skills laboratory training as an alternative approach to face-to-face procedure demonstration.

METHODS

An open-label, parallel (1:1), randomized controlled trial study was conducted among third-year undergraduate nursing students at Hiroshima University, Japan. The nursing students were block-randomized into 360º VR video and face-to-face demonstration group. After a 3-hour theoretical class of patient management on ventilator and closed-suction principles of mechanically ventilated patients in an Intensive Care Unit focused class, the 360º VR group watched the 360º VR video of closed tracheal suction (including oral) using the head-mounted display of Meta Quest 2 individually, while the face-to-face group attended the instructor's demonstration. A week after the skills laboratory, the students' psychomotor skills, knowledge, satisfaction, confidence were evaluated; the 360º VR video group's perception was explored; Wilcoxon rank-sum test was used to compare the two groups.

RESULTS

A total of 57 students were analyzed; 27 students in the 360º VR video group and 30 students in face-to-face group. There were no statistically significant differences between both groups in skills, knowledge, and confidence. However, the face-to-face group had higher satisfaction level than the 360º VR group; this difference was statistically significant. In the 360º VR video group, 62% agreed that VR makes learning more interesting; more than half of students (62.5%) experienced VR sickness symptoms, and "feeling of drunk" is the highest. The students appreciated the ready to use, immersiveness, and realism; however, symptoms and discomfort, burdensomeness, and production limitations were improvements recommended.

CONCLUSION

Although face-to-face demonstration is the established method of teaching psychomotor skills to nursing students, the use of 360º VR video could achieve similar learning effect as an alternative approach.

Show them what they can't see! An evaluation of the use of customized 3D printed models in head and neck anatomy

Difficulty in visualizing anatomical structures has been identified as a challenge in anatomy learning and the emergence of three-dimensional printed models (3DPMs) offers a potential solution. This study evaluated the effectiveness of 3DPMs for learning the arterial supply of the head and neck region. One hundred eighty-four undergraduate medical students were randomly assigned to one of four learning modalities including wet specimen, digital model, 3DPM, and textbook image. Posttest scores indicated that all four modalities supported participants' knowledge acquisition, most significantly in the wet specimen group. While the participants rated 3DPMs lower for helping correct identification of structures than wet specimens, they praised 3DPMs for their ability to demonstrate topographical relationships between the arterial supply and adjacent structures. The data further suggested that the biggest limitation of the 3DPMs was their simplicity, thus making it more difficult for users to recognize the equivalent structures on the wet specimens. It was concluded that future designs of 3DPMs will need to consider the balance between the ease of visualization of anatomical structures and the degree of complexity required for successful transfer of learning. Overall, this study presented some conflicting evidence of the favorable outcomes of 3DPMs reported in other similar studies. While effective for anatomy learning as a standalone modality, educators must identify the position 3DPM models hold relative to other modalities in the continuum of undergraduate anatomy education in order to maximize their advantages for students.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

Effectiveness of using 2D atlas and 3D PDF as a teaching tool in anatomy lectures in initial learners: a randomized controlled trial in a medical school

BACKGROUND

Anatomy is a crucial part of medical education, and there have been attempts to improve this field by utilizing various methods. With the advancement of technology, three-dimensional (3D) materials have gained popularity and become a matter of debate about their effectiveness compared to two-dimensional (2D) sources. This research aims to analyze the effectiveness of 3D PDFs compared to 2D atlases.

METHODS

This study is a randomized controlled trial involving 87 Year-1 and Year-2 medical students at Gazi University Faculty of Medicine, Turkey. The study was conducted in two steps. In Step-1, students were randomized to watch lecture videos on liver anatomy and male genitalia anatomy supplemented with either a 3D PDF (intervention group) or 2D atlas (control group) images. Following the video lectures, a test (immediate test) was administered. In Step-2, the same test (delayed test) was administered 10 days after the immediate test. The test scores were compared between the intervention and control groups. In addition to the descriptive analyses, Chi-square and Mann-Whitney U tests were performed.

RESULTS

In the immediate test, while there was no significant difference between the groups for the liver test (p > 0.05), 3D PDF group's scores (Median = 24.50) was significantly higher than the 2D atlas group's in the genitalia test (Median = 21.00), (p = 0.017). The effect size (Cohen's d) was 0.57. In the delayed test, there was no significant difference between the groups in the liver and genitalia tests (p > 0.05). However, the effect size in the immediate genitalia test was 0.40. Year-1 students' immediate test of genitalia performances were significantly higher in the 3D PDF group (Median = 24.00) than the 2D atlas group (Median = 19.00), (p = 0.016). The effect size was 0.76. Also, Year-1 students' 3D PDF group (Median = 20.50) presented with significantly higher performance than the 2D atlas group (Median = 12.00), (p = 0.044) in the delayed test of genitalia, with the 0.63 effect size.

CONCLUSION

3D PDF is more effective than 2D atlases in teaching anatomy, especially to initial learners. It is particularly useful for teaching complex anatomical structures, such as male genitalia, compared to the liver. Hence, it may be a valuable tool for medical teachers to utilize during lectures.

Assessment of the Extent of Intracerebral Hemorrhage Using 3D Modeling Technology

The second most common cause of stroke, accounting for 10% of hospital admissions, is intracerebral hemorrhage (ICH), and risk factors include diabetes, smoking, and hypertension. People with intracerebral bleeding experience symptoms that are related to the functions that are managed by the affected part of the brain. Having obtained 15 computed tomography (CT) scans from five patients with ICH, we decided to use three-dimensional (3D) modeling technology to estimate the bleeding volume. CT was performed on admission to hospital, and after one week and two weeks of treatment. We segmented the brain, ventricles, and hemorrhage using semi-automatic algorithms in Slicer 3D, then improved the obtained models in Blender. Moreover, the accuracy of the models was checked by comparing corresponding CT scans with 3D brain model cross-sections. The goal of the research was to examine the possibility of using 3D modeling technology to visualize intracerebral hemorrhage and assess its treatment.

The Impact of Virtual Interactive Three-Dimensional Model in the Conceptualization of the Anatomy of the Sacrum: A Randomized Controlled Trial

Introduction Virtual interactive three-dimensional model (VI3DM) is an emerging technology with promising futures in medical education. It allows learners to view and interact with the three-dimensional (3D) object in an isolated virtual environment, as well as on screen-based platforms. This technology seems more helpful in understanding the learning objectives that demand high cognitive and visuospatial skills. The sacrum, part of the posterior wall of the bony pelvis, is a structure of interest to medical professionals and forensic experts. Understanding the anatomy and relations of the sacrum demands good spatial understanding. Hypothetically, virtual 3D models should help in learning the anatomy of the sacrum along with its relations and attachments. This study was conducted to find out the effect of low-cost digital 3D models on the anatomical knowledge of the study. Aims and objectives The goal of the work was to identify the role of virtual 3D models in the conceptualization of the anatomy of the sacrum. The study's objectives were to identify the impact of virtual 3D models on students' knowledge of the external features, relations, attachments, and joints formed by the sacrum. Material and methods Two hundred first-year medical students (168 males and 32 females) who participated in the study after providing informed consent were divided into two equal groups, a control group (n=100) and an experimental group (n=100), after matching the age, gender, and anatomical knowledge of the sacrum. We used two-dimensional (2D) images and virtual interactive 3D models of the sacrum as control and intervention, respectively, in this randomized controlled study. We conducted a post-test quiz after the 30-minute session of self-directed learning. Results The mean difference between the post-test score and the pre-test score of the experimental group (4.1±1.6 ) was significantly higher than the difference between the post-test and pre-test scores of the control group (2.5±1.2). The virtual interactive 3D model of the sacrum was significantly effective in the conceptualization of the sacrum anatomy. Conclusion A virtual interactive 3D model is an effective tool to conceptualize the anatomy of the sacrum and can be explored for its use in further complex anatomical structures. Digital 3D models can become a platform for the application of various virtual realities (VR) and artificial intelligences in medical education.

From bones to bytes: Do manipulable 3D models have added value in osteology education compared to static images?

BACKGROUND

Over the past few years, anatomy education has been revolutionized through digital media, resulting in innovative computer-based 3D models to supplement or even replace traditional learning materials. However, the added value of these models in terms of learning performance remains unclear. Multiple mechanisms may contribute to the inconclusive findings. This study focusses on the impact of active manipulation on learning performance and the influence that posttest design features may have on the outcome measurement.

METHODS

Participants were randomly assigned to one of two research conditions: studying on the base of a computer-based manipulable pelvic bone model versus online static images of the same model. Pretests focused on students' baseline anatomy knowledge and spatial ability. Three knowledge posttests were administered: a test based on a physical pelvic bone model, and two computer-based tests based on static images and a manipulable model. Mental effort was measured with the Paas mental effort rating scale.

RESULTS

In the static images-based posttest, significantly higher knowledge scores were attained by participants studying in the static images research condition (p = 0.043). No other significant knowledge-related differences could be observed. In the manipulable model-based posttest, spatial ability rather than the research condition seemed to have an influential role on the outcome scores (r = 0.18, p = 0.049). Mental effort scores reflected no difference between both research conditions.

CONCLUSION

The research results are counter-intuitive, especially because no significant differences were found in the physical model-based posttest in students who studied with the manipulable model. Explaining the results builds on differences in anatomical models requiring less or more active manipulation to process spatial information. The pelvic bone manipulable model, and by extension osteology models, might be insufficiently complex to provide added value compared with static images. Moreover, the posttest modality should be chosen with care since spatial ability rather than anatomy knowledge may be measured.

The utility of a structured, interactive cardiac anatomy teaching session for resident education

BACKGROUND

Paediatric residents are often taught cardiac anatomy with two-dimensional images of heart specimens, or via imaging such as echocardiography or computed tomography. This study aimed to determine if the use of a structured, interactive, teaching session using heart specimens with CHD would be effective in teaching the concepts of cardiac anatomy.

METHODS

The interest amongst paediatric residents of a cardiac anatomy session using heart specimens was assessed initially by circulating a survey. Next, four major cardiac lesions were identified to be of interest: atrial septal defect, ventricular septal defect, tetralogy of Fallot, and transposition. A list of key structures and anatomic concepts for these lesions was developed, and appropriate specimens demonstrating these features were identified by a cardiac morphologist. A structured, interactive, teaching session was then held with the paediatric residents using the cardiac specimens. The same 10-question assessment was administered at the beginning and end of the session.

RESULTS

The initial survey demonstrated that all the paediatric residents had an interest in a cardiac anatomy teaching session. A total of 24 participated in the 2-hour session. The median pre-test score was 45%, compared to a median post-test score of 90% (p < 0.01). All paediatric residents who completed a post-session survey indicated that the session was a good use of educational time and contributed to increasing their knowledge base. They expressed great interest in future sessions.

CONCLUSION

A 2-hour hands-on cardiac anatomy teaching session using cardiac specimens can successfully highlight key anatomic concepts for paediatric residents.

Digital learning designs in occupational therapy education: a scoping review

BACKGROUND

Digital learning is a rapidly advancing method for teaching and learning in professional health education. Although various digital learning designs have been tried in OT education, studies on digital learning designs are still limited.

METHODS

We conducted a scoping study that aimed to identify the digital learning designs used in occupational therapy (OT) education and review the effectiveness, learner perceptions, clinical skills integrated, and technology-based learning strategies used to facilitate learning. Four databases were searched using subheadings and terms relating to digital learning, occupational therapy, and education. The included studies were mapped according to the types of digital learning design, subjects, key clinical skills, and outcomes.

RESULTS

Twenty-two studies were included in this review, most of which were qualitative, observational, or mixed studies of the two designs. The digital learning designs identified in OT education were flipped, blended, hybrid, and distance learning, including e-learning and massive open online courses (MOOC). Among the components of clinical skills, professional reasoning and procedural knowledge were the most integrated into digital learning, and covered various OT subjects. Digital learning designs were reported to be equivalent to or more effective than the traditional face-to-face (F2F) class in learning outcomes of knowledge and skill acquisition, enhancing learning participation, reflection, and collaboration between learners. Various technologies have been used to promote synchronous or asynchronous active learning, providing learning strategies such as thinking, reflection, discussion, peer learning-group activity, and gamifying online learning.

CONCLUSIONS

In OT digital learning, appropriate learning subjects, the arrangement of clinical skill components that can be well integrated into digital learning, and the selection of appropriate technologies for effective learning are important. The results should be confirmed within an experimental study design.

Visualization in Anatomy Education

In the post-pandemic era, one of the significant challenges for anatomy teachers is to reciprocate the experience of practical exposure while teaching the subject to undergraduates. These challenges span from conducting cadaveric dissections to handling real human bones, museum specimens, and tissue sections in the histology lab. Such exposures help the instructors to develop interactive communication with their fellow students and thus help to enhance communication skills among them. Recently, anatomy teachers all over the world started using cutting-edge educational technologies to make teaching-learning experiences for students more engaging, interesting, and interactive. Utilizing such cutting-edge educational technologies was an "option" prior to the pandemic, but the pandemic has significantly altered the situation. What was previously an "option" is now a "compulsion." Despite the fact that the majority of medical schools have resumed their regular on-campus classes, body donation and the availability of cadavers remain extremely limited, resulting in a deadlock. Anatomy teachers must incorporate cutting-edge educational technologies into their teaching and learning activities to make the subject more visual. In this chapter, we have attempted to discuss various new technologies which can provide a near-realistic perception of anatomical structures as a complementary tool for dissection/cadaver, various visualization techniques currently available and explore their importance as a pedagogic alternative in learning anatomy. We also discussed the recent advancement in visualization techniques and the pros and cons of technology-based visualization. This chapter identifies the limitations of technology-based visualization as a supplement and discusses effective utilization as an adjunct to the conventional pedagogical approaches to undergraduate anatomy education.

Examining Science and Technology/Engineering Educators' Views of Teaching Biomedical Concepts Through Physical Computing

Programming and automation continue to evolve rapidly and advance the capabilities of science, technology, engineering, and mathematics (STEM) fields. However, physical computing (the integration of programming and interactive physical devices) integrated within biomedical contexts remains an area of limited focus in secondary STEM education programs. As this is an emerging area, many educators may not be well prepared to teach physical computing concepts within authentic biomedical contexts. This shortcoming provided the rationale for this study, to examine if professional development (PD) had a noticeable influence on high school science and technology and engineering (T&E) teachers' (1) perceptions of teaching biomedical and computational thinking (CT) concepts and (2) plans to integrate physical computing within the context of authentic biomedical engineering challenges. The findings revealed a significant difference in the amount of biomedical and CT concepts that teachers planned to implement as a result of the PD. Using a modified version of the Science Teaching Efficacy Belief Instrument (STEBI-A) Riggs and Enochs in Science Education, 74(6), 625-637 (1990), analyses revealed significant gains in teachers' self-efficacy toward teaching both biomedical and CT concepts from the PD. Further analyses revealed that teachers reported increases in their perceived knowledge of biomedical and CT concepts and a significant increase in their intent to collaborate with a science or T&E educator outside of their content area. This study provides implications for researchers and educators to integrate more biomedical and physical computing instruction at the secondary education level.

Outcomes, Measurement Instruments, and Their Validity Evidence in Randomized Controlled Trials on Virtual, Augmented, and Mixed Reality in Undergraduate Medical Education: Systematic Mapping Review

BACKGROUND

Extended reality, which encompasses virtual reality (VR), augmented reality (AR), and mixed reality (MR), is increasingly used in medical education. Studies assessing the effectiveness of these new educational modalities should measure relevant outcomes using outcome measurement tools with validity evidence.

OBJECTIVE

Our aim is to determine the choice of outcomes, measurement instruments, and the use of measurement instruments with validity evidence in randomized controlled trials (RCTs) on the effectiveness of VR, AR, and MR in medical student education.

METHODS

We conducted a systematic mapping review. We searched 7 major bibliographic databases from January 1990 to April 2020, and 2 reviewers screened the citations and extracted data independently from the included studies. We report our findings in line with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.

RESULTS

Of the 126 retrieved RCTs, 115 (91.3%) were on VR and 11 (8.7%) were on AR. No RCT on MR in medical student education was found. Of the 115 studies on VR, 64 (55.6%) were on VR simulators, 30 (26.1%) on screen-based VR, 9 (7.8%) on VR patient simulations, and 12 (10.4%) on VR serious games. Most studies reported only a single outcome and immediate postintervention assessment data. Skills outcome was the most common outcome reported in studies on VR simulators (97%), VR patient simulations (100%), and AR (73%). Knowledge was the most common outcome reported in studies on screen-based VR (80%) and VR serious games (58%). Less common outcomes included participants' attitudes, satisfaction, cognitive or mental load, learning efficacy, engagement or self-efficacy beliefs, emotional state, competency developed, and patient outcomes. At least one form of validity evidence was found in approximately half of the studies on VR simulators (55%), VR patient simulations (56%), VR serious games (58%), and AR (55%) and in a quarter of the studies on screen-based VR (27%). Most studies used assessment methods that were implemented in a nondigital format, such as paper-based written exercises or in-person assessments where examiners observed performance (72%).

CONCLUSIONS

RCTs on VR and AR in medical education report a restricted range of outcomes, mostly skills and knowledge. The studies largely report immediate postintervention outcome data and use assessment methods that are in a nondigital format. Future RCTs should include a broader set of outcomes, report on the validity evidence of the measurement instruments used, and explore the use of assessments that are implemented digitally.

Support for using a three-dimensional anatomy application over anatomical atlases in a randomized comparison

To investigate to what extent the use of a three-dimensional (3D) anatomy computer application can improve the acquisition of anatomical knowledge compared with anatomical atlases, junior and advanced medical students participated in an experiment. Participants were asked to answer anatomical questions with the use of a 3D anatomy application (developed at the University Medical Center in Utrecht, the Netherlands) or anatomy atlases. Every student had to complete two assignments, either with an atlas or with the 3D anatomy application. One assignment consisted of 20 questions about the anatomy of the hand, the other one had 20 questions about the anatomy of the foot. The scores on the assignments and time to complete the assignments were registered and investigated. A total of 76 students participated. Students scored significantly higher and were significantly faster when they used the 3D anatomy application. Junior medical students were significantly faster than advanced medical students and particularly, advanced students who worked with an atlas needed most time. These results suggest that the 3D anatomy application is more effective as a studying tool, when compared to the use of paper atlases, for both junior and advanced medical students. The difference in time could indicate an influence of the increased number of mental steps it takes to convert two-dimensional atlas images to a 3D mental representation compared to using the 3D anatomy application, although practical issues explaining this cannot be ruled out. Future studies should establish whether the application leads to better learning/retention and to more time-efficient studying.

The Effectiveness of Collaborative Augmented Reality in Gross Anatomy Teaching: A Quantitative and Qualitative Pilot Study

In the context of gross anatomy education, novel augmented reality (AR) systems have the potential to serve as complementary pedagogical tools and facilitate interactive, student-centered learning. However, there is a lack of AR systems that enable multiple students to engage in collaborative, team-based learning environments. This article presents the results of a pilot study in which first-year medical students (n = 16) had the opportunity to work with such a collaborative AR system during a full-day gross anatomy seminar. Student performance in an anatomy knowledge test, conducted after an extensive group learning session, increased significantly compared to a pre-test in both the experimental group working with the collaborative AR system (P < 0.01) and in the control group working with traditional anatomy atlases and three-dimensional (3D) models (P < 0.01). However, no significant differences were found between the test results of both groups. While the experienced mental effort during the collaborative learning session was considered rather high (5.13 ± 2.45 on a seven-point Likert scale), both qualitative and quantitative feedback during a survey as well as the results of a System Usability Scale (SUS) questionnaire (80.00 ± 13.90) outlined the potential of the collaborative AR system for increasing students' 3D understanding of topographic anatomy and its advantages over comparable AR systems for single-user experiences. Overall, these outcomes show that collaborative AR systems such as the one evaluated within this work stimulate interactive, student-centered learning in teams and have the potential to become an integral part of a modern, multi-modal anatomy curriculum.

Use of 360° virtual reality video in medical obstetrical education: a quasi-experimental design

BACKGROUND

Video-based teaching has been part of medical education for some time but 360° videos using a virtual reality (VR) device are a new medium that offer extended possibilities. We investigated whether adding a 360° VR video to the internship curriculum leads to an improvement of long-term recall of specific knowledge on a gentle Caesarean Sections (gCS) and on general obstetric knowledge.

METHODS

Two weeks prior to their Obstetrics and Gynaecology (O&G) internship, medical students were divided in teaching groups, that did or did not have access to a VR-video of a gCS. Six weeks after their O&G internship, potentially having observed one or multiple real-life CSs, knowledge on the gCS was assessed with an open questionnaire, and knowledge on general obstetrics with a multiple-choice questionnaire. Furthermore we assessed experienced anxiety during in-person attendance of CSs, and we asked whether the interns would have wanted to attend more CSs in-person. The 360° VR video group was questioned about their experience directly after they watched the video. We used linear regression analyses to determine significant effects on outcomes.

RESULTS

A total of 89 medical students participated, 41 in the 360° VR video group and 48 in the conventional study group. Watching the 360° VR video did not result in a difference in either specific or general knowledge retention between the intervention group and the conventional study group. This was both true for the grade received for the internship, the open-ended questions as well as the multiple-choice questions and this did not change after adjustment for confounding factors. Still, 83.4% of the 360° VR video-group reported that more videos should be used in training to prepare for surgical procedures. In the 360° VR video-group 56.7% reported side effects like nausea or dizziness. After adjustment for the number of attended CSs during the practical internship, students in the 360° VR video-group stated less often (p = 0.04) that they would have liked to attend more CSs in-person as compared to the conventional study group.

CONCLUSION

Even though the use of 360° VR video did not increase knowledge, it did offer a potential alternative for attending a CS in-person and a new way to prepare the students for their first operating room experiences.

The Visible Korean: movable surface models of the hip joint

PURPOSE

In this study, we presented movable surface models to help medical students understand the multiaxial movements of the hip joint. The secondary objective was to demonstrate a simple method to make movable surface models for other researchers.

METHODS

We used 166 surface models of the virtual human, and the commercial software was used for all the processes described in this study. Virtual joints were created for the hip joint of the surface models to simulate realistic movements of the joints. Bone surface models were processed to maintain the original shape of the bones during movement. Muscle surface models were processed to express deformation of the muscle shapes during movement. Next, the muscle and bone surface models were moved over six movements of the hip joint (flexion, extension, abduction, adduction, lateral rotation, and medial rotation). The surface models of these six movements were saved and packaged in a PDF file.

RESULTS

The PDF file enabled users to see the stereoscopic shapes of the bones and muscles of the hip joint and to scrutinize the six movements on the X, Y, and Z axes of the joint.

CONCLUSION

The movable surface models of the hip joint of this study will be helpful for medical students to learn the multiaxial movements of the hip joint. We expect to develop simulations of other joints that can be used in the education of medical students using the materials and methods described in this study.

Current and Future Applications of Virtual, Augmented, and Mixed Reality in Cardiothoracic Surgery

BACKGROUND

This review aims to examine the existing literature to address currently used virtual, augmented, and mixed reality modalities in the areas of preoperative surgical planning, intraoperative guidance, and postoperative management in the field of cardiothoracic surgery. In addition, this innovative technology provides future perspectives and potential benefits for cardiothoracic surgeons, trainees, and patients.

METHODS

A targeted, non-systematic literature assessment was performed within the Medline and Google Scholar databases to help identify current trends and to provide better understanding of the current state-of-the-art extended reality (XR) modalities in cardiothoracic surgery. Related articles published up to July 2020, are included in the review.

RESULTS

XR is a novel technique gaining increasing application in cardiothoracic surgery. It provides a three-dimensional (3D) and realistic view of structures and environments and offers the user the ability to interact with digital projections of surgical targets. Recent studies showed the validity and benefits of XR applications in cardiothoracic surgery. Examples include XR-guided pre-operative planning, intraoperative guidance and navigation, post-operative pain and rehabilitation management, surgical simulation, and patient education.

CONCLUSIONS

XR is gaining interest in the field of cardiothoracic surgery. In particular, there are promising roles for XR applications in televirtuality, surgical planning, surgical simulation, and perioperative management. However, future refinement and research is needed to further implement XR in the aforementioned settings within cardiothoracic surgery.

TEL Methods Used for the Learning of Clinical Neuroanatomy

Ubiquity of information technology is undoubtedly the most substantial change to society in the twentieth and twenty-first centuries and has resulted in a paradigm shift in how business and social interactions are conducted universally. Information dissemination and acquisition is now effortless, and the way we visualise information is constantly evolving. The face of anatomy education has been altered by the advent of such innovation with Technology-Enhanced Learning (TEL) now commonplace in modern curricula.With the constant development of new computing systems, the temptation is to push the boundaries of what can be achieved rather than addressing what should be achieved. As with clinical practice, education in healthcare should be evidence driven. Learning theory has supplied educators with a wealth of information on how to design teaching tools, and this should form the bedrock of technology-enhanced educational platforms. When analysing resources and assessing if they are fit for purpose, the application of pedagogical theory should be explored and the degree to which it has been applied should be considered.

Can virtual reality improve traditional anatomy education programmes? A mixed-methods study on the use of a 3D skull model

BACKGROUND

Realistic, portable, and scalable lectures, cadaveric models, 2D atlases and computer simulations are being combined more frequently for teaching anatomy, which result in major increases in user satisfaction. However, although digital simulations may be more portable, interesting, or motivating than traditional teaching tools, whether they are superior in terms of student learning remain unclear. This paper presents a study in which the educational effectiveness of a virtual reality (VR) skull model is compared with that of cadaveric skulls and atlases. The aim of this study was to compare the results of teaching with VR to results of teaching with traditional teaching methods by administering objective questionnaires and perception surveys.

METHODS

A mixed-methods study with 73 medical students was conducted with three different groups, namely, the VR group (N = 25), cadaver group (N = 25) and atlas group (N = 23). Anatomical structures were taught through an introductory lecture and model-based learning. All students completed the pre- and post-intervention tests, which comprised a theory test and an identification test. The theory test consisted of 18 multiple-choice questions, and the identification test consisted of 25 fill-in-the-blank questions.

RESULTS

The participants in all three groups had significantly higher total scores on the post-intervention test than on the pre-intervention test; the post-intervention test score in the VR group was not statistically significantly higher than the post-intervention test score of the other groups (VR: 30 [IQR: 22-33.5], cadaver: 26 [IQR: 20-31.5], atlas: 28[IQR: 20-33]; p > 0.05). The participants in the VR and cadaver groups provided more positive feedback on their learning models than the atlas group (VR: 26 [IQR: 19-30], cadaver: 25 [IQR: 19.5-29.5], atlas: 12 [IQR: 9-20]; p < 0.001).

CONCLUSIONS

The skull virtual learning resource (VLR) was equally efficient as the cadaver skull and atlas in teaching anatomy structures. Such a model can aid individuals in understanding complex anatomical structures with a higher level of motivation and tolerable adverse effects.

Mixed reality as a time-efficient alternative to cadaveric dissection

Objectives: The extent of medical knowledge increases yearly, but the time available for students to learn is limited, leading to administrative pressures to revise and reconfigure medical school curricula. The goal of the present study is to determine whether the mixed reality platform HoloAnatomy represents an effective and time-efficient modality to learn anatomy when compared to traditional cadaveric dissection.Methods: This was a prospective, longitudinal study of medical students completing a musculoskeletal anatomy course at Case Western Reserve University School of Medicine. Participants were divided into two groups based on learning platform (HoloAnatomy versus traditional cadaveric dissection) and content area (upper limb versus lower limb anatomy). Time spent in lab and end of course practical exam scores were compared between groups.Results: The average study time of 48 medical students who completed study requirements was 4.564 h using HoloAnatomy and 7.318 h in the cadaver lab (p = 0.001). No significant difference was found between exam scores for HoloAnatomy and cadaver learners (p = 0.185).Conclusions: Our results indicate that HoloAnatomy may decrease the time necessary for anatomy didactics without sacrificing student understanding of the material.

Virtual Reality in Anatomy: A Pilot Study Evaluating Different Delivery Modalities

Technologies such as virtual reality are used in higher education to develop virtual learning resources (VLRs). These VLRs can be delivered in multiple modalities, from truly immersive involving wearable devices to less immersive modalities such as desktop. However, research investigating perceptions of VLRs in anatomy has mainly focused on a single delivery modality and a limited-demographic participant cohort, warranting a comparison of different modalities and a consideration of different cohorts. This pilot study aimed to compare perceptions of highly immersive and less immersive VLR deliveries among anatomy students and tutors and evaluate the impact of prior university experience on students' perceptions of VLRs. A skull anatomy VLR was developed using the Unity^® gaming platform and participants were voluntarily recruited to assess highly immersive stereoscopic and less immersive desktop deliveries of the VLR. A validated survey tool was used to gather perceptions of both deliveries. Most participants agreed that both VLR deliveries were interesting and engaging and provided an immersive experience. Anatomy students perceived the stereoscopic delivery to be significantly more useful for understanding (P = 0.013), while anatomy tutors perceived the desktop delivery as more useful. A degree of physical discomfort and disorientation was reported by some participants for both deliveries, although to a greater extent for the stereoscopic delivery. The stereoscopic delivery was also found to be more mentally taxing than desktop delivery. These results suggest that desktop VLR delivery may minimize the risk of discomfort and disorientation associated with more immersive modalities while still providing a valuable learning experience.

The effectiveness of virtual reality-based technology on anatomy teaching: a meta-analysis of randomized controlled studies

BACKGROUND

Virtual reality (VR) is an innovation that permits the individual to discover and operate within three-dimensional (3D) environment to gain practical understanding. This research aimed to examine the general efficiency of VR for teaching medical anatomy.

METHODS

We executed a meta-analysis of randomized controlled studies of the performance of VR anatomy education. We browsed five databases from the year 1990 to 2019. Ultimately, 15 randomized controlled trials with a teaching outcome measure analysis were included. Two authors separately chose studies, extracted information, and examined the risk of bias. The primary outcomes were examination scores of the students. Secondary outcomes were the degrees of satisfaction of the students. Random-effects models were used for the pooled evaluations of scores and satisfaction degrees. Standardized mean difference (SMD) was applied to assess the systematic results. The heterogeneity was determined by I² statistics, and then was investigated by meta-regression and subgroup analyses.

RESULTS

In this review, we screened and included fifteen randomized controlled researches (816 students). The pooled analysis of primary outcomes showed that VR improves test scores moderately compared with other approaches (standardized mean difference [SMD] = 0.53; 95% Confidence Interval [CI] 0.09-0.97, p < 0.05; I² = 87.8%). The high homogeneity indicated that the studies were different from each other. Therefore, we carried out meta-regression as well as subgroup analyses using seven variables (year, country, learners, course, intervention, comparator, and duration). We found that VR improves post-intervention test score of anatomy compared with other types of teaching methods.

CONCLUSIONS

The finding confirms that VR may act as an efficient way to improve the learners' level of anatomy knowledge. Future research should assess other factors like degree of satisfaction, cost-effectiveness, and adverse reactions when evaluating the teaching effectiveness of VR in anatomy.

A Randomised Control Trial and Comparative Analysis of Multi-Dimensional Learning Tools in Anatomy

This article presents the results of a study that examined students' ability to retain what they have learned in an anatomy course after thirty days via using various learning tools for twenty minutes. Fifty-two second-year medical students were randomly assigned to three learning tools: text-only, three-dimension visualisation in a two-dimensional screen (3DM), or mixed reality (MR). An anatomy test lasting for twenty minutes measuring spatial and nominal knowledge was taken immediately after the learning intervention and another thirty days later. Psychometric tests were also used to measure participants' memory, reasoning and concentration abilities. Additionally, electroencephalogram data was captured to measure the participants' awakeness during the learning session. Results of this study showed that the MR group performed poorly in the nominal questions compared to the other groups; however, the MR group demonstrated higher retention in both the nominal and spatial type information for at least a month compared to the other groups. Furthermore, participants in the 3DM and MR groups reported increased engagement. The results of this study suggest that three-dimensional visualiser tools are likely to enhance learning in anatomy education. However, the study itself has several limitations; some include limited sample size and various threats to internal validity.

Printed 3-Dimensional Computed Tomography Scanned Ankle Fractures as an Educational Instrument

The evaluation of and treatment protocols for ankle fractures represents an important aspect of the education of podiatric medical students. The objective of this investigation was to examine the feasibility of and student satisfaction with using 3-dimensional (3D) printed bone models representative of the Lauge-Hansen classification. The computed tomography scans of subjects with actual rotational ankle fractures representative of the Lauge-Hansen classification were identified and extracted into a format compatible with a 3D printer. The models were approximately 20 cm in height and made of acrylonitrile butadiene styrene plastic in ivory color. These were subsequently implemented into the curriculum of a traumatology course with third year podiatric medical students in the form of a hands-on workshop. Students expressed high levels of satisfaction with the use of these models, and most recommended their continued implementation within the curriculum. The results of this investigation indicate that 3D technology within podiatric medical education is feasible with high levels of student satisfaction.

Does three-dimensional anatomy improve student understanding?

We aim to provide an overview of the various digital three‐dimensional visualizations used for learning anatomy and to assess whether these improve medical students' understanding of anatomy compared to traditional learning methods. Furthermore, we evaluate the attitudes of the users of three‐dimensional visualizations. We included articles that compared advanced newer three‐dimensional anatomy visualization methods (i.e., virtual reality, augmented reality, and computer‐based three‐dimensional visualizations) to traditional methods that have been used for a long time (i.e., cadaver and textbooks) with regard to users' understanding of anatomy. Of the 1,148 articles identified, 21 articles reported data on the effectiveness of using three‐dimensional visualization methods compared to two‐dimensional methods. Twelve articles found that three‐dimensional visualization is a significantly more effective learning method compared to traditional methods, whereas nine articles did not find that three‐dimensional visualization was a significantly more effective method. In general, based on these articles, medical students prefer to use three‐dimensional visualizations to learn anatomy. In most of the articles, using three‐dimensional visualization was shown to be a more effective method to gain anatomical knowledge compared to traditional methods. Besides that, students are motivated and interested in using these new visualization methods for learning anatomical structures. Clin. Anat. 32:25–33, 2019. © 2019 Wiley Periodicals, Inc.

Creating virtual 3-dimensional models for teaching pre-clinical tooth preparation: Students' usages and perceptions

PURPOSE

This research aimed to evaluate the students' usage and perceptions of using smartphones in their general dental education and learning tooth preparation with the individually designed virtual 3D instructional models in the pre-clinical removable partial denture course.

MATERIALS AND METHODS

Second-year dental students were asked to voluntarily participate in a survey to investigate their demographic information, general usages of smartphones, perception of smartphones usage in dental education (construct 1) and perception of individually designed virtual 3D instructional models (construct 2). Students' responses of general usages of the smartphones were compared with their demographic and educational backgrounds using nonparametric Kruskal-Wallis test (for age) and Fisher's exact test (for sex, race and educational background). The sums of scores of the construct 1 and construct 2 were tested for associations with student's demographic and educational backgrounds using the Pearson product-moment correlation (for age), t test (for sex and educational background) or one-way ANOVA F test (for race) (α = .05).

RESULTS

A 75% response rate (N = 90) was achieved in this study, and all 90 participants owned smartphones. Students' responses to general usages of the smartphones were not significantly influenced by their demographic background. For the construct 1, more than 73% of participants responded either agree or strongly agree to the usage of smartphones in general dental education and pre-clinical setting; however, only 49% of participants responded the same way in the clinical setting. For the construct 2, 48 of 90 participants viewed the 3D models, and more than 73% of these 48 participants responded either agree or strongly agree to the usage of the 3D models in the pre-clinical course. Student's demographic background did not have significant influence on the sums of scores of the construct 1 and construct 2.

CONCLUSIONS

Within the limitations of this study, high usages and ownerships of smartphones were found amongst the students surveyed. The individually designed virtual 3D instructional models as supplemental teaching materials in the pre-clinical course were perceived positively by the students.

How comprehensive are research studies investigating the efficacy of technology-enhanced learning resources in anatomy education? A systematic review

Anatomy education is at the forefront of integrating innovative technologies into its curricula. However, despite this rise in technology numerous authors have commented on the shortfall in efficacy studies to assess the impact such technology-enhanced learning (TEL) resources have on learning. To assess the range of evaluation approaches to TEL across anatomy education, a systematic review was conducted using MEDLINE, the Educational Resources Information Centre (ERIC), Scopus, and Google Scholar, with a total of 3,345 articles retrieved. Following the PRISMA method for reporting items, 153 articles were identified and reviewed against a published framework-the technology-enhanced learning evaluation model (TELEM). The model allowed published reports to be categorized according to evaluations at the level of (1) learner satisfaction, (2) learning gain, (3) learner impact, and (4) institutional impact. The results of this systematic review reveal that most evaluation studies into TEL within anatomy curricula were based on learner satisfaction, followed by module or course learning outcomes. Randomized controlled studies assessing learning gain with a specific TEL resource were in a minority, with no studies reporting a comprehensive assessment on the overall impact of introducing a specific TEL resource (e.g., return on investment). This systematic review has provided clear evidence that anatomy education is engaged in evaluating the impact of TEL resources on student education, although it remains at a level that fails to provide comprehensive causative evidence. Anat Sci Educ 11: 303-319. © 2017 American Association of Anatomists.

Evaluation by medical students of the educational value of multi-material and multi-colored three-dimensional printed models of the upper limb for anatomical education

For centuries, cadaveric material has been the cornerstone of anatomical education. For reasons of changes in curriculum emphasis, cost, availability, expertise, and ethical concerns, several medical schools have replaced wet cadaveric specimens with plastinated prosections, plastic models, imaging, and digital models. Discussions about the qualities and limitations of these alternative teaching resources are on-going. We hypothesize that three-dimensional printed (3DP) models can replace or indeed enhance existing resources for anatomical education. A novel multi-colored and multi-material 3DP model of the upper limb was developed based on a plastinated upper limb prosection, capturing muscles, nerves, arteries and bones with a spatial resolution of ∼1 mm. This study aims to examine the educational value of the 3DP model from the learner's point of view. Students (n = 15) compared the developed 3DP models with the plastinated prosections, and provided their views on their learning experience using 3DP models using a survey and focus group discussion. Anatomical features in 3DP models were rated as accurate by all students. Several positive aspects of 3DP models were highlighted, such as the color coding by tissue type, flexibility and that less care was needed in the handling and examination of the specimen than plastinated specimens which facilitated the appreciation of relations between the anatomical structures. However, students reported that anatomical features in 3DP models are less realistic compared to the plastinated specimens. Multi-colored, multi-material 3DP models are a valuable resource for anatomical education and an excellent adjunct to wet cadaveric or plastinated prosections. Anat Sci Educ 11: 54-64. © 2017 American Association of Anatomists.

The effectiveness of virtual and augmented reality in health sciences and medical anatomy

Although cadavers constitute the gold standard for teaching anatomy to medical and health science students, there are substantial financial, ethical, and supervisory constraints on their use. In addition, although anatomy remains one of the fundamental areas of medical education, universities have decreased the hours allocated to teaching gross anatomy in favor of applied clinical work. The release of virtual (VR) and augmented reality (AR) devices allows learning to occur through hands-on immersive experiences. The aim of this research was to assess whether learning structural anatomy utilizing VR or AR is as effective as tablet-based (TB) applications, and whether these modes allowed enhanced student learning, engagement and performance. Participants (n = 59) were randomly allocated to one of the three learning modes: VR, AR, or TB and completed a lesson on skull anatomy, after which they completed an anatomical knowledge assessment. Student perceptions of each learning mode and any adverse effects experienced were recorded. No significant differences were found between mean assessment scores in VR, AR, or TB. During the lessons however, VR participants were more likely to exhibit adverse effects such as headaches (25% in VR P < 0.05), dizziness (40% in VR, P < 0.001), or blurred vision (35% in VR, P < 0.01). Both VR and AR are as valuable for teaching anatomy as tablet devices, but also promote intrinsic benefits such as increased learner immersion and engagement. These outcomes show great promise for the effective use of virtual and augmented reality as means to supplement lesson content in anatomical education. Anat Sci Educ 10: 549-559. © 2017 American Association of Anatomists.

A meta-analysis of the educational effectiveness of three-dimensional visualization technologies in teaching anatomy

Many medical graduates are deficient in anatomy knowledge and perhaps below the standards for safe medical practice. Three-dimensional visualization technology (3DVT) has been advanced as a promising tool to enhance anatomy knowledge. The purpose of this review is to conduct a meta-analysis of the effectiveness of 3DVT in teaching and learning anatomy compared to all teaching methods. The primary outcomes were scores of anatomy knowledge tests expressed as factual or spatial knowledge percentage means. Secondary outcomes were perception scores of the learners. Thirty-six studies met the inclusion criteria including 28 (78%) randomized studies. Based on 2,226 participants including 2,128 from studies with comparison groups, 3DVTs (1) resulted in higher (d = 0.30, 95%CI: 0.02-0.62) factual knowledge, (2) yielded significant better results (d = 0.50, 95%CI: 0.20-0.80) in spatial knowledge acquisition, and (3) produced significant increase in user satisfaction (d = 0.28, 95%CI = 0.12-0.44) and in learners' perception of the effectiveness of the learning tool (d = 0.28, 95%CI = 0.14-0.43). The total mean scores (out of five) and ±SDs for QUESTS's Quality and Strength dimensions were 4.38 (±SD 1.3) and 3.3 (±SD 1.7), respectively. The results have high internal validity, for the improved outcomes of 3DVTs compared to other methods of anatomy teaching. Given that anatomy teaching and learning in the modern medical school appears to be approaching a crisis, 3DVT can be a potential solution to the problem of inadequate anatomy pedagogy.

Stereoscopic neuroanatomy lectures using a three-dimensional virtual reality environment

INTRODUCTION

Three-dimensional (3D) computer graphics are increasingly used to supplement the teaching of anatomy. While most systems consist of a program which produces 3D renderings on a workstation with a standard screen, the Dextrobeam virtual reality VR environment allows the presentation of spatial neuroanatomical models to larger groups of students through a stereoscopic projection system.

MATERIALS AND METHODS

Second-year medical students (n=169) were randomly allocated to receive a standardised pre-recorded audio lecture detailing the anatomy of the third ventricle accompanied by either a two-dimensional (2D) PowerPoint presentation (n=80) or a 3D animated tour of the third ventricle with the DextroBeam. Students completed a 10-question multiple-choice exam based on the content learned and a subjective evaluation of the teaching method immediately after the lecture.

RESULTS

Students in the 2D group achieved a mean score of 5.19 (±2.12) compared to 5.45 (±2.16) in the 3D group, with the results in the 3D group statistically non-inferior to those of the 2D group (p<0.0001). The students rated the 3D method superior to 2D teaching in four domains (spatial understanding, application in future anatomy classes, effectiveness, enjoyableness) (p<0.01).

CONCLUSION

Stereoscopically enhanced 3D lectures are valid methods of imparting neuroanatomical knowledge and are well received by students. More research is required to define and develop the role of large-group VR systems in modern neuroanatomy curricula.