The eye of the beholder: Can patterns in eye movement reveal aptitudes for spatial reasoning?

Using Stereoscopic Virtual Presentation for Clinical Anatomy Instruction and Procedural Training in Medical Education

This chapter begins by exploring the current landscape of virtual and augmented reality technologies in a post-pandemic world and asserting the importance of virtual technologies that improve students' learning outcomes while also reducing costs. Next, the chapter describes clinical anatomy instruction concepts in medical education, including applied anatomy content knowledge, pedagogical anatomy content knowledge, and virtual stereoscopic visualization studies that exemplify these concept areas, respectively. The chapter then explores the concept of procedural training with a specific emphasis on virtual stereoscopic anatomy visualization studies that exemplify or have implications for procedural training in medical education. Subsequently, the chapter discusses the benefits and challenges as well as the potential future positive and negative implications of virtual stereoscopic visualizations in medical education before finally concluding with some pensive considerations for the present and future of anatomy education and training using virtual technologies.

Do our hands see what our eyes see? Investigating spatial and haptic abilities

Spatial abilities (SAs) are cognitive resources used to mentally manipulate representations of objects to solve problems. Haptic abilities (HAs) represent tactile interactions with real-world objects transforming somatic information into mental representations. Both are proposed to be factors in anatomy education, yet relationships between SAs and HAs remain unknown. The objective of the current study was to explore SA-HA interactions. A haptic ability test (HAT) was developed based on the mental rotations test (MRT) with three-dimensional (3D) objects. The HAT was undertaken in three sensory conditions: (1) sighted, (2) sighted with haptics, and (3) haptics. Participants (n = 22; 13 females, 9 males) completed the MRT and were categorized into high spatial abilities (HSAs) (n = 12, mean± standard deviation: 13.7 ± 3.0) and low spatial abilities (LSAs) (n = 10, 5.6 ± 2.0) based on score distributions about the overall mean. Each SA group's HAT scores were compared across the three sensory conditions. Spearman's correlation coefficients between MRT and HAT scores indicated a statistically significant correlation in sighted condition (r = 0.553, p = 0.015) but were not significant in the sighted with haptics (r = 0.0.078, p = 0.212) and haptics (r = 0.043, p = 0.279) conditions. These data suggest HAs appear unrelated to SAs. With haptic exploration, LSA HAT scores were compensated; comparing HSA with LSA: sighted with haptics [median (lower and upper quartiles): 12 (12,13) vs. 12 (11,13), p = 0.254], and haptics [12 (11,13) vs. 12 (10,12), p = 0.381] conditions. Migrations to online anatomy teaching may unwittingly remove important sensory modalities from the learner. Understanding learner behaviors and performance when haptic inputs are removed from the learning environment represents valuable insight informing future anatomy curriculum and resource development.

Crashing from cadaver to computer: Covid-driven crisis-mode pedagogy spawns active online substitute for teaching gross anatomy

In early 2020, the Covid-19 crisis forced medical institutions worldwide to convert quickly to online platforms for content delivery. Although many components of medical education were adaptable to that format, anatomical dissection laboratory lost substantial content in that conversion, including features of active student participation, three-dimensional spatial relationships of structures, and the perception of texture, variation, and scale. The present study aimed to develop and assess online anatomy laboratory sessions that sought to preserve benefits of the dissection experience for first-year medical students. The online teaching package was based on a novel form of active videography that emulates eye movement patterns that occur during processes of visual identification, scene analysis, and learning. Using this video-image library of dissected materials, content was presented through asynchronous narrated laboratory demonstrations and synchronous/active video conference sessions and included a novel, video-based assessment tool. Data were obtained using summative assessments and a final course evaluation. Test scores for the online practical examination were significantly improved over those for previous in-person dissection-based examinations, as evidenced by several measures of performance (Mean: 2015-2019: 82.5%; 2020: 94.9%; P = 0.003). Concurrently, didactic test scores were slightly, but not significantly, improved (Mean: 2015-2019: 88.0%; 2020: 89.9%). Student evaluations of online sessions and overall course were highly positive. Results indicated that this innovative online teaching package can provide an effective alternative when in-person dissection laboratory is unavailable. Although this approach consumed considerable faculty time for video editing, further development will include video conference breakout rooms to emulate dissection small-group teamwork.

Assessing the efficacy of tablet-based simulations for learning pseudo-surgical instrumentation

Nurses and surgeons must identify and handle specialized instruments with high temporal and spatial precision. It is crucial that they are trained effectively. Traditional training methods include supervised practices and text-based study, which may expose patients to undue risk during practice procedures and lack motor/haptic training respectively. Tablet-based simulations have been proposed to mediate some of these limitations. We implemented a learning task that simulates surgical instrumentation nomenclature encountered by novice perioperative nurses. Learning was assessed following training in three distinct conditions: tablet-based simulations, text-based study, and real-world practice. Immediately following a 30-minute training period, instrument identification was performed with comparable accuracy and response times following tablet-based versus text-based training, with both being inferior to real-world practice. Following a week without practice, response times were equivalent between real-world and tablet-based practice. While tablet-based training does not achieve equivalent results in instrument identification accuracy as real-world practice, more practice repetitions in simulated environments may help reduce performance decline. This project has established a technological framework to assess how we can implement simulated educational environments in a maximally beneficial manner.

Gender Expression and Its Correlates in a Nationally Representative Sample of the U.S. Adult Population: Findings from the National Survey of Sexual Health and Behavior

We explored the associations of gender expression with childhood gender expression, sexual identity, and demographic characteristics in a representative sample of the U.S. population aged 18 to 65 years (N = 1277), using data from the 2015 National Survey of Sexual Health and Behavior. As expected, gay men were less gender conforming than heterosexual men. However, among women, persons with a bisexual identity were less gender conforming compared to heterosexual and lesbian persons. In multivariate analyses, childhood gender expression trumped the role of sexual identity. In terms of demographic characteristics, gender conformity seemed to be more present among persons with positions with less social status in terms of age, race/ethnicity, education, income, and relationship status. Finally, we found among both men and women, that a large proportion saw themselves as more masculine or feminine than men and women on average, respectively, suggesting that accentuating one's gender conformity has a psychological function.

Spatial Abilities Training in Anatomy Education: A Systematic Review

Spatial abilities have been correlated to anatomy knowledge assessment and spatial training has been found to improve spatial abilities in previous systematic reviews. The objective of this systematic review was to evaluate spatial abilities training in anatomy education. A literature search was done from inception to 3 August 2017 in Scopus^® and several databases on the EBSCOhost platform. Citations were reviewed and those involving anatomy education, an intervention, and a spatial abilities test were retained and the corresponding full-text articles were reviewed for inclusion. Before and after training studies, as well as comparative training programs, relating a spatial training intervention to spatial abilities were eligible. Of the 2,405 citations obtained, 52 articles were identified and reviewed, yielding eight eligible articles. Instruction in anatomy and mental rotations training were found to improve spatial abilities. For the seven studies retained for the meta-analysis that included the effect of interventions on spatial abilities test scores, the pooled treatment effect difference was 0.49 (95% CI [0.17; 0.82]; n = 11) improvement. For the two studies that included the practice effect on spatial abilities test scores in a control group, the pooled treatment effect difference was 0.47 (95% CI [-0.03; 0.97]; n = 2) improvement. In these two studies, the impact of the intervention on spatial abilities test scores was found despite the practice effect. Evidence was found for improvement of spatial abilities in anatomy education using instruction in anatomy and mental rotations training.

Guiding Low Spatial Ability Individuals through Visual Cueing: The Dual Importance of Where and When to Look

Research suggests that spatial ability may predict success in complex disciplines including anatomy, where mastery requires a firm understanding of the intricate relationships occurring along the course of veins, arteries, and nerves, as they traverse through and around bones, muscles, and organs. Debate exists on the malleability of spatial ability, and some suggest that spatial ability can be enhanced through training. It is hypothesized that spatial ability can be trained in low-performing individuals through visual guidance. To address this, training was completed through a visual guidance protocol. This protocol was based on eye-movement patterns of high-performing individuals, collected via eye-tracking as they completed an Electronic Mental Rotations Test (EMRT). The effects of guidance were evaluated using 33 individuals with low mental rotation ability, in a counterbalanced crossover design. Individuals were placed in one of two treatment groups (late or early guidance) and completed both a guided, and an unguided EMRT. A third group (no guidance/control) completed two unguided EMRTs. All groups demonstrated an increase in EMRT scores on their second test (P < 0.001); however, an interaction was observed between treatment and test iteration (P = 0.024). The effect of guidance on scores was contingent on when the guidance was applied. When guidance was applied early, scores were significantly greater than expected (P = 0.028). These findings suggest that by guiding individuals with low mental rotation ability "where" to look early in training, better search approaches may be adopted, yielding improvements in spatial reasoning scores. It is proposed that visual guidance may be applied in spatial fields, such as STEMM (science, technology, engineering, mathematics and medicine), surgery, and anatomy to improve student's interpretation of visual content. Anat Sci Educ. © 2018 American Association of Anatomists.

Gender differences in mental rotation strategy depend on degree of autistic traits

Participants with low, medium, and high autistic traits completed a mental rotation task while their eye movements were recorded. Men were more accurate than women (F(1, 102) = 4.36, P = 0.04, η²_p  = 0.04), but there were no group differences in reaction time. In terms of eye movements, all participants tended to rely on top corners of cube figures for most angles of rotation, and bottom corners of cube figures for 0 and 90 degree rotations (duration: F(8, 816) = 21.70, P < 0.001, η²_p  = 0.18; count: F(8, 816) = 24.42, P < 0.001, η²_p  = 0.19) suggesting a shift in strategy with rotation angle. Eye movements to corners of cube figures also varied by autistic traits group and gender (duration: F(4, 204) = 2.44, P = 0.05, η²_p  = 0.05; count: F(4, 204) = 2.47, P = 0.05, η²_p  = 0.05). Participants with low and medium autistic traits tended to rely more often on the top corners, whereas women with high autistic traits relied on both the top and bottom corners and men with high autistic traits relied on all corners equally. These results suggest mental rotation strategies may vary by both gender and autistic traits. Autism Res 2018, 11: 1024-1037. © 2018 International Society for Autism Research, Wiley Periodicals, Inc.

LAY SUMMARY

The current study looked at eye movements to assess adults' strategies when mentally rotating three-dimensional cube figures. Adults with varying levels of autistic traits differ in their mental rotation strategies. In addition, gender differences in strategies are observed in adults with the highest level of autistic traits.

Time limits in testing: An analysis of eye movements and visual attention in spatial problem solving

Individuals with an aptitude for interpreting spatial information (high mental rotation ability: HMRA) typically master anatomy with more ease, and more quickly, than those with low mental rotation ability (LMRA). This article explores how visual attention differs with time limits on spatial reasoning tests. Participants were assorted to two groups based on their mental rotation ability scores and their eye movements were collected during these tests. Analysis of salience during testing revealed similarities between MRA groups in untimed conditions but significant differences between the groups in the timed one. Question-by-question analyses demonstrate that HMRA individuals were more consistent across the two timing conditions (κ = 0.25), than the LMRA (κ = 0.013). It is clear that the groups respond to time limits differently and their apprehension of images during spatial problem solving differs significantly. Without time restrictions, salience analysis suggests LMRA individuals attended to similar aspects of the images as HMRA and their test scores rose concomitantly. Under timed conditions however, LMRA diverge from HMRA attention patterns, adopting inflexible approaches to visual search and attaining lower test scores. With this in mind, anatomical educators may wish to revisit some evaluations and teaching approaches in their own practice. Although examinations need to evaluate understanding of anatomical relationships, the addition of time limits may induce an unforeseen interaction of spatial reasoning and anatomical knowledge. Anat Sci Educ 10: 528-537. © 2017 American Association of Anatomists.

Uncovering the cognitive processes underlying mental rotation: an eye-movement study

Mental rotation is an important paradigm for spatial ability. Mental-rotation tasks are assumed to involve five or three sequential cognitive-processing states, though this has not been demonstrated experimentally. Here, we investigated how processing states alternate during mental-rotation tasks. Inference was carried out using an advanced statistical modelling and data-driven approach - a discriminative hidden Markov model (dHMM) trained using eye-movement data obtained from an experiment consisting of two different strategies: (I) mentally rotate the right-side figure to be aligned with the left-side figure and (II) mentally rotate the left-side figure to be aligned with the right-side figure. Eye movements were found to contain the necessary information for determining the processing strategy, and the dHMM that best fit our data segmented the mental-rotation process into three hidden states, which we termed encoding and searching, comparison, and searching on one-side pair. Additionally, we applied three classification methods, logistic regression, support vector model and dHMM, of which dHMM predicted the strategies with the highest accuracy (76.8%). Our study did confirm that there are differences in processing states between these two of mental-rotation strategies, and were consistent with the previous suggestion that mental rotation is discrete process that is accomplished in a piecemeal fashion.

Different perspectives: Spatial ability influences where individuals look on a timed spatial test

Learning in anatomy can be both spatially and visually complex. Pedagogical investigations have begun exploration as to how spatial ability may mitigate learning. Emerging hypotheses suggests individuals with higher spatial reasoning may attend to images differently than those who are lacking. To elucidate attentional patterns associated with different spatial ability, eye movements were measured in individuals completing a timed electronic mental rotation test (EMRT). The EMRT was based on the line drawings of Shepherd and Metzler. Individuals deduced whether image pairs were rotations (same) or mirror images (different). It was hypothesized that individuals with high spatial ability (HSA) would demonstrate shorter average fixation durations during problem solving and attend to different features of the EMRT than low spatial ability (LSA) counterparts. Moreover, question response accuracy would be associated with fewer fixations and shorter average response times, regardless of spatial reasoning ability. Average fixation duration in the HSA group was shorter than LSA (F(1,8) = 7.99; P = 0.022). Importantly, HSA and LSA individuals looked to different regions of the EMRT images (Fisher Exact Test: 12.47; P = 0.018); attending to the same locations only 34% of the time. Correctly answered questions were characterized by fewer fixations per question (F(1, 8) = 18.12; P = 0.003) and shorter average response times (F(1, 8) = 23.89; P = 0.001). The results indicate that spatial ability may influence visual attention to salient areas of images and this may be key to problem solving processes for low spatial individuals. Anat Sci Educ 10: 224-234. © 2016 American Association of Anatomists.