Focused Multisensory Anatomy Observation and Drawing for Enhancing Social Learning and Three-Dimensional Spatial Understanding

A workshop to enrich physiological understanding through hands-on learning about mitochondria-endoplasmic reticulum contact sites

Physiology is an important field for students to gain a better understanding of biological mechanisms. Yet, many students often find it difficult to learn from lectures, resulting in poor retention. Here, we utilize a learning workshop model to teach students at different levels ranging from middle school to undergraduate. We specifically designed a workshop to teach students about mitochondria-endoplasmic reticulum contact (MERC) sites. The workshop was implemented for middle school students in a laboratory setting that incorporated a pretest to gauge prior knowledge, instructional time, hands-on activities, interactive learning from experts, and a posttest. We observed that the students remained engaged during the session of interactive methods, teamed with their peers to complete tasks, and delighted in the experience. Implications for the design of future physiological workshops are further offered.NEW & NOTEWORTHY This manuscript offers a design for a workshop that utilizes blended learning to engage middle school, high school, and undergraduate students while teaching them about mitochondria-endoplasmic reticulum contact sites.

Which are the most effective methods of teaching sectional anatomy? A scoping review

PURPOSE

Sectional anatomy knowledge is essential for a wide spectrum of health professionals and is extensively applied to their everyday practice. We performed a scoping review to find which are the most effective methods of teaching sectional anatomy.

METHODS

We searched PubMed, Scopus, and Cochrane Library to detect articles which investigated the effectiveness of sectional anatomy education methods, based on test scores. From each included paper, we extracted: author(s), number of participants, the anatomical region or regions, the method or methods of sectional anatomy education and the outcomes concerning only the acquisition of sectional anatomy knowledge.

RESULTS

Seven studies were included. There were four articles, which involved combined teaching approaches, and three articles, which did not comprise such approaches. In all studies which evaluated the effectiveness of a combination of teaching methods (comprising three-dimensional digital or physical tools) compared to cross-sections only, the anatomy test scores were significantly higher in the first case. The students' interaction with the educational material significantly enhanced the effectiveness of the implemented methods.

CONCLUSIONS

The multimodal teaching of sectional anatomy, especially involving three-dimensional methods, both digital and physical, was more effective than teaching based only on cross-sections. The students' interaction with the educational material improved the effectiveness of the teaching, which they received. These outcomes may stimulate anatomy teachers to enhance sectional anatomy education and encourage researchers to shed more light on the investigation of the optimal teaching strategies.

Everyone can draw: An inclusive and transformative activity for conceptualization of topographic anatomy

Anatomical drawing traditionally involves illustration of labeled diagrams on two-dimensional surfaces to represent topographical features. Despite the visual nature of anatomy, many learners perceive that they lack drawing skills and do not engage in art-based learning. Recent advances in the capabilities of technology-enhanced learning have enabled the rapid and inexpensive production of three-dimensional anatomical models. This work describes a "drawing on model" activity in which learners observe and draw specific structures onto three-dimensional models. Sport and exercise sciences (SES, n = 79) and medical (MED, n = 156) students at a United Kingdom medical school completed this activity using heart and femur models, respectively. Learner demographics, their perceptions of anatomy learning approaches, the value of the activity, and their confidence in understanding anatomical features, were obtained via validated questionnaire. Responses to 7-point Likert-type and free-text items were analyzed by descriptive statistics and semi-quantitative content analysis. Learners valued art-based study (SES mean = 5.94 SD ±0.98; MED = 5.92 ± 1.05) and the "drawing on model" activity (SES = 6.33 ± 0.93; MED = 6.21 ± 0.94) and reported enhanced confidence in understanding of cardiac anatomy (5.61 ± 1.11), coronary arteries (6.03 ± 0.83), femur osteology (6.07 ± 1.07), and hip joint muscle actions (5.80 ± 1.20). Perceptions of learners were independent of both their sex and their art-based study preferences (p < 0.05). Themes constructed from free-text responses identified "interactivity," "topography," "transformative," and "visualization," as key elements of the approach, in addition to revealing some limitations. This work will have implications for anatomy educators seeking to engage learners in an inclusive, interactive, and effective learning activity for supporting three-dimensional anatomical understanding.

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

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

Using represented bodies in Renaissance artworks to teach musculoskeletal and surface anatomy

Surface anatomy is an important skill for students in preparation for patient care, and peer examination is often used to teach musculoskeletal and surface anatomy. An alternative pedagogical approach is to use bodies represented in artworks. Represented bodies display fictive anatomy, providing students with the opportunity to apply their musculoskeletal knowledge and to think critically when evaluating the anatomical fidelity of a represented body. An elective course at the University of Michigan enabled undergraduate students to analyze the musculoskeletal and surface anatomy depicted in Renaissance artworks. Students traveled to Italy in 2018 (n = 14) and 2022 (n = 15) to analyze the fictive anatomy portrayed in artistic sculptures and musculoskeletal structures depicted in wax anatomy models and sculpted skeletons. In assignments, students were asked to identify musculoskeletal structures as portrayed in the context of represented anatomy created by Italian Renaissance artists and to assess the fidelity of the depicted anatomy. The students also applied their knowledge of musculoskeletal anatomy to describe body position and evaluate muscle function in their assessments of the accuracy or inaccuracy of the fictive anatomy. The students reported that evaluating the anatomical fidelity of represented bodies in artworks supported their learning of musculoskeletal and surface anatomy, and that their critical thinking skills improved in the course. Evaluation of the anatomical fidelity of represented bodies in artworks is an effective pedagogical approach that can be implemented in art museums as an adjunctive learning experience to deepen students' musculoskeletal and surface anatomy knowledge and further develop their critical thinking skills.

Anatomy in Practice: How Do Equine and Production Animal Veterinarians Apply Anatomy in Primary Care Settings?

To successfully prepare veterinary undergraduates for the workplace, it is critical that anatomy educators consider the context in which developing knowledge and skills will be applied. This study aimed to establish how farm animal and equine general practitioners use anatomy and related skills within their daily work. Qualitative ethnographic data in the form of observations and semi-structured interviews were collected from 12 veterinarians working in equine or farm animal first-opinion practice. Data underwent thematic analysis using a grounded theory approach. The five themes identified were relevant to both equine and farm animal veterinarians and represented the breadth and complexity of anatomy, its importance for professional and practical competence, as well as the requirement for continuous learning. The centrality and broad and multifaceted nature of anatomy was found to challenge equine and farm animal veterinarians, highlighting that essential anatomy knowledge and related skills are vital for their professional and practical competence. This aligns with the previously described experiences of companion animal clinicians. In equine practice, the complexity of anatomical knowledge required was particularly high, especially in relation to diagnostic imaging and assessing normal variation. This resulted in greater importance being placed on formal and informal professional development opportunities. For farm animal clinicians, anatomy application in the context of necropsy and euthanasia was particularly noted. Our findings allow anatomy educators to design appropriate and effective learning opportunities to ensure that veterinary graduates are equipped with the skills, knowledge, and resources required to succeed in first-opinion veterinary practice.

Can drawing instruction help students with low visuospatial ability in learning anatomy?

Visuospatial skills are considered important attributes when learning anatomy and there is evidence suggesting that this ability can be improved with training techniques including drawing. The Mental Rotations Test (MRT) has been routinely used to assess visuospatial ability. This study aimed to introduce students to drawing as a learning strategy for anatomy. Undergraduate speech science anatomy students took part in a drawing tutorial (n = 92), completed an MRT test, pre- and post-tutorial tests, and surveys regarding their use and attitudes toward drawing as a study tool. The impact on their examination performance was then assessed. Regardless of MRT score or attitude to drawing, students who participated in the drawing tutorial demonstrated immediate improvement in post-tutorial test scores. Students in the drawing group performed better in most anatomy components of the examination, but the result did not reach statistical significance. There was only a positive correlation between MRT score and one type of anatomy question (non-image-based) and speech physics questions (r = 0.315, p = 0.002). The unexpected finding may relate to the MRT which assesses spatial rather than object visualization skills. Students who liked drawing also performed significantly better in word-based and speech physics questions. It is likely that the style of identification question did not require the mental manipulation ability assessed in the MRT. This study demonstrated that students with lower MRT scores are not outperformed in all aspects of anatomy assessment. The study highlights the importance of a more nuanced understanding of visuospatial skills required in anatomy.

Transforming musculoskeletal anatomy learning with haptic surface painting

Anatomical body painting has traditionally been utilized to support learner engagement and understanding of surface anatomy. Learners apply two-dimensional representations of surface markings directly on to the skin, based on the identification of key landmarks. Esthetically satisfying representations of musculature and viscera can also be created. However, established body painting approaches do not typically address three-dimensional spatial anatomical concepts. Haptic Surface Painting (HSP) is a novel activity, distinct from traditional body painting, and aims to develop learner spatial awareness. The HSP process is underpinned by previous work describing how a Haptico-visual observation and drawing method can support spatial, holistic, and collaborative anatomy learning. In HSP, superficial and underlying musculoskeletal and vascular structures are located haptically by palpation. Transparent colors are then immediately applied to the skin using purposive and cross-contour drawing techniques to produce corresponding visual representations of learner observation and cognition. Undergraduate students at a United Kingdom medical school (n = 7) participated in remote HSP workshops and focus groups. A phenomenological study of learner perspectives identified four themes from semantic qualitative analysis of transcripts: Three-dimensional haptico-visual exploration relating to learner spatial awareness of their own anatomy; cognitive freedom and accessibility provided by a flexible and empowering learning process; altered perspectives of anatomical detail, relationships, and clinical relevance; and delivery and context, relating to curricular integration, session format, and educator guidance. This work expands the pedagogic repertoire of anatomical body painting and has implications for anatomy educators seeking to integrate innovative, engaging, and effective learning approaches for transforming student learning.

Flashcards: The Preferred Online Game-Based Study Tool Self-Selected by Students to Review Medical Histology Image Content

Medical students use several supplementary digital resources to support learning. Majority of these supplementary resources enhance learning by recall and repetition. A few examples of these resources are concept maps, flashcards (FCs), and self-testing tools. Traditionally, paper-based FCs are used in higher education. The concept of paper-based FCs is extended to the digital world in the form of electronic/web-based FCs. The use of electronic/digital flashcards has been reported to review course material in the medical school curriculum. Some of the medical school coursework requires students to acquire visual skills, for example, histology and pathology. Students, who do not have prior knowledge of the basic content on histology and pathology struggle to identify microscopic tissues and organs. Therefore, students look for other supplementary resources to support visual learning. Digital resources like Anki, Quizlet, and Osmosis provide study tools that support visual skills. A review of the literature revealed only a few publications pertaining to the use of digital testing tools for histology education in medical school curriculum. In the medical histology course at the Albert Einstein College of Medicine (Einstein), Bronx, NY, first-year medical students used a game-based platform (Quizlet) to review image-based histology course content in the form of four Quizlet study sets. Students chose from six Quizlet study tools (Flashcards, Learn, Speller, Test, Match, and Race/Gravity) to review the image-based course material and test their knowledge on accurate identification of histological images. The data on student usage of study tools was tracked and analyzed for 4 years (Graduating Classes of 2018 to 2021) to calculate: the total usage of the game-based study tools (Flashcards, Learn, Speller, Test, Match, and Race/Gravity) over the period of 4 years, total percent usage over 4 years of each game-based study tools (Flashcards, Learn, Speller, Test, Match, and Race/Gravity) in each of the four Quizlet study sets and to identify the preferred game-based study tool. The data showed a consistent year-on-year increase in usage of game-based study tools by 50% (M = 445 in 2018 compared to M = 849 in 2021). For the four Quizlet study sets the percent usage of each study tool Flashcards, Learn, Test, Match, Gravity, and Speller was tracked and combined across the four academic years. It was found that Flashcards were used significantly more frequently than any other tool and this was followed by Learn, Test, Match, Gravity, and Speller (p < 0.0001 using chi-square). The study concludes that flashcards are the preferred study tool used by students to acquire visual skills for identifying histological images and could be incorporated when designing online study tools.

Evolving anatomy education strategies for surgical residents: A scoping review

INTRODUCTION

Dedicated anatomy educational time in medical schools has decreased significantly, disproportionately affecting surgical residents. In this scoping review, we aim to consolidate existing evidence, describe ongoing research, and highlight future directions for surgical anatomy education.

METHODS

Two independent investigators searched MEDLINE, EMBASE, and the Cochrane library, for educational interventions targeting anatomy knowledge in surgical residents. English articles until October 28, 2021, were reviewed.

RESULTS

1135 abstracts were considered, and 59 (5.2%) included. Agreement on inclusion was excellent (k = 0.90). The majority were single-cohort studies (53%) and prospective cohort studies (17%). The most common disciplines were General Surgery (17%) and Obstetrics and Gynecology (17%).

DISCUSSION

Cadavers consistently produce positive knowledge gains and are heavily favored by residents. They remain the educational method to which new educational models are compared. New technologies do not yet match cadaver fidelity. Research showing knowledge translation from cadaver labs to patient outcomes remains limited.

Exploring Visualisation for Embryology Education: A Twenty-First-Century Perspective

Embryology and congenital malformations play a key role in multiple medical specialties including obstetrics and paediatrics. The process of learning clinical embryology involves two basic principles; firstly, understanding time-sensitive morphological changes that happen in the developing embryo and, secondly, appreciating the clinical implications of congenital conditions when development varies from the norm. Visualising the sequence of dynamic events in embryonic development is likely to be challenging for students, as these processes occur not only in three dimensions but also in the fourth dimensions of time. Consequently, features identified at any one timepoint can subsequently undergo morphological transitions into distinct structures or may degenerate and disappear. When studying embryology, learners face significant challenges in understanding complex, multiple and simultaneous events which are likely to increase student cognitive load. Moreover, the embryology content is very nonlinear. This nonlinear content presentation makes embryology teaching challenging for educators. Embryology is typically taught in large groups, via didactic lecture presentations that incorporate two-dimensional diagrams or foetal ultrasound images. This approach is limited by incomplete or insufficient visualisation and lack of interactivity.It is recommended that the focus of embryology teaching should instill an understanding of embryological processes and emphasise conceptualising the potential congenital conditions that can occur, linking pre-clinical and clinical disciplines together. A variety of teaching methods within case-based and problem-based curricula are commonly used to teach embryology. Additional and supplementary resources including animations and videos are also typically utilised to demonstrate complex embryological processes such as septation, rotation and folding.We propose that there is a need for embryology teaching in the twenty-first century to evolve. This is particularly required in terms of appropriate visualisation resources and teaching methodologies which can ensure embryology learning is relevant to real-world scenarios. Here we explore embryology teaching resources and methodologies and review existing evidence-based studies on their implementation and impact on student learning. In doing so, we aim to inform and support the practice of embryology educators and the learning of their students.

Multimodal Three-Dimensional Visualization Enhances Novice Learner Interpretation of Basic Cross-Sectional Anatomy

While integrated delivery of anatomy and radiology can support undergraduate anatomical education, the interpretation of complex three-dimensional spatial relationships in cross-sectional and radiological images is likely to be demanding for novices. Due to the value of technology-enhanced and multimodal strategies, it was hypothesized that simultaneous digital and physical learning could enhance student understanding of cross-sectional anatomy. A novel learning approach introduced at a United Kingdom university medical school combined visualization table-based thoracic cross-sections and digital models with a three-dimensional printed heart. A mixed-method experimental and survey approach investigated student perceptions of challenging anatomical areas and compared the multimodal intervention to a two-dimensional cross-section control. Analysis of seven-point Likert-type responses of new medical students (n = 319) found that clinical imaging (mean 5.64 SD ± 1.20) was significantly more challenging (P < 0.001) than surface anatomy (4.19 ± 1.31) and gross anatomy (4.92 ± 1.22). Pre-post testing of students who used the intervention during their first anatomy class at medical school (n = 229), identified significant increases (P < 0.001) in thoracic cross-sectional anatomy interpretation performance (mean 31.4% ± 15.3) when compared to the subsequent abdominal control activity (24.1% ± 17.6). Student test scores were independent of mental-rotation ability. As depicted on a seven-point Likert-type scale, the intervention may have contributed to students considering cross-sectional interpretation of thoracic images (4.2 ± 1.23) as significantly less challenging (P < 0.001) than comparable abdominal images (5.59 ± 1.14). These findings could have implications for how multimodal cross-sectional anatomy learning approaches are implemented within medical curricula.

A Novel Cadaveric Embalming Technique for Enhancing Visualisation of Human Anatomy

Within the discipline of anatomical education, the use of donated human cadavers in laboratory-based learning activities is often described as the 'gold standard' resource for supporting student understanding of anatomy. Due to both historical and educational factors, cadaveric dissection has traditionally been the approach against which other anatomy learning modalities and resources have been judged. To prepare human donors for teaching purposes, bodies must be embalmed with fixative agents to preserve the tissues. Embalmed cadavers can then be dissected by students or can be prosected or plastinated to produce teaching resources. Here, we describe the history of cadaveric preservation in anatomy education and review the practical strengths and limitations of current approaches for the embalming of human bodies. Furthermore, we investigate the pedagogic benefits of a range of established modern embalming techniques. We describe relevant cadaveric attributes and their impacts on learning, including the importance of colour, texture, smell, and joint mobility. We also explore the emotional and humanistic elements of the use of human donors in anatomy education, and the relative impact of these factors when alternative types of embalming process are performed. Based on these underpinnings, we provide a technical description of our modern Newcastle-WhitWell embalming process. In doing so, we aim to inform anatomy educators and technical staff seeking to embalm human donors rapidly and safely and at reduced costs, while enhancing visual and haptic tissue characteristics. We propose that our technique has logistical and pedagogic implications, both for the development of embalming techniques and for student visualisation and learning.

Cone Beam Computed Tomography (CBCT) Technology and Learning Outcomes in Dental Anatomy Education: E-Learning Approach

E-learning is an educational method that improves knowledge innovation by sharing relevant images for advanced learning, especially in a pandemic state. Furthermore, cone-beam computed tomography (CBCT) is a method that gathers medical or dental diagnostic images. This study aimed to analyze the effectiveness of dental anatomy education through a CBCT technology tool, through teachers' and students' perspectives, adjusted according to the disruptions caused by the Covid-19 pandemic. A cohort study and longitudinal exploratory analysis were performed. Forty undergraduate first-year dental students, from the University of Coimbra in Portugal, were selected as per the inclusion and exclusion criteria. Two different teaching methods were applied during an identical time-period: face-to-face lectures complemented by physical models (T1 cohort) and webinar lectures complemented by CBCT images (T2 cohort). Learning outcomes were then studied according to theoretical and spatial orientation contexts. A self-reported survey that focused on students' satisfaction, stress, and support was studied. Both teaching methods were analyzed with paired sample student's t-test and Pearson Correlation Confidence intervals 95% with P < 0.05. Furthermore, exploratory factor analysis (EFA) was used for self-reported satisfaction survey validity and reliability analysis. The learning outcomes between T1 and T2 cohorts were statistically significant, (P < 0.001) corresponding to differences with a large effect degree (r > 0.60). Students' satisfaction, as measured on a six-point Likert scale, was positively influenced by the webinar lectures supplemented with CBCT images (T2 cohort) in a learning context (4.95 ± 0.5) and future applications (5.92 ± 0.27). In conclusion, the webinar approach with CBCT images was more effective and better learning method for teaching dental anatomy.

Drawing in Veterinary Anatomy Education: What Do Students Use It For?

In contrast to medical education, information on the use of arts as a learning approach is scarce in veterinary anatomy. The aim of this prospective, questionnaire-based study was to survey students' use of drawing in various aspects of veterinary anatomy learning (self-study, examinations, preparation for, and reflection on cadaver dissection). The quantitative data showed that first-year students with artistic preferences used drawing significantly more often in most aspects of anatomy learning than students with no such preferences, apart from the reported use of drawing in examinations and for reflection after cadaver dissection. The lack of significant correlations of the reported use of drawing in examinations with any other study variable provided support for the author's observation that student-generated drawings are not as commonly used in examinations as previously. In contrast to the study hypothesis, previous university studies did not correlate significantly with any aspect of the use of drawing in anatomy learning. None of the reported uses of drawing addressed the benefits of drawing in learning the comparative anatomy of animal species, a characteristic distinguishing veterinary anatomy from human anatomy. Qualitative student feedback indicated that encouragement and teacher-produced images would increase the use of drawing as a learning approach even if the implementation of drawing into the curriculum is not feasible. Conclusions from this study were implemented through self-directed learning in anatomy courses that replaced the canceled cadaveric dissections during the COVID-19 outbreak and also through the ongoing drawing workshops to further advance the use of drawing in veterinary anatomy learning.

Observation of Patients' 3D Printed Anatomical Features and 3D Visualisation Technologies Improve Spatial Awareness for Surgical Planning and in-Theatre Performance

Improved spatial awareness is vital in anatomy education as well as in many areas of medical practice. Many healthcare professionals struggle with the extrapolation of 2D data to its locus within the 3D volume of the anatomy. In this chapter, we outline the use of touch as an important sensory modality in the observation of 3D forms, including anatomical parts, with the specific neuroscientific underpinnings in this regard being described. We explore how improved spatial awareness is directly linked to improved spatial skill. The reader is offered two practical exercises that lead to improved spatial awareness for application in exploring external 3D anatomy volume as well as internal 3D anatomy volume. These exercises are derived from the Haptico-visual observation and drawing (HVOD) method. The resulting cognitive improvement in spatial awareness that these exercises engender can be of benefit to students in their study of anatomy and for application by healthcare professionals in many aspects of their medical practice. The use of autostereoscopic visualisation technology (AS3D) to view the anatomy from DICOM data, in combination with the haptic exploration of a 3D print (3Dp) of the same stereoscopic on-screen image, is recommended as a practice for improved understanding of any anatomical part or feature. We describe a surgical innovation that relies on the haptic perception of patients' 3D printed (3Dp) anatomical features from patient DICOM data, for improved surgical planning and in-theatre surgical performance. Throughout the chapter, underlying neuroscientific correlates to haptic and visual observation, memory, working memory, and cognitive load are provided.

Interdimensional Travel: Visualisation of 3D-2D Transitions in Anatomy Learning

Clinical image interpretation is one of the most challenging activities for students when they first arrive at medical school. Interpretation of clinical images concerns the identification of three-dimensional anatomical features in two-dimensional cross-sectional computed tomography (CT) and magnetic resonance imaging (MRI) images in axial, sagittal and coronal planes, and the recognition of structures in ultrasound and plain radiographs. We propose that a cognitive transition occurs when initially attempting to interpret clinical images, which requires reconciling known 3D structures with previously unknown 2D visual information. Additionally, we propose that this 3D-2D transition is required when integrating an understanding of superficial 2D surface landmarks with an appreciation of underlying 3D anatomical structures during clinical examinations.Based on educational theory and research findings, we recommend that 3D and 2D approaches should be simultaneously combined within radiological and surface anatomy education. With a view to this, we have developed and utilised digital and art-based methods to support the 3D-2D transition. We outline our observations and evaluations, and describe our practical implementation of these approaches within medical curricula to serve as a guide for anatomy educators. Furthermore, we define the theoretical underpinnings and evidence supporting the integration of 3D-2D approaches and the value of our specific activities for enhancing the clinical image interpretation and surface anatomy learning of medical students.