The Effectiveness of an Augmented Reality Head-Mounted Display in Learning Skull Anatomy at a Community College

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.

A multimodal virtual vision platform as a next-generation vision system for a surgical robot

Robot-assisted surgery platforms are utilized globally thanks to their stereoscopic vision systems and enhanced functional assistance. However, the necessity of ergonomic improvement for their use by surgeons has been increased. In surgical robots, issues with chronic fatigue exist owing to the fixed posture of the conventional stereo viewer (SV) vision system. A head-mounted display was adopted to alleviate the inconvenience, and a virtual vision platform (VVP) is proposed in this study. The VVP can provide various critical data, including medical images, vital signs, and patient records, in three-dimensional virtual reality space so that users can access medical information simultaneously. An availability of the VVP was investigated based on various user evaluations by surgeons and novices, who executed the given tasks and answered questionnaires. The performances of the SV and VVP were not significantly different; however, the craniovertebral angle of the VVP was 16.35° higher on average than that of the SV. Survey results regarding the VVP were positive; participants indicated that the optimal number of displays was six, preferring the 2 × 3 array. Reflecting the tendencies, the VVP can be a neoconceptual candidate to be customized for medical use, which opens a new prospect in a next-generation surgical robot.

Application of augmented reality models of canine skull in veterinary anatomical education

Veterinary anatomy plays a crucial role in the curriculum for veterinary medicine and surgery. The integration of modern information technology in veterinary education can greatly benefit from innovative tools such as augmented reality (AR) applications. The aim of this study was to develop an accurate and interactive three-dimensional (3D) digital model of an animal skull using AR technology, aiming to enhance the learning of skull anatomy in veterinary anatomy education. In this study, a canine skull specimen was isolated, and the skull bones were scanned using a structured light scanner to create a 3D digital model of the canine skull, which was found to be indistinguishable from the original specimen by measurement of skull proportions. Furthermore, the interactive AR model of the canine skull, displayed using Unity3D, was subjected to testing and evaluation by 60 first-year veterinary medical students attending the gross anatomy of the animal. The students were divided into two groups: the traditional group and AR group. Both groups completed an objective test and a questionnaire. The evaluation of learning effectiveness in the test revealed no significant difference between the traditional group (which learned using textbooks and a canine skull specimen) and AR group (which learned using AR tools). However, in the questionnaire, students displayed high enthusiasm and interest in using the AR tool. Therefore, the application of AR tools can improve students' motivation for learning and enhance the comprehension of anatomical structures in three dimensions. Furthermore, this study exemplifies the use of AR as an auxiliary tool for teaching and learning in veterinary anatomy education.

Anatomy in the metaverse: Exploring student technology acceptance through the UTAUT2 model

The impact of technology on educational domains has been a subject of research for many years. Therefore, understanding how students perceive and utilize technologies for educational purposes is crucial. Especially in a critical subject like anatomy education, it is essential to employ various models to determine students' technology acceptance and usage levels. One of these models is the unified theory of acceptance and use of technology-2 (UTAUT2). In this study, the acceptance and usage levels of metaverse technology by students in the context of anatomy education in the metaverse environment have been investigated within the framework of the UTAUT2 model. The study was conducted with students from the Department of Midwifery at the Faculty of Health Sciences during the fall semester of the 2022-2023 academic year. After 6 weeks of anatomy education in the metaverse environment, the student's acceptance and usage levels of metaverse technology were assessed using the UTAUT2 scale. The collected data were analyzed using the partial least squares structural equation modeling method. The research has revealed the technology acceptance and usage levels of students who utilized metaverse technology in anatomy education. According to the obtained results, it has been observed that social influence affects behavioral intention, facilitating conditions influence behavioral intention, and habit variable affects behavioral intention, while habit, in turn, influences usage. Other variables explain behavioral intention with a proportion of 75.30%, whereas other variables explain usage behavior with 54.90%. Upon analyzing the responses to the UTAUT2 scale, it has been concluded that there is the highest level of participation in hedonic motivation. In contrast, the habit variable has the lowest participation level. The findings of this study have enabled the identification of the impacts of metaverse technologies on anatomy and health education. These results will likely contribute to improving the utilization of metaverse technologies in anatomy and health education.

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.

Learning technology in health professions education: Realising an (un)imagined future

CONTEXT

Technology is being introduced, used and studied in almost all areas of health professions education (HPE), often with a claim of making HPE better in one way or another. However, it remains unclear if technology has driven real change in HPE. In this article, we seek to develop an understanding of the transformative capacity of learning technology in HPE.

METHODS AND OUTCOMES

We first consider the wider scholarship highlighting the intersection between technology and pedagogy, articulating what is meant by transformation and the role of learning technology in driving educational transformation. We then undertake a synthesis of the current high visibility HPE-focused research. We sampled the literature in two ways-for the five highest impact factor health professional education journals over the past decade and for all PubMed indexed journals for the last 3 years-and categorised the extant research against the Substitution, Augmentation, Modification, Redefinition model. We found that the majority of research we sampled focussed on substituting or augmenting learning through technology, with relatively few studies using technology to modify or redefine what HPE is through the use of technology. Of more concern was the lack of theoretical justification for pedagogical improvement, including transformation, underpinning the majority of studies.

CONCLUSIONS

While all kinds of technology use in learning have their place, the next step for HPE is the robust use of technology aiming to lead transformation. This should be guided by transformational educational theory and aligned with pedagogical context. We challenge HPE practitioners and scholars to work thoughtfully and with intent to enable transformation in education for future health professionals.

Using Immersive Virtual Reality in an Online Biology Course

Interest in virtual reality (VR) for teaching and learning in higher education is growing, given its many potential applications. VR offers a socially interactive environment with novel ways to engage students with materials, objects, and activities and provide students with experiences such as "field trips" that would be otherwise very difficult. Preliminary work indicates overall positive gains in student learning across disciplines compared to other technology and traditional techniques, although more studies are needed to better our understanding of this tool. We employed an "immersive" VR (with a head-mounted display) in an online course which provided students with the opportunity to interact with peers and engage in activities. We asked about perceptions of the learning experience with the technology and how using VR impacts students' performance. We also noted the benefits and challenges of VR in an online course. Students perceived VR as a helpful component of the course, although performance on the cardiovascular unit assessment did not differ compared to the previous semester without VR.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41979-023-00095-9.

Head-Mounted Projector for Manual Precision Tasks: Performance Assessment

The growing interest in augmented reality applications has led to an in-depth look at the performance of head-mounted displays and their testing in numerous domains. Other devices for augmenting the real world with virtual information are presented less frequently and usually focus on the description of the device rather than on its performance analysis. This is the case of projected augmented reality, which, compared to head-worn AR displays, offers the advantages of being simultaneously accessible by multiple users whilst preserving user awareness of the environment and feeling of immersion. This work provides a general evaluation of a custom-made head-mounted projector for the aid of precision manual tasks through an experimental protocol designed for investigating spatial and temporal registration and their combination. The results of the tests show that the accuracy (0.6±0.1 mm of spatial registration error) and motion-to-photon latency (113±12 ms) make the proposed solution suitable for guiding precision tasks.

Application of HoloLens-based augmented reality and three-dimensional printed anatomical tooth reference models in dental education

Tooth anatomy is fundamental knowledge used in everyday dental practice to reconstruct the occlusal surface during cavity fillings. The main objective of this project was to evaluate the suitability of two types of anatomical tooth reference models used to support reconstruction of the occlusal anatomy of the teeth: (1) a three-dimensional (3D)-printed model and (2) a model displayed in augmented reality (AR) using Microsoft HoloLens. The secondary objective was to evaluate three aspects impacting the outcome: clinical experience, comfort of work, and other variables. The tertiary objective was to evaluate the usefulness of AR in dental education. Anatomical models of crowns of three different molars were made using cone beam computed tomography image segmentation, printed with a stereolithographic 3D-printer, and then displayed in the HoloLens. Each participant reconstructed the occlusal anatomy of three teeth. One without any reference materials and two with an anatomical reference model, either 3D-printed or holographic. The reconstruction work was followed by the completion of an evaluation questionnaire. The maximum Hausdorff distances (Hmax) between the superimposed images of the specimens after the procedures and the anatomical models were then calculated. The results showed that the most accurate but slowest reconstruction was achieved with the use of 3D-printed reference models and that the results were not affected by other aspects considered. For this method, the Hmax was observed to be 630 μm (p = 0.004). It was concluded that while AR models can be helpful in dental anatomy education, they are not suitable replacements for physical models.

The role of spatial ability in mixed reality learning with the HoloLens

The use of mixed reality in science education has been increasing and as such it has become more important to understand how information is learned in these virtual environments. Spatial ability is important in many learning contexts, but especially in neuroanatomy education where learning the locations and spatial relationships between brain regions is paramount. It is currently unclear what role spatial ability plays in mixed reality learning environments, and whether it is different compared to traditional physical environments. To test this, a learning experiment was conducted where students learned neuroanatomy using both mixed reality and a physical plastic model of a brain (N = 27). Spatial ability was assessed and analyzed to determine its effect on performance across the two learning modalities. The results showed that spatial ability facilitated learning in mixed reality (β = 0.21, P = 0.003), but not when using a plastic model (β = 0.08, P = 0.318). A non-significant difference was observed between the modalities in terms of knowledge test performance (d = 0.39, P = 0.052); however, mixed reality was more engaging (d = 0.59, P = 0.005) and learners were more confident in the information they learned compared to using a physical model (d = 0.56, P = 0.007). Overall, these findings suggest that spatial ability is more relevant in virtual learning environments, where the ability to manipulate and interact with an object is diminished or abstracted through a virtual user interface.

Scoping review: The use of augmented reality in clinical anatomical education and its assessment tools

The purpose of this review was to identify the different augmented reality (AR) modalities used to teach anatomy to students, health professional trainees, and surgeons, and to examine the assessment tools used to evaluate the performance of various AR modalities. A scoping review of four databases was performed using variations of: (1) AR, (2) medical or anatomical teaching/education/training, and (3) anatomy or radiology or cadaver. Scientific articles were identified and screened for the inclusion and exclusion criteria as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses with extension for scoping reviews guidelines. Virtual reality was an exclusion criterion. From this scoping review, data were extracted from a total of 54 articles and the following four AR modalities were identified: head-mounted display, projection, instrument and screen, and mobile device. The usability, feasibility, and acceptability of these AR modalities were evaluated using a variety of quantitative and qualitative assessment tools. Within more recent years of AR integration into anatomy education, the assessment of visuospatial ability, cognitive load, time on task, and increasing academic achievement outcomes are variables of interest, which continue to warrant more exploration. Sufficiently powered studies using validated assessment tools must be conducted to better understand the role of AR in anatomical education.

Technological resources for teaching and learning about human anatomy in the medical course: Systematic review of literature

The consolidation of technology as an alternative strategy to cadaveric dissection for teaching anatomy in medical courses was accelerated by the recent Covid-19 pandemic, which caused the need for social distance policies and the closure of laboratories and classrooms. Consequently, new technologies were created, and those already been developed started to be better explored. However, information about many of these instruments and resources is not available to anatomy teachers. This systematic review presents the technological means for teaching and learning about human anatomy developed and applied in medical courses in the last ten years, besides the infrastructure necessary to use them. Studies in English, Portuguese, and Spanish were searched in MEDLINE, Scopus, ERIC, LILACS, and SciELO databases, initially resulting in a total of 875 identified articles, from which 102 were included in the analysis. They were classified according to the type of technology used: three-dimensional (3D) printing (n = 22), extended reality (n = 49), digital tools (n = 23), and other technological resources (n = 8). It was made a detailed description of technologies, including the stage of the medical curriculum in which it was applied, the infrastructure utilized, and which contents were covered. The analysis shows that between all technologies, those related to the internet and 3D printing are the most applicable, both in student learning and the financial cost necessary for its structural implementation.

AEducaAR, Anatomical Education in Augmented Reality: A Pilot Experience of an Innovative Educational Tool Combining AR Technology and 3D Printing

Gross anatomy knowledge is an essential element for medical students in their education, and nowadays, cadaver-based instruction represents the main instructional tool able to provide three-dimensional (3D) and topographical comprehensions. The aim of the study was to develop and test a prototype of an innovative tool for medical education in human anatomy based on the combination of augmented reality (AR) technology and a tangible 3D printed model that can be explored and manipulated by trainees, thus favoring a three-dimensional and topographical learning approach. After development of the tool, called AEducaAR (Anatomical Education with Augmented Reality), it was tested and evaluated by 62 second-year degree medical students attending the human anatomy course at the International School of Medicine and Surgery of the University of Bologna. Students were divided into two groups: AEducaAR-based learning ("AEducaAR group") was compared to standard learning using human anatomy atlas ("Control group"). Both groups performed an objective test and an anonymous questionnaire. In the objective test, the results showed no significant difference between the two learning methods; instead, in the questionnaire, students showed enthusiasm and interest for the new tool and highlighted its training potentiality in open-ended comments. Therefore, the presented AEducaAR tool, once implemented, may contribute to enhancing students' motivation for learning, increasing long-term memory retention and 3D comprehension of anatomical structures. Moreover, this new tool might help medical students to approach to innovative medical devices and technologies useful in their future careers.

Emerging simulation technologies in global craniofacial surgical training

The last few decades have seen an exponential growth in the development and adoption of novel technologies in medical and surgical training of residents globally. Simulation is an active and innovative teaching method, and can be achieved via physical or digital models. Simulation allows the learners to repeatedly practice without the risk of causing any error in an actual patient and enhance their surgical skills and efficiency. Simulation may also allow the clinical instructor to objectively test the ability of the trainee to carry out the clinical procedure competently and independently prior to trainee's completion of the program. This review aims to explore the role of emerging simulation technologies globally in craniofacial training of students and residents in improving their surgical knowledge and skills. These technologies include 3D printed biomodels, virtual and augmented reality, use of google glass, hololens and haptic feedback, surgical boot camps, serious games and escape games and how they can be implemented in low and middle income countries. Craniofacial surgical training methods will probably go through a sea change in the coming years, with the integration of these new technologies in the surgical curriculum, allowing learning in a safe environment with a virtual patient, through repeated exercise. In future, it may also be used as an assessment tool to perform any specific procedure, without putting the actual patient on risk. Although these new technologies are being enthusiastically welcomed by the young surgeons, they should only be used as an addition to the actual curriculum and not as a replacement to the conventional tools, as the mentor-mentee relationship can never be replaced by any technology.

Anatomy 3.0: Rediscovering Theatrum Anatomicum in the wake of Covid-19

The Covid-19 pandemic has challenged medical educators internationally to confront the challenges of adapting their present educational activities to a rapidly evolving digital world. In this article, the authors use anatomy education as proxy to reflect on and remap the past, present, and future of medical education in the face of these disruptions. Inspired by the historical Theatrum Anatomicum (Anatomy 1.0), the authors argue replacing current anatomy dissection laboratory (Anatomy 2.0) with a prototype anatomy studio (Anatomy 3.0). In this studio, anatomists are web-performers who not only collaborate with other foundational science educators to devise meaningful and interactive content but who also partner with actors, directors, web-designers, computer engineers, information technologists, and visual artists to master online interactions and processes in order to optimize students' engagement and learning. This anatomy studio also offers students opportunities to create their own online content and thus reposition themselves digitally, a step into developing a new competency of stage presence within medical education. So restructured, Anatomy 3.0 will prepare students with the skills to navigate an emergent era of tele and digital medicine as well as help to foreshadow forthcoming changes in medical education.