Virtual and Augmented Reality Enhancements to Medical and Science Student Physiology and Anatomy Test Performance: A Systematic Review and Meta-Analysis

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

BACKGROUND

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

DISCUSSION

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

CONCLUSION

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

Tooth Anatomy Inspector: A comprehensive assessment of an extended reality (XR) application designed for teaching and learning of root canal anatomy by students

AIM

To develop and evaluate a suitable software application for mobile devices designed for teaching root canal anatomy to undergraduate students in an informative and engaging manner.

METHODOLOGY

Extracted human teeth were scanned by μCT and digitized by converting into STL files. An extended reality (XR) application illustrating the root canal anatomy of the scanned teeth was developed. Prior to deployment, undergraduate dental students were voluntarily asked about their expectations regarding an educational application on tooth anatomy. After a testing phase of the application on a mobile device and within a virtual reality environment, a subsequent evaluation was conducted to assess their overall experience in relation to their initial expectations. Data were analysed using Kolmogorov-Smirnov test and Mann-Whitney U test. The level of significance was set to .05 (p = .05).

RESULTS

The application was able to meet the expectations of the students in all categories (p < .466-.731). Furthermore, it was evaluated as user-friendly (98.2%) and highly motivating for the purpose of learning more on root canal anatomy (100%).

CONCLUSION

Given the overwhelmingly positive reception from undergraduate dental students, the application emerges to be a promising supplementary teaching method for the endodontic curriculum.

Reviewing the current state of virtual reality integration in medical education - a scoping review

BACKGROUND

In medical education, new technologies like Virtual Reality (VR) are increasingly integrated to enhance digital learning. Originally used to train surgical procedures, now use cases also cover emergency scenarios and non-technical skills like clinical decision-making. This scoping review aims to provide an overview of VR in medical education, including requirements, advantages, disadvantages, as well as evaluation methods and respective study results to establish a foundation for future VR integration into medical curricula.

METHODS

This review follows the updated JBI methodology for scoping reviews and adheres to the respective PRISMA extension. We included reviews in English or German language from 2012 to March 2022 that examine the use of VR in education for medical and nursing students, registered nurses, and qualified physicians. Data extraction focused on medical specialties, subjects, curricula, technical/didactic requirements, evaluation methods and study outcomes as well as advantages and disadvantages of VR.

RESULTS

A total of 763 records were identified. After eligibility assessment, 69 studies were included. Nearly half of them were published between 2021 and 2022, predominantly from high-income countries. Most reviews focused on surgical training in laparoscopic and minimally invasive procedures (43.5%) and included studies with qualified physicians as participants (43.5%). Technical, didactic and organisational requirements were highlighted and evaluations covering performance time and quality, skills acquisition and validity, often showed positive outcomes. Accessibility, repeatability, cost-effectiveness, and improved skill development were reported as advantages, while financial challenges, technical limitations, lack of scientific evidence, and potential user discomfort were cited as disadvantages.

DISCUSSION

Despite a high potential of VR in medical education, there are mandatory requirements for its integration into medical curricula addressing challenges related to finances, technical limitations, and didactic aspects. The reported lack of standardised and validated guidelines for evaluating VR training must be overcome to enable high-quality evidence for VR usage in medical education. Interdisciplinary teams of software developers, AI experts, designers, medical didactics experts and end users are required to design useful VR courses. Technical issues and compromised realism can be mitigated by further technological advancements.

Nursing students' experiences with test-enhanced learning in teams: A cross-sectional study

BACKGROUND

Many nursing students struggle with the disciplines of biosciences, particularly Anatomy, physiology, and biochemistry, which are introduced in the first year. Nursing students' motivation, prior knowledge, and academic performance matter, but teaching methods may also influence students' learning process. Retrieving knowledge through testing has previously proven to enhance learning to a greater extent than time spent on other classroom activities.

OBJECTIVE

The aim of this study was to explore nursing students' experiences with test-enhanced learning as a way of enhancing learning in Anatomy, physiology, and biochemistry.

DESIGN

The lectures in each topic were followed by testing five days later. The tests were typically multiple-choice tests with short reply-times. The effect was measured in terms of students' self-reported level of satisfaction with test-enhanced learning, and their performance on the final exam in Anatomy, physiology, and biochemistry. The tests were performed in teams to avoid stressful situations that could negatively affect the students' learning process.

RESULTS

A key achievement from introducing test-enhanced learning in the Anatomy, physiology, and biochemistry course was a perceived higher learning outcome and increased engagement and motivation among the students, resulting in resulting in more students achieving the highest grades (A and B). However, the students' academic results from upper secondary school also seemed to matter for their achievements on the final exam.

CONCLUSION

These results indicated that many students benefited from test-enhanced learning, suggesting that test-enhanced learning can be an important teaching strategy in nursing education, particularly for biosciences.

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.

Encouraging Study in Health Sciences: Informing School Students Through Interprofessional Healthcare Simulations

INTRODUCTION

Although commonly considered postgraduate-level study, universities are increasingly providing options for direct undergraduate entry into health professional programs. This presents a need to inform high school students about the wide variety of careers available in the medical and allied health professions.

METHODS

To accomplish this, the developed "Health Simulation Experience" uses a case-based learning approach to introduce high school students to careers in health through the management and care of simulated patients. Participants worked through 3 simulated scenarios during the 1-day event and reported their perceptions on written feedback forms at the conclusion. A qualitative research approach was used to identify whether the simulation-based structure was an appropriate approach to assist with enhancing their understanding of career options within the primary and allied healthcare systems.

RESULTS

Of the 528 student attendees who engaged with the program between 2018-2022, 333 provided ratings of their experience (94% overall satisfaction) and written feedback. From qualitative analysis of written comments, the following 3 key themes emerged: the approach provided insights into health professions careers; they enjoyed the authentic and immersive approach to learning; and the event developed an understanding of commonly performed clinical skills.

CONCLUSIONS

Overall, the use of case-based learning with interprofessional hands-on experiences is an effective approach to introduce students to future study options and career pathways in primary and allied health.

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

INTRODUCTION

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

REVIEW OF LITERATURE

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

SUBJECTS

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

METHODS

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

RESULTS

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

DISCUSSION AND CONCLUSION

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

Smart glasses use experience of nursing graduate students: qualitative study

BACKGROUND

Immersive technologies such as smart glasses can benefit nursing training and clinical practice. In this paper, we explore the views of nursing graduate students about their experience with smart glasses.

METHODS

Nursing graduate students (n = 13) were recruited using purposeful sampling. First, a virtual reality intervention for hyperglycemia in nursing care was shown. This was an attempt to introduce people to the technology and start discussions about how it might be used in nursing care. After that, participants underwent online interviews. Thematic analysis was used to examine the data.

RESULTS

The study findings indicated that the use of smart glasses as an enjoyable learning experience and immersive games positively affects nursing students. In addition, it was determined that they had negative experiences such as costs, lack of infrastructure, and smart glass side effects.

CONCLUSIONS

Smart glasses indicate good usability and availability in nursing education and potential for use in hospital nursing practice.

Immersive virtual reality and augmented reality in anatomy education: A systematic review and meta-analysis

The purpose of this review was to (1) analyze the effectiveness of immersive virtual reality (iVR) and augmented reality (AR) as teaching/learning resources (collectively called XR-technologies) for gaining anatomy knowledge compared to traditional approaches and (2) gauge students' perceptions of the usefulness of these technologies as learning tools. This meta-analysis, previously registered in PROSPERO (CRD42023423017), followed PRISMA guidelines. A systematic bibliographical search, without time parameters, was conducted through four databases until June 2023. A meta-analytic approach investigated knowledge gains and XR's usefulness for learning. Pooled effect sizes were estimated using Cohen's standardized mean difference (SMD) and 95% confidence intervals (95% CI). A single-group proportional meta-analysis was conducted to quantify the percentage of students who considered XR devices useful for their learning. Twenty-seven experimental studies, reporting data from 2199 health sciences students, were included for analysis. XR-technologies yielded higher knowledge gains than traditional approaches (SMD = 0.40; 95% CI = 0.22 to 0.60), especially when used as supplemental/complementary learning resources (SMD = 0.52; 95% CI = 0.40 to 0.63). Specifically, knowledge performance using XR devices outperformed textbooks and atlases (SMD = 0.32; 95% CI = 0.10 to 0.54) and didactic lectures (SMD = 1.00; 95% CI = 0.57 to 1.42), especially among undergraduate students (SMD = 0.41; 95% CI = 0.20 to 0.62). XR devices were perceived to be more useful for learning than traditional approaches (SMD = 0.54; 95% CI = 0.04 to 1), and 80% of all students who used XR devices reported these devices as useful for learning anatomy. Learners using XR technologies demonstrated increased anatomy knowledge gains and considered these technologies useful for learning anatomy.

Neuroanatomy in virtual reality: Development and pedagogical evaluation of photogrammetry-based 3D brain models

Anatomy studies are an essential part of medical training. The study of neuroanatomy in particular presents students with a unique challenge of three-dimensional spatial understanding. Virtual Reality (VR) has been suggested to address this challenge, yet the majority of previous reports have implemented computer-generated or imaging-based models rather than models of real brain specimens. Using photogrammetry of real human bodies and advanced editing software, we developed 3D models of a real human brain at different stages of dissection. Models were placed in a custom-built virtual laboratory, where students can walk around freely, explore, and manipulate (i.e., lift the models, rotate them for different viewpoints, etc.). Sixty participants were randomly assigned to one of three learning groups: VR, 3D printed models or read-only, and given 1 h to study the white matter tracts of the cerebrum, followed by theoretical and practical exams and a learning experience questionnaire. We show that following self-guided learning in virtual reality, students demonstrate a gain in spatial understanding and an increased satisfaction with the learning experience, compared with traditional learning approaches. We conclude that the models and virtual lab described in this work may enhance learning experience and improve learning outcomes.

Virtual and augmented reality in cardiovascular care in low and middle income country

The global health sector has witnessed an escalating integration of Virtual Reality (VR) and Augmented Reality (AR) technologies, particularly in high-income countries. The application of these cutting-edge technologies is gradually extending to Low- and Middle-Income Countries (LMICs), notably in the domain of cardiovascular care. AR and VR technologies are revolutionizing cardiovascular care by offering solutions for diagnosis, medical training, and surgical planning. AR and VR provide detailed and immersive visualizations of cardiac structures, aiding in diagnosis and intervention planning. In cardiovascular care, VR reduces patient-reported pain, eases anxiety, and accelerates post-procedural recovery. AR and VR are also valuable for life support training, creating immersive and controlled learning environments. AR and VR have the potential to significantly impact healthcare in low- and middle-income countries with enhanced accessibility and affordability. This review outlines the existing spectrum of VR and AR adoption and its burgeoning utility in the cardiovascular domain within LMICs.

3D human anatomy augmentation over a mannequin for the training of nursing skills

BACKGROUND

The in-depth understanding of human anatomy is the foundation for safety in nursing practice. Augmented reality is an emerging technology that can be used for integrative learning in nursing education.

OBJECTIVE

The study aimed to develop a human anatomy-based skill training system and pilot test its usability and feasibility.

METHODS

Twenty-seven nursing students participated in 3D anatomy-based skill training for intramuscular injection and Levin tube feeding using HoloLens 2. Various user interfaces including pictures, videos, animation graphics, and annotation boxes assisted users with a comprehensive understanding of the step-by-step procedures for these techniques. A one-group pre-post test was conducted to observe changes in skill performance competency, usability, and learning satisfaction.

RESULTS

After study participation, a statistically significant improvement in skill performance competency (p< 0.05) was observed. The usability results showed that students were satisfied with the usefulness of the program (9.55 ± 0.49) and scored highly for the intention to participate in other educational programs (9.62 ± 0.59). A high level of learning satisfaction was achieved (9.55 ± 0.49), with positive responses in fostering students' engagement and excitement in the application of cutting-edge technology.

CONCLUSION

The 3D anatomy-based nursing skill training demonstrated good potential to improve learning outcomes and facilitate engagement in self-directed practice. This can be integrated into undergraduate nursing education as an assistant teaching tool, contributing to the combination of knowledge and practice.

Does Extended Reality Simulation Improve Surgical/Procedural Learning and Patient Outcomes When Compared With Standard Training Methods?: A Systematic Review

INTRODUCTION

The use of extended reality (XR) technologies, including virtual, augmented, and mixed reality, has increased within surgical and procedural training programs. Few studies have assessed experiential learning- and patient-based outcomes using XR compared with standard training methods.

METHODS

As a working group for the Society for Simulation in Healthcare, we used Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and a PICO strategy to perform a systematic review of 4238 articles to assess the effectiveness of XR technologies compared with standard training methods. Outcomes were grouped into knowledge, time-to-completion, technical proficiency, reactions, and patient outcomes. Because of study heterogeneity, a meta-analysis was not feasible.

RESULTS

Thirty-two studies met eligibility criteria: 18 randomized controlled trials, 7 comparative studies, and 7 systematic reviews. Outcomes of most studies included Kirkpatrick levels of evidence I-III (reactions, knowledge, and behavior), while few reported level IV outcomes (patient). The overall risk of bias was low. With few exceptions, included studies showed XR technology to be more effective than standard training methods in improving objective skills and performance, shortening procedure time, and receiving more positive learner ratings. However, XR use did not show significant differences in gained knowledge.

CONCLUSIONS

Surgical or procedural XR training may improve technical skill development among trainees and is generally favored over standard training methods. However, there should be an additional focus on how skill development translates to clinically relevant outcomes. We recommend longitudinal studies to examine retention and transfer of training to clinical settings, methods to improve timely, adaptive feedback for deliberate practice, and cost analyses.

Developing 3D models using photogrammetry for virtual reality training in anatomy

Virtual reality (VR) is an increasingly available resource with numerous applications to medical education, and as a teaching tool has been widely validated in the literature. Photogrammetry, the process of overlapping two-dimensional (2D) photographic images of three-dimensional (3D) objects to create a 3D image or "model," can be used in conjunction with VR to create pedagogically sound learning modules for anatomy education. However, to date, there has not been a detailed description of the process of developing and implementing an in-house VR tool to supplement anatomy instruction. In this article, we examine the methods, benefits, and challenges of using photogrammetry to implement a VR classroom that capitalizes on the strengths of a traditional body donor-based course and the unique strengths of VR. Using off-the-shelf equipment, developing VR content and a VR curriculum is both feasible and approachable for medical educators.

A new dimension in medical education: Virtual reality in anatomy during COVID-19 pandemic

Virtual reality technology has been increasingly used in the field of anatomy education, particularly in response to the COVID-19 pandemic. Virtual reality in anatomy (VRA) allows the creation of immersive, three-dimensional environments or experiences that can interact in a seemingly real or physical way. A comprehensive search of electronic databases was conducted to identify relevant studies. The search included studies published between 2020 and June 2023. The use of VRA education has been shown to be effective in improving students' understanding and retention of knowledge, as well as developing practical skills such as surgical techniques. VRA can allow students to visualize and interact with complex structures and systems in a way that is not possible with traditional methods. It can also provide a safe and ethical alternative to cadavers, which may be in short supply or have access restrictions. Additionally, VRA can be used to create customized learning experiences, allowing students to focus on specific areas of anatomy or to repeat certain exercises as needed. However, there are also limitations to the use of VRA education, including cost and the need for specialized equipment and training, as well as concerns about the realism and accuracy of VRA models. To fully utilize the potential of VRA education, it is important for educators to carefully consider the appropriate use of VR and to continuously evaluate its effectiveness. It is important for educators to carefully consider the appropriate use of VRA and to continuously evaluate its effectiveness to fully utilize its potential.

Using XR (Extended Reality) for Behavioral, Clinical, and Learning Sciences Requires Updates in Infrastructure and Funding

Extended reality (XR, including augmented and virtual reality) creates a powerful intersection between information technology and cognitive, clinical, and education sciences. XR technology has long captured the public imagination, and its development is the focus of major technology companies. This article demonstrates the potential of XR to (1) deliver behavioral insights, (2) transform clinical treatments, and (3) improve learning and education. However, without appropriate policy, funding, and infrastructural investment, many research institutions will struggle to keep pace with the advances and opportunities of XR. To realize the full potential of XR for basic and translational research, funding should incentivize (1) appropriate training, (2) open software solutions, and (3) collaborations between complementary academic and industry partners. Bolstering the XR research infrastructure with the right investments and incentives is vital for delivering on the potential for transformative discoveries, innovations, and applications.

Mixed Reality as a Teaching Tool for Medical Students in Neurosurgery

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

Virtual reality: a technology to promote active learning of physiology for students across multiple disciplines

The usefulness of virtual reality (VR) technology in physiology education is largely unexplored. Although VR has the potential to enrich learning experience by enhancing the spatial awareness of students, it is unclear whether VR contributes to active learning of physiology. In the present study, we used a mixed-method research approach to investigate students' perceptions of physiology learning based on VR simulations. Quantitative and qualitative data indicate that the implementation of VR learning environments improves the quality of physiology education by promoting active learning in terms of interactive engagement, interest, problem-solving skills, and feedback. In the Technology-Enabled Active Learning Inventory, which consisted of 20 questions to which students responded along a 7-point Likert scale, the majority of students agreed that VR learning of physiology not only stimulated their curiosity (77%; P < 0.001) but also allowed them to obtain knowledge through diverse formats (76%; P < 0.001), participate in thought-provoking dialogue (72%; P < 0.001), and interact better with peers (72%; P < 0.001). Positive responses in the social, cognitive, behavioral, and evaluative domains of active learning were received from students across different disciplines, including medicine, Chinese medicine, biomedical sciences, and biomedical engineering. Their written feedback showed that VR enhanced their interest in physiology and facilitated the visualization of physiological processes to improve their learning. Overall, this study supports that the integration of VR technology into physiology courses can be an effective teaching strategy.NEW & NOTEWORTHY Virtual reality (VR) improves physiology education by promoting active learning in terms of interactive engagement, interest, problem-solving skills, and feedback. Positive responses toward multiple components of active learning were received from students across different disciplines. The majority of students agreed that VR learning of physiology not only stimulated their curiosity but also allowed them to obtain knowledge through diverse formats, participate in thought-provoking dialogue, and interact better with peers.

Unpacking and validating the "integration" core concept of physiology by an Australian team

Consensus was reached on seven core concepts of physiology using the Delphi method, including "integration," outlined by the descriptor "cells, tissues, organs, and organ systems interact to create and sustain life." This core concept was unpacked by a team of 3 Australian physiology educators into hierarchical levels, identifying 5 themes and 10 subthemes, up to 1 level deep. The unpacked core concept was then circulated among 23 experienced physiology educators for comments and to rate both level of importance and level of difficulty for each theme and subtheme. Data were analyzed using a one-way ANOVA to compare between and within themes. The main theme (theme 1: the body is organized within a hierarchy of structures, from atoms to molecules, cells, tissues, organs, and organ systems) was almost universally rated as Essential. Interestingly, the main theme was also rated between Slightly Difficult to Not Difficult, which was significantly different from all other subthemes. There were two separate subsets of themes in relation to importance, with three themes rating between Essential and Important and the two other themes rating as Important. Two subsets in the difficulty of the main themes were also identified. While many core concepts can be taught concurrently, Integration requires the application of prior knowledge, with the expectation that learners should be able to apply concepts from "cell-cell communication," "homeostasis," and "structure and function," before understanding the overall Integration core concept. As such, themes from the Integration core concept should be taught within the endmost semesters of a Physiology program.NEW & NOTEWORTHY This article proposes the inclusion of a core concept regarding "integration" into physiology-based curricula, with the descriptor "cells, tissues, organs, and organ systems interact to create and sustain life." This concept expands prior knowledge and applies physiological understanding to real-world scenarios and introduces contexts such as medications, diseases, and aging to the student learning experience. To comprehend the topics within the Integration core concept, students will need to apply learned material from earlier semesters.

Augmented reality-The way forward in patient education for intracranial aneurysms? A qualitative exploration of views, expectations and preferences of patients suffering from an unruptured intracranial aneurysm regarding augmented reality in patient education

Objectives: The goal of this project is to explore the views, expectations and preferences of patients with an unruptured intracranial aneurysm regarding the use of AR in patient education. Methods: To gain an in-depth understanding of the patients' perspective, a face-to-face interview study was conducted using an interview protocol with a predefined topic list. All interviews were audio-recorded and transcribed verbatim afterwards. Transcripts were analyzed using thematic content analyses. Coding was performed using Atlas.ti software. Results: Seventeen interviews were conducted. The views, expectations and preferences of patients regarding patient education with AR could be subdivided into 15 categories, which could be grouped into 4 general themes: 1) experiences with current patient education, 2) expectations of AR in patient education, 3) opportunities and limitations of AR, and 4) out-of-hospital use of an AR application. Patients' expectations were predominantly positive regarding improving patients' understanding of their medical situation and doctor-patient communication. Discusssion: This study suggests that patients with unruptured intracranial aneurysms are open to receive patient education regarding their disease with AR. Patients expect that AR models can help patients with intra-cranial aneurysms better understand their disease, treatment options and risks. Additionally, patients expect AR could improve doctor-patient communication.

Virtual Models Using Augmented Reality May Provide a Suitable Supplement, Although Not a Physical Specimen Replacement, in Pathology Education

There is a growing trend towards using virtual models within medical programs. In some disciplines, the use of human samples or cadavers is increasingly being replaced by technology-enhanced modes of delivery. Although this transition can occur with some success, the impact of virtual representations to replace depictions of disease states from dissected samples displayed in acrylic pathological specimen jars has never been investigated. This study assessed medical student perceptions of replacing teaching through physical specimens (i.e. specimen jars or real tissue) with virtual models across cardiovascular, neural, musculoskeletal, haematology, endocrine and immunological pathology curricula. Seventy-four year 2 (n = 31) and year 5 (n = 43) medical students participated in the study. After being provided with a demonstration of a potential tablet-based lesson on lung pathology using augmented reality, participants completed a Likert-scale survey and provided written feedback. Questions requested thoughts on the usefulness of the 3D-virtual model compared to physical specimens and whether current teaching in pathology could be replaced by technology-enhanced practices. Most students (58.15%) disagreed on the replacement of physical specimens with virtual models. Furthermore, over half the students (55.4%) indicated that the replacement of physical specimens with augmented reality models would not be beneficial for pathology learning. Nearly two-thirds of students believed that the absence of physical specimens would negatively impact their knowledge. Nonetheless, many students would appreciate the opportunity to revise pathology away from the labs with virtual options. As such, an overwhelming number of students (89.2%) would prefer having both physical specimens and virtual models for learning. This study identifies that technology-enhanced learning may be a suitable supplement alongside traditional hands-on teaching but should not replace the use of pathological specimens within a medical curriculum.

Immersive Virtual Reality and Cadaveric Bone are Equally Effective in Skeletal Anatomy Education: A Randomized Crossover Noninferiority Trial

OBJECTIVE

Immersive virtual reality (IVR) technology is transforming medical education. Our aim was to compare the effectiveness of IVR with cadaveric bone models in teaching skeletal anatomy.

DESIGN

A randomized crossover noninferiority trial was conducted.

SETTING

Anatomy laboratory of a large medical school.

PARTICIPANTS

Incoming first-year medical students. Participants were randomized to IVR or cadaveric groups studying upper limb skeletal anatomy, and then were crossed over to use the opposite tool, to study lower limb skeletal anatomy. Participants in both groups completed a pre-and postintervention knowledge test. The primary endpoint of the study was change in performance from the pre-to postintervention knowledge test. Surveys were completed to assess participant's impressions on IVR as an educational tool.

RESULTS

Fifty first-year medical students met inclusion criteria and were randomized. Among all students, the average score on the preintervention knowledge test was 14.6% (standard deviation (SD) = 18.2%) and 25.0% (SD = 17%) for upper and lower limbs, respectively. Percentage increase in scores between pre-and postintervention knowledge test, was 15.0% in the upper limb IVR group, and 16.7% for upper limb cadaveric bones (p = 0.286). For the lower limb, score increase was 22.6% in the IVR and 22.5% in the cadaveric bone group (p = 0.936). 79% of participants found that IVR was most valuable for teaching 3-dimensional orientation, anatomical relationships, and key landmarks. Majority of participants were favorable towards combination use of traditional methods and IVR technology for learning skeletal anatomy (LSM>3).

CONCLUSIONS

In this randomized controlled trial, there was no significant difference in knowledge after using IVR or cadaveric bones for skeletal anatomy education. These findings have further implications for medical schools that face challenges in acquiring human cadavers and cadaveric parts.

Visual Gait Analysis Based on UE4

With the development of artificial intelligence technology, virtual reality technology has been widely used in the medical and entertainment fields, as well as other fields. This study is supported by the 3D modeling platform in UE4 platform technology and designs a 3D pose model based on inertial sensors through blueprint language and C++ programming. It can vividly display changes in gait, as well as changes in angles and displacements of 12 parts such as the big and small legs and arms. It can be used to combine with the module of capturing motion which is based on inertial sensors to display the 3D posture of the human body in real-time and analyze the motion data. Each part of the model contains an independent coordinate system, which can analyze the angle and displacement changes of any part of the model. All joints of the model are interrelated, the motion data can be automatically calibrated and corrected, and errors measured by an inertial sensor can be compensated, so that each joint of the model will not separate from the whole model and there will not occur actions that against the human body's structures, improving the accuracy of the data. The 3D pose model designed in this study can correct motion data in real time and display the human body's motion posture, which has great application prospects in the field of gait analysis.

A mixed-reality stimulator for lumbar puncture training: a pilot study

BACKGROUND

The simulation is one of the basic methods of medical education, which is often used for procedural skills training. However, the existing simulator lacks internal anatomical landmarks. The study developed a mixed-reality stimulator and evaluated its usability and feasibility in lumbar puncture training.

METHODS

The study recruited 40 subjects, including medical students, residents and faulty with varied levels of experience. Before training, participants completed the questionnaire about the basic information and watched a presentation about mixed reality. After practicing on mixed-reality stimulator, which provided internal anatomical structure, the examination was carried out and the results were documented. At the end of the training, trainees completed a survey of MR technology.

RESULTS

In this study, participants generally believed that the MR technology was very realistic (90%), and that the presentation of internal anatomy could help the operation (95%). Moreover, 72.5% and 75%, respectively, strongly agreed that the MR technology promoted learning and should be used in medical training. After this training, the success rate of puncture and the puncture time were significantly improved in experienced and non-experienced participants.

CONCLUSION

The existing simulator was easy to be transformed into MR simulator. This study showed the usability and feasibility of MR simulator in lumbar puncture training. As a potentially good tool to simulated medical skills training, next, MR technology would be developed and evaluated in more clinical skills teaching scenarios.

The Triple-S framework: ensuring scalable, sustainable, and serviceable practices in educational technology

Educational institutions are increasingly investing into digital delivery, acquiring new devices, and employing novel software and services. The rising costs associated with maintenance, in combination with increasing redundancy of older technologies, presents multiple challenges. While lesson content itself may not have changed, the educational landscape constantly evolves, where tertiary institutions are incorporating new modes of content delivery, hybrid-style learning, and interactive technologies. Investments into digital expansions must be taken with caution, particularly prior to the procurement of technology, with a need for the proposed interventions' scalability, sustainability, and serviceability to be considered. This article presents the Triple-S framework for educators, administrators, and educational institutions, and outlines examples of its application within curricula. The paper synthesises research evidence to provide the foundation underlying the key principles of the Triple-S framework, presenting a useful model to use when evaluating digital interventions. Utilising the framework for decisions regarding the acquisition of educational technology, devices, software, applications, and online resources can assist in the assurance of viable and  appropriate investments.

Virtual Practical Examination for Student Nurse Educators in Health Sciences Education during the COVID-19 Pandemic: A Narrative Review

(1) Background: There is a gap in the literature that explores challenges and opportunities relating to virtual or e-assessment health science education with particular relevance to the Health Sciences Education practical examination for student nurse educators. Therefore, this review aimed to address this gap and provide recommendations for enhancing identified opportunities and for overcoming identified challenges.; (2) Methods: The review was conducted across Google Scholar, PubMed/MEDLINE, Science Direct, Directory of Open Access Journals, Complementary Index, SCOPUS, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) with the intention of identifying opportunities and challenges presented by e-assessment in the HSE practical examination for student nurse educators during the COVID-19 pandemic.; (3) Results: The following aspects are discussed: (1) opportunities, including benefits, for both student nurse educators and facilitators and opportunities for Nursing Education; and (2) challenges, including issues with accessibility and connectivity as well as the attitudes of both students and facilitators.; (4) Conclusions: Despite challenges which included connectivity issues that led to frustration and stress, the unpreparedness and attitudes of students and facilitators, there are some opportunities that have emerged from e-assessment that can be beneficial to both the students and the facilitators, as well as the institutions. These include a reduced administrative burden, improved teaching and learning, and immediate feedback from facilitators to students and from students to facilitators.

Determinants of Learning Anatomy in an Immersive Virtual Reality Environment - A Scoping Review

Given the decline of cadavers as anatomy teaching tools, immersive virtual reality (VR) technology has gained popularity as a potential alternative. To better understand how to maximize the educational potential of VR, this scoping review aimed to identify potential determinants of learning anatomy in an immersive VR environment. A literature search yielded 4523 studies, 25 of which were included after screening. Six common factors were derived from secondary outcomes in these papers: cognitive load, cybersickness, student perceptions, stereopsis, spatial understanding, and interactivity. Further objective research investigating the impact of these factors on anatomy examination performance is required.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-022-01701-y.

Universal design for learning in anatomy education of healthcare students: A scoping review

There are concerns among healthcare practitioners about poor anatomical knowledge among recent healthcare graduates. Universal Design for Learning (UDL) is a framework developed to enhance students' experience of learning and help students to become motivated learners. This scoping review identified whether UDL has been utilized in third level healthcare education and if so, whether it had been used to enhance student motivation to study anatomy. Seven online databases were searched for studies reporting the use of UDL in the curricula of medical, dental, occupational therapy (OT) or speech and language therapy (SLT) programs. Studies were screened for eligibility with set inclusion criteria. Data were extracted and analyzed. Analysis revealed that UDL was not specifically mentioned in any of the studies thus there are no published studies on UDL being formally applied in healthcare education. However, the authors identified 33 publications that described teaching methods which aligned with UDL in anatomy curricula and a thematic analysis yielded four main themes relating to teaching strategies being employed. Universal design for learning was not mentioned specifically, indicating that educators may not be aware of the educational framework, although they appeared to be utilizing aspects of it in their teaching. The review revealed that there is a lack of research concerning the anatomy education of OT and SLT students. The role of UDL in enhancing motivation to learn anatomy in medical, dental, OT and SLT programs has yet to be explored.

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

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

Technology-Enhanced Preclinical Medical Education (Anatomy, Histology and Occasionally, Biochemistry): A Practical Guide

The recent explosion of technological innovations in mobile technology, virtual reality (VR), digital dissection, online learning platform, 3D printing, and augmented reality (AR) has provided new avenues for improving preclinical education, particularly in anatomy and histology education. Anatomy and histology are fundamental components of medical education that teach students the essential knowledge of human body structure and organization. However, these subjects are widely considered to be some of the most difficult disciplines for healthcare students. Students often face challenges in areas such as the complexity and overwhelming volume of knowledge, difficulties in visualizing body structures, navigating and identifying tissue specimens, limited exposure to learning materials, and lack of clinical relevance. The COVID-19 pandemic has further exacerbated the situation by reducing face-to-face teaching opportunities and affecting the availability of body donations for medical education.To overcome these challenges, educators have integrated various educational technologies, such as virtual reality, digital 3D anatomy apps, 3D printing, and AI chatbots, into preclinical education. These technologies have effectively improved students' learning experiences and knowledge retention. However, the integration of technologies into preclinical education requires appropriate pedagogical approaches and logistics to align with educational theories and achieve the intended learning outcomes.The chapter provides practical guidance and examples for integrating technologies into anatomy, histology, and biochemistry preclinical education. The author emphasizes that every technology has its own benefits and limitations and is best suited to specific learning scenarios. Therefore, it is recommended that educators and students should utilize multiple modalities for teaching and learning to achieve the best outcomes. The chapter also acknowledges that cadaver-based anatomy education is essential and proposes that educational technologies can serve as a crucial complement for promoting active learning, problem solving, knowledge application, and enhancing conventional cadaver-based education.

[Use of virtual reality in ENT teaching: an alternative to the conventional anatomic model]

BACKGROUND

Assessment of the middle ear requires a complex three-dimensional understanding, the teaching of which is just as important for curricular teaching as for further medical training.

OBJECTIVE

The extent to which virtual reality (VR) can be used as an alternative to conventional educational methods for teaching anatomy, physiology, and pathology was examined. The objective was to evaluate a VR-supported teaching method in comparison to conventional learning on an anatomic model.

METHODS

The study was conducted as a prospective two-arm single-center trial in the summer semester of 2021 at the University Hospital of Freiburg. During a seminar on the topic of the middle ear, 177 students were randomly assigned to either a control or a study group. Demographic data were collected in advance and a quantitative evaluation regarding competence and personal attitude was performed. After processing the models, the groups were formatively tested and the results were analyzed comparatively. Ultimately, crossover of the models enabled a qualitative comparative evaluation of the models and a renewed quantitative evaluation was carried out.

RESULTS

No significant differences between the groups were identified in the formative testing. The evaluations demonstrated increased self-assessment of knowledge competence, a tendency towards a highly positive attitude towards the VR method after completion of the course, and generally beneficial subjective aspects of the VR model. In addition, there was a positive effect and a positive perception of the delivery of anatomic content.

CONCLUSION

Use of VR is suitable as an alternative to conventional teaching methods in curricular ENT teaching. The current evidence demonstrates the equality of VR and indicates its great potential for future educational tasks.

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.

Perceptions of Augmented Reality in Remote Medical Care: Interview Study of Emergency Telemedicine Providers (Preprint)

BACKGROUND

Augmented reality (AR) and virtual reality (VR) have increasingly appeared in the medical literature in the past decade, with AR recently being studied for its potential role in remote health care delivery and communication. Recent literature describes AR's implementation in real-time telemedicine contexts across multiple specialties and settings, with remote emergency services in particular using AR to enhance disaster support and simulation education. Despite the introduction of AR in the medical literature and its potential to shape the future of remote medical services, studies have yet to investigate the perspectives of telemedicine providers regarding this novel technology.

OBJECTIVE

This study aimed to understand the applications and challenges of AR in telemedicine anticipated by emergency medicine providers with a range of experiences in using telemedicine and AR or VR technology.

METHODS

Across 10 academic medical institutions, 21 emergency medicine providers with variable exposures to telemedicine and AR or VR technology were recruited for semistructured interviews via snowball sampling. The interview questions focused on various potential uses of AR, anticipated obstacles that prevent its implementation in the telemedicine area, and how providers and patients might respond to its introduction. We included video demonstrations of a prototype using AR during the interviews to elicit more informed and complete insights regarding AR's potential in remote health care. Interviews were transcribed and analyzed via thematic coding.

RESULTS

Our study identified 2 major areas of use for AR in telemedicine. First, AR is perceived to facilitate information gathering by enhancing observational tasks such as visual examination and granting simultaneous access to data and remote experts. Second, AR is anticipated to supplement distance learning of both minor and major procedures and nonprocedural skills such as cue recognition and empathy for patients and trainees. AR may also supplement long-distance education programs and thereby support less specialized medical facilities. However, the addition of AR may exacerbate the preexisting financial, structural, and literacy barriers to telemedicine. Providers seek value demonstrated by extensive research on the clinical outcome, satisfaction, and financial benefits of AR. They also seek institutional support and early training before adopting novel tools such as AR. Although an overall mixed reception is anticipated, consumer adoption and awareness are key components in AR's adoption.

CONCLUSIONS

AR has the potential to enhance the ability to gather observational and medical information, which would serve a diverse set of applications in remote health care delivery and education. However, AR faces obstacles similar to those faced by the current telemedicine technology, such as lack of access, infrastructure, and familiarity. This paper discusses the potential areas of investigation that would inform future studies and approaches to implementing AR in telemedicine.

Utilizing the metaverse in anatomy and physiology

Of the many disruptive technologies being introduced within modern curricula, the metaverse, is of particular interest for its ability to transform the environment in which students learn. The modern metaverse refers to a computer-generated world which is networked, immersive, and allows users to interact with others by engaging a number of senses (including eyesight, hearing, kinesthesia, and proprioception). This multisensory involvement allows the learner to feel part of the virtual environment, in a way that somewhat resembles real-world experiences. Socially, it allows learners to interact with others in real-time regardless of where on earth they are located. This article outlines 20 use-cases where the metaverse could be employed within a health sciences, medicine, anatomy, and physiology disciplines, considering the benefits for learning and engagement, as well as the potental risks.

Incorporating Mixed Reality for Knowledge Retention in Physiology, Anatomy, Pathology, and Pharmacology Interdisciplinary Education: A Randomized Controlled Trial

Disease education is a fundamental component in health science and medicine curricula, as it prepares students for their progression into health profession careers. However, this requires an ability to integrate concepts across multiple disciplines. Technology-enhanced interventions may bridge this gap, and this study assessed the effectiveness of a textbook-style or a three-dimensional mixed reality (MR, a hybrid of augmented and virtual reality) HoloLens resource for student learning and knowledge retention using asthma as a model of disease. Sixty-seven first-year undergraduate health science and medical students were randomized into two groups to complete a lesson on the physiology, anatomy, pathology, and pharmacology of asthma, delivered through either a textbook-style (n = 34) or MR (n = 33) resource. Participants took part in the study in small groups and completed the intervention and surveys in separate areas of a large laboratory space. A pre-test prior to the lesson included multiple-choice questions, with the post-test having additional multiple-choice questions to assess learning. A follow-up test to assess retention was performed two weeks later. Pre- and post-test scores revealed increased learning across both the textbook (p = 0.001) and MR (p = 0.05) interventions, although higher test results were obtained by those using the textbook-style resource (p < 0.05). There was no difference between groups in knowledge retention scores. Although the textbook-style resource was more effective for increasing test results, participants perceived MR as more favorable, highlighting the experience as enjoyable and useful. This study presents MR as an option for integration in cases where educators wish to enhance student enjoyment of the learning experience. However, the results suggest that traditional text-based resources persist as a fundamental delivery mode within a modern curriculum.

An authentic learner-centered planetary health assignment: A five-year evaluation of student choices to address Sustainable Development Goal 13 (Climate Action)

A Code Red has been declared for the planet and human health. Climate change (e.g., increasing temperatures, adverse weather events, rising sea levels) threatens the planet's already declining ecosystems. Without urgent action, all of Earth's inhabitants face an existential threat. Health professions education should therefore prepare learners to not only practice in a changing world, but authentic educational activities should also develop competencies for global and planetary citizenship. Planetary health has been integrated across the five-year Bond University (Australia) medical curriculum. It begins in the second week of Year 1 and ends with a session on Environmentally Sustainable Healthcare in the General Practice rotation in the final year. The purpose of this article is to describe the outcomes of the first 5 years (2018-2022) of a learner-centered planetary health assignment, underpinned by the 2030 United Nations (UN) Sustainable Development Goals (SDGs), in the second year of a five-year medical program. Using systems and/or design thinking with a focus on SDG13 (Climate Action) plus a second SDG of choice, self-selected teams of 4-6 students submit a protocol (with feedback) to develop a deliverable "product" for an intended audience. Data analysis of the first 5 years of implementation found that the most frequently selected SDGs in addition to SDG13 were: SDG12 Sustainable Production and Consumption (41% of teams), mostly relating to healthcare emissions and waste; SDG3 Health and Well-being (22%), generally involving the impact of air pollution; and SDG6 Clean Water and Sanitation (15%). A survey at the concluding conference garnered student feedback across various criteria. The planetary health assignment is authentic in that teams provide solutions to address climate change. Where appropriate, final "products" are sent to local or federal ministers for consideration (e.g., policy proposals) or integrated into the curriculum (e.g., learning modules). We believe that the competencies, attitudes, and values fostered through engagement with planetary health. Throughout the medical program, as evidenced by their evaluations, stands students in good stead to be change agents, not only in clinical practice but in society. An awareness has been created about the need for planetary citizenship in addition to global citizenship.

Flipped anatomy classroom integrating multimodal digital resources shows positive influence upon students' experience and learning performance

Anatomy is shifting toward a greater focus on adopting digital delivery. To advance digital and authentic learning in anatomy, a flipped classroom model integrating multimodal digital resources and a multimedia group assignment was designed and implemented for first-year neuroanatomy and third-year regional anatomy curricula. A five-point Likert scale learning and teaching survey was conducted for a total of 145 undergraduate health science students to evaluate students' perception of the flipped classroom model and digital resources. This study revealed that over two-thirds of participants strongly agreed or agreed that the flipped classroom model helped their independent learning and understanding of difficult anatomy concepts. The response showed students consistently enjoyed their experience of using multimodal digital anatomy resources. Both first-year (75%) and third-year (88%) students strongly agreed or agreed that digital tools are very valuable and interactive for studying anatomy. Most students strongly agreed or agreed that digital anatomy tools increased their learning experience (~80%) and confidence (> 70%). The third-year students rated the value of digital anatomy tools significantly higher than the first-year students (p = 0.0038). A taxonomy-based assessment strategy revealed that the third-year students, but not the first-year, demonstrated improved performance in assessments relating to clinical application (p = 0.045). In summary, a flipped anatomy classroom integrating multimodal digital approaches exerted positive impact upon learning experience of both junior and senior students, the latter of whom demonstrated improved learning performance. This study extends the pedagogy innovation of flipped classroom teaching, which will advance future anatomy curriculum development, pertinent to post-pandemic education.

Are extended reality technologies (ERTs) more effective than traditional anatomy education methods?

PURPOSE

Reviews and meta-analyses concerning the effectiveness of extended reality technologies (ERTs) (namely virtual, augmented, and mixed reality-VR, AR, and MR) in anatomy education (AE) have resulted in conflicting outcomes. The current review explores the existing evidence provided by reviews of AE literature regarding the effectiveness of ERTs after their comparison with traditional (either cadaveric or two-dimensional) anatomy teaching modalities and sheds light on the factors associated with the conflicting outcomes.

METHODS

PubMed, SCOPUS, ERIC, and Cochrane databases were searched for review articles with the purpose to investigate the effectiveness of ERTs in AE.

RESULTS

Nine (four systematic with or without meta-analysis and five non-systematic) reviews were included. A lack of robust evidence provided by those reviews was noted, mainly due to a remarkable confusion in the definition of each ERT, along with confusion when authors referred to traditional AE (TAE) methods.

CONCLUSIONS

To clarify to what extent VR, AR, or MR can replace or supplement TAE methods, there is a primary need for addressing issues regarding the definition of each technology and determining which specific TAE methods are used as comparators.

A Novel Immersive Anatomy Education System (Anat_Hub): Redefining Blended Learning for the Musculoskeletal System

Immersive technologies are redefining ways of interacting with 3D objects and their environments. Moreover, efforts in blended learning have presented several advantages of incorporating educational technology into the learning space. The advances in educational technology have in turn helped to widen the choice of different pedagogies for improving learner engagement and levels of understanding. However, there is limited research in anatomy education that has considered the use and adoption of immersive technologies for the musculoskeletal system, despite its immense advantage. This research presents a practical immersive anatomy education system (coined Anat_Hub) developed using the agile scrum and participatory design method at a selected tertiary institution in Cape Town, South Africa, which promotes learner engagement through an asynchronous technological means using augmented reality (AR). The aim of the study was to develop an immersive AR mobile application that will assist learners and educators in studying and teaching the names, attachments, and actions of muscles of the human musculoskeletal system (upper and lower limbs). The Anat_Hub application offers a wide range of useful features for promoting active and self-regulated learning, such as 3D and AR modes, glossary, and quiz features. The application was tested with potential users, and on a variety of mobile device specifications. Very few volunteers have used AR prior to this study (13.2%). On a scale of 1 to 5, the majority of volunteers scored the application a 4 or 5. Overall, results and feedback obtained from users show that the proposed immersive anatomy system could effectively improve learner engagement and retention of anatomy concepts.

The Opportunities and Challenges of Digital Anatomy for Medical Sciences: Narrative Review

BACKGROUND

Anatomy has been the cornerstone of medical education for centuries. However, given the advances in the Internet of Things, this landscape has been augmented in the past decade, shifting toward a greater focus on adopting digital technologies. Digital anatomy is emerging as a new discipline that represents an opportunity to embrace advances in digital health technologies and apply them to the domain of modern medical sciences. Notably, the use of augmented or mixed and virtual reality as well as mobile and platforms and 3D printing in modern anatomy has dramatically increased in the last 5 years.

OBJECTIVE

This review aims to outline the emerging area of digital anatomy and summarize opportunities and challenges for incorporating digital anatomy in medical science education and practices.

METHODS

Literature searches were performed using the PubMed, Embase, and MEDLINE bibliographic databases for research articles published between January 2005 and June 2021 (inclusive). Out of the 4650 articles, 651 (14%) were advanced to full-text screening and 77 (1.7%) were eligible for inclusion in the narrative review. We performed a Strength, Weakness, Opportunity, and Threat (SWOT) analysis to evaluate the role that digital anatomy plays in both the learning and teaching of medicine and health sciences as well as its practice.

RESULTS

Digital anatomy has not only revolutionized undergraduate anatomy education via 3D reconstruction of the human body but is shifting the paradigm of pre- and vocational training for medical professionals via digital simulation, advancing health care. Importantly, it was noted that digital anatomy not only benefits in situ real time clinical practice but also has many advantages for learning and teaching clinicians at multiple levels. Using the SWOT analysis, we described strengths and opportunities that together serve to underscore the benefits of embracing digital anatomy, in particular the areas for collaboration and medical advances. The SWOT analysis also identified a few weaknesses associated with digital anatomy, which are primarily related to the fact that the current reach and range of applications for digital anatomy are very limited owing to its nascent nature. Furthermore, threats are limited to technical aspects such as hardware and software issues.

CONCLUSIONS

This review highlights the advances in digital health and Health 4.0 in key areas of digital anatomy analytics. The continuous evolution of digital technologies will increase their ability to reinforce anatomy knowledge and advance clinical practice. However, digital anatomy education should not be viewed as a simple technical conversion and needs an explicit pedagogical framework. This review will be a valuable asset for educators and researchers to incorporate digital anatomy into the learning and teaching of medical sciences and their practice.

Evaluation of an Augmented Reality Application for Learning Neuroanatomy in Psychology

Neuroanatomy is difficult for psychology students because of spatial visualization and the relationship among brain structures. Some technologies have been implemented to facilitate the learning of anatomy using three-dimensional (3D) visualization of anatomy contents. Augmented reality (AR) is a promising technology in this field. A mobile AR application to provide the visualization of morphological and functional information of the brain was developed. A sample of 67 students of neuropsychology completed tests for visuospatial ability, anatomical knowledge, learning goals, and experience with technologies. Subsequently, they performed a learning activity using one of the visualization methods considered: a 3D method using the AR application and a two-dimensional (2D) method using a textbook to color, followed by questions concerning their satisfaction and knowledge. After using the alternative method, the students expressed their preference. The two methods improved knowledge equally, but the 3D method obtained higher satisfaction scores and was more preferred by students. The 3D method was also more preferred by the students who used this method during the activity. After controlling for the method used in the activity, associations were found between the preference of the 3D method because of its usability and experience with technologies. These results found that the AR application was highly valued by students to learn and was as effective as the textbook for this purpose.

AV. A Novel Online Dissection Course on Lower Limb Anatomy During the COVID-19 Pandemic

Introduction: The teaching of human anatomy, a medical subject that relies heavily on live teaching, teacher-student interactivity, and visuospatial skills, has suffered tremendously since the COVID-19 pandemic mandated the shutting down of medical institutions. The medical education fraternity was compelled to replace the traditional teaching method of hands-on cadaveric dissections (HOCDs) with online education to overcome this new challenge, but it came at the cost of reduced student engagement and lesser spatial orientation.

Method: In this cross-sectional, questionnaire-based study, we designed a novel online dissection course on lower limb anatomy and collected student feedback on the same from consenting Phase I Bachelor of Medicine, Bachelor of Surgery (MBBS) students of Symbiosis Medical College for Women, Pune, India. The course design consisted of three different modes: a live Zoom session using a handheld camera phone, a pre-recorded video dissection uploaded on the institute learning management system, and a Powerpoint presentation with high-resolution photographs of each dissected layer; and the feedback intended to find out what works best for the students. Overall feedback regarding their preferences in terms of presentation design, use of background music in pre-recorded videos, and overall learning experience was also collected. The course consisted of six two-hour teaching sessions. The first three sessions each used a different mode of teaching, repeating the same pattern in the next three sessions. The first mode of teaching implemented was a live Zoom session where instructors used a hand-held cell phone camera to show specimens that had been dissected a day prior. The second mode involved a pre-recorded video showing step-by-step dissection performed by the instructor which was then uploaded on the Institute Learning Management System. Of the two pre-recorded videos, background music consisting of a low-volume instrumental track was added to the second video. The third mode utilized Powerpoint presentations containing high-resolution photographs of each dissected layer on a separate slide along with labeling. The presentations were shown to the students over a Zoom call. A Google Form (GF) questionnaire was created after validation by subject experts to gather the students’ feedback on the teaching and learning of anatomy via these sessions. The GF responses were collected and analyzed using Microsoft Excel.

Results: 41.7% of students recommended the use of a combination of all three modes in the same session, while 36.7% favored pre-recorded videos. 86.7% of students said that a good quality presentation design helps in keeping them engaged and only 23% of students favored the use of background music for increasing their ability to concentrate. 63.3% of students found the learning experience highly satisfactory.

Conclusion: Although virtual dissection teaching methods may not be able to completely replace HOCDs, a well-planned online dissection course incorporating multiple modes of online dissections with an emphasis on good quality presentation design and frequent teacher-student interactivity can provide a strong impetus for learning in the absence of live teaching methods.