Immersive Anatomy Atlas: Learning Factual Medical Knowledge in a Virtual Reality Environment

[Views of assistant professors on digital transformation in otorhinolaryngology education : Current status and perspectives in undergraduate and advanced training]

BACKGROUND

Digital transformation in curricular teaching in medicine comprises the use of digital teaching and learning formats as well as the transfer of digital skills for medical staff. Concepts of knowledge transfer and competency profiles also have to be adapted and transferred in advanced training due to necessary changes.

OBJECTIVE

The aim of this study was an evaluation of the current state of digital transformation in otorhinolaryngology teaching in undergraduate and advanced training at otorhinolaryngology departments of university medical centers in Germany.

MATERIALS AND METHODS

A questionnaire with nine questions on digital transformation was sent to the assistant professors of 37 national university ENT departments. The anonymous survey was conducted online via the online platform SurveyMonkey®.

RESULTS

Of the contacted assistant professors, 86.5% participated in the survey. Teaching sessions on digital skills for medical students are part of the curriculum in only 25% of ENT departments. Digital teaching formats are used by half of the departments in undergraduate training. Only 56.25% of the assistant professors receive support to realize the changes required by digital transformation. In 40.62% of departments, the issue of digital transformation is broached during advanced training, but only 28.12% use digital teaching methods to train junior doctors.

CONCLUSION

Aspects of digital transformation are implemented mainly in undergraduate education, partly driven by the COVID 19 pandemic. Overall, there is still considerable backlog in undergraduate and advanced training in ENT.

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.

Cadaver Dissection Experience for First-Time Dissectors: a Hypothetical Three-Pronged Approach for Student Preparation

This systematic review synthesized evidence for the development of a preparatory process for first-time dissectors, geared toward improving cadaver dissection (CD) experiences. Eleven studies focused on pre-CD intervention were selected from a literature search in PubMed, the Education Resources Information Centre (ERIC), Google Scholar, PsycNET, and the Cochrane Library. A three-pronged preparatory process was formulated for first-time dissectors based on the evidence from the review. The process includes (1) background assessment; (2) pre-CD education; and (3) gradual exposure and desensitization. The preparatory process shows some hypothetical potential for decreasing negative CD-related experiences, but it still needs validation before implementation.

Enhancing Anatomy Education Throu€gh Flipped Classroom and Adaptive Learning A Pilot Project on Liver Anatomy

OBJECTIVES

Anatomy education plays a critical role in medical practice, and the level of anatomical knowledge among students and physicians significantly impacts patient care. This article presents a pilot project aimed at exploring the effectiveness of the Area9's Rhapsode platform, an intelligent tutoring system that uses artificial intelligence (AI) to personalize learning and collect data on mastery acquisition.

METHODS

The study focused on liver anatomy (microscopic and macroscopic anatomy, embryology, clinical anatomy) and employed a flipped classroom approach, incorporating adaptive learning modules and an interactive in-class session. A total of 123 first-year medicine students (55 M/68F) participated to the study. Content and resources of the module were adaptable to various digital devices. Statistics were compiled based, on the one hand, on the measurement of mastery for every single learning objective provided automatically by the platform via the student interactions with the system probes (questions); on the other hand, metacognition data were worked out by crossing mastery data with the self-awareness declared in every question and learning resource by each learner.

RESULTS AND CONCLUSIONS

At the outset of the study, students displayed a 18.11% level of conscious incompetence and a 19.43% level of unconscious incompetence. Additionally, 50.86% of students demonstrated conscious competence. By the conclusion of the learning module, the level of conscious incompetence had decreased to 1.87%, and 98.73% of students exhibited conscious mastery of the materials. The results demonstrated improved learning quality, positive repurposing of study time, enhanced metacognitive awareness among students, with most students demonstrating conscious mastery of the materials and a clear understanding of their level of competence. This approach, by providing valuable insights into the potential of AI-based adaptive learning systems in anatomy education, could address the challenges posed by limited teaching hours, shortage of anatomist, and the need for individualized instruction.

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.

Evaluation of a Virtual Reality-Based Open Educational Resource Software

OBJECTIVES

Virtual reality (VR) teaching methods have potential to support medical students acquire increasing amounts of knowledge. EVENT (Easy VR EducatioN Tool) is an open educational resource software for immersive VR environments, which is designed for use without programming skills. In this work, EVENT was used in a medical student VR course on pancreatic cancer.

METHODS

Medical students were invited to participate in the course. Before and after VR simulation, participants completed a multiple-choice knowledge assessment, with a maximum score of 10, and a VR experience questionnaire. The primary endpoint compared pre- and post-VR simulation test scores. Secondary endpoints included usability and factors that could affect learning growth and test results.

RESULTS

Data from 117 of the 135 participating students was available for analysis. Student test scores improved by an average of 3.4 points (95% CI 3.1-3.7, P < 0.001) after VR course. The secondary endpoints of gender, age, prior knowledge regarding the medical subject, professional training completed in the medical field, video game play, three-dimensional imagination skills, or cyber-sickness had no major impact on test scores or final ranking (top or bottom 25%). The 27 students whose post-VR simulation test scores ranked in the top 25% had no prior experience with VR. The average System Usability Scale score was 86.1, which corresponds to an excellent outcome for user-friendliness. Questionnaire responses post-VR simulation show students (81.2% [95/117]) interest in more VR options in medical school.

CONCLUSIONS

We present a freely available software that allows for the development of VR teaching lessons without programming skills.

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.

A comparative analysis of lecturers' satisfaction with Anatomage and Pirogov virtual dissection tables during clinical and topographic anatomy courses in Russian universities

Anatomy is increasingly taught using computer-assisted learning tools, including electronic interactive anatomy dissection tables. Anatomage was he first virtual anatomy dissection table introduced in Russian medical universities and gained popularity among lecturers and students. The Pirogov interactive anatomy table was recently released, but the strengths and weakness of each platform is currently unknown. The objective of this article is to survey lecturers in anatomy to understand their perspectives on the Pirogov versus Anatomage virtual dissection tables' application to teaching in medical universities. A total of 80 anatomy educators from 12 Russian universities, using Anatomage (n = 40) and Pirogov (n = 40) tables were surveyed regarding their satisfaction with the application of the respective tables. Using a five-point Likert scale, both tables were assessed, and responses were statistically analyzed. In addition, qualitative analysis was performed on free response comments provided by survey respondents. There was no significant difference in overall satisfaction ratings between Pirogov (4.38 ± 0.53) and Anatomage (3.94 ± 0.60) interactive tables (p > 0.05). The Anatomage table ranked significantly higher on the accuracy of displayed anatomical details, resolution of the images, and its suitability for teaching senior medical and postgraduate students. Pirogov table performed significantly better on survey items measuring ergonomics, ability to assess students' performance, and teaching basic anatomy to junior first- and second-year medical students. Thus, in summary, anatomists' responses indicated that while both tables are suitable for teaching anatomy, the Pirogov table was superior in undergraduate medical education and the Anatomage table was more beneficial for teaching more senior trainees.

Game on: immersive virtual laboratory simulation improves student learning outcomes & motivation

The use of gamified learning interventions is expanding in postsecondary education as a means to improve students' motivation and learning outcomes. Virtual laboratory simulations have been used in science education to supplement students' learning, as well as to increase engagement with course material. Due to COVID-19, many instructors sought to replace or supplement hands-on 'wet-lab' work in an online environment. In this paper, we explored how the use of head-mounted display technology in two laboratory simulations impacts learner motivation and learning outcomes. We used a mixed-methods approach to analyze the experience of 39 undergraduate participants, examining test scores pre- and postsimulation, qualitative feedback, and quantitative experience ratings. The head-mounted display technology was described as easy to use, with eye strain identified as a common occurrence. Participants had increased test scores following the laboratory simulations, with no significant difference between simulation groups. Very positive self-reported measures of motivation and learner engagement were documented. Ninety-one percent of participants agreed that virtual reality laboratory simulation would be a good supplement to regular teaching modalities. Overall, our results suggest that immersive virtual reality laboratory simulations experienced through head-mounted display technology can be used to enhance learning outcomes and increase learner motivation.

Students' performance in teaching neuroanatomy using traditional and technology-based methods

The use of digital teaching resources became widespread and very helpful during the COVID-19 pandemic as an alternative to a traditional course with cadavers. Technologies such as augmented reality (AR), virtual reality (VR), 3D models, video lectures and other online resources enable three-dimensional visualization of the anatomical structures and allow students to learn more interactively. The aim of this study was to compare students' performance in the traditional anatomical courses in teaching neuroanatomy and technology-based learning methods such as video lectures, 3D models and 3D printed specimens. Four groups of first-year students of Veterinary Faculty established for the practical classes during the academic year 2021/2022 took part in this research. The total number of students participating in this research was 72. Each group attended separately the theoretical lecture with a demonstration based on a different technique; the control group used formalized specimens, while the three experimental groups used video lectures, 3D models and 3D printed specimens, respectively. Subsequently, all groups completed the same questionnaire testing their short-term memory of the neuroanatomical structures. After four weeks students were tested for their long-term memory of the neuroanatomy lecture with the follow-up test containing an identical list of questions. The test scores using video lectures and 3D printed models were significantly higher compared with the group that learned in the traditional way. This study suggests that alternative approaches such as technology-based digital methods can facilitate memorization of anatomical terms and structures in a more interactive and sensory engaging way of learning.

New virtual platform for teaching comparative animal neuroanatomy based on metameric slices of the central nervous system

With the limitations imposed by the COVID-19 pandemic, new technologies were used as methods to continue teaching and learning activities. This scenario brought forth the need to develop online tools for teaching. Therefore, this research aimed to develop a digital platform linking the knowledge about the central nervous system (CNS) anatomy from feline, equine, and sheep models. The platform was produced from the analysis of a collection of mesoscopic slides made from the sequenced cross-section of the CNS of a feline, an equine, and a sheep. All sections were analysed and stained using the Paul-Wiegert modified technique. The platform was organized in four modules: (1) Neuroanatomy of the Central Nervous System; (2) Neuroanatomy of Feline; (3) Neuroanatomy of Equine; and (4) Neuroanatomy of sheep. For each module, an explanatory document in PDF was developed, as well as video lectures and a descriptive atlas identifying the structures present in the encephalon and in the cervical part of the spinal cord. Even though there are numerous online platforms that allow the study of veterinary anatomy of different species and organs, the veterinary neuroanatomy platform presented here is the first platform that conjointly addresses the CNS anatomy of felines, equines, and sheep. Future research applying this platform as an aid to the study of neuroanatomy by students, teachers, and veterinary professionals should validate its use as a complementary tool for teaching and learning animal neuroanatomy.

A validated instrument measuring students' perceptions on plastinated and three-dimensional printed anatomy tools

Due to the modernization of the medical curriculum and technological advancements, anatomy education has evolved beyond cadaveric dissection alone. Plastination techniques, three-dimensional (3D) modeling, and 3D printing technologies have progressively gained importance. However, there are limited valid and reliable surveys to evaluate students' perceptions of these new anatomy tools. Hence, this study aimed to develop a validated instrument to measure students' learning satisfaction, self-efficacy, humanistic values, and perceived limitations of plastinated and 3D printed models. A 41-item survey (five-point Likert scale, 1 = strongly disagree to 5 = strongly agree) was administered to Year 1 undergraduate medical students following a randomized controlled crossover study that evaluated plastinated and 3D printed cardiac and neck models. Ninety-six responses were received, and a factor analysis was performed with the Kaiser-Meyer-Olkin sampling adequacy of 0.878. The confirmatory factor analysis yielded a 4-factor, 19 items model that had a good fit with the latent constructs of x ² (147) = 211.568, P < 0.001, root mean square error of approximation = 0.068, root mean square residual = 0.064, comparative fit index = 0.946, and Tucker Lewis index = 0.937. The Cronbach's alpha for the individual factors ranged from 0.74 to 0.95, indicating good internal consistency. This demonstrated a psychometrically valid and reliable instrument to measure students' perceptions toward plastinated and 3D printed models.

Digital body preservation: Technique and applications

High-fidelity anatomical models can be produced with three-dimensional (3D) scanning techniques and as such be digitally preserved, archived, and subsequently rendered through various media. Here, a novel methodology-digital body preservation-is presented for combining and matching scan geometry with radiographic imaging. The technique encompasses joining layers of 3D surface scans in an anatomical correct spatial relationship. To do so, a computed tomography (CT) volume is used as template to join and merge different surface scan geometries by means of nonrigid registration into a single environment. In addition, the use and applicability of the generated 3D models in digital learning modalities is presented. Finally, as computational expense is usually the main bottleneck in extended 3D applications, the influence of mesh simplification in combination with texture mapping on the quality of 3D models was investigated. The physical fidelity of the simplified meshes was evaluated in relation to their resolution and with respect to key anatomical features. Large- and medium-scale features were well preserved despite extensive 3D mesh simplification. Subtle fine-scale features, particular in curved areas demonstrated the major limitation to extensive mesh size reduction. Depending on the local topography, workable mesh sizes ranging from 10% to 3% of the original size could be obtained, making them usable in various learning applications and environments.

Technology-Enhanced Education through VR-Making and Metaverse-Linking to Foster Teacher Readiness and Sustainable Learning

The main purpose of this paper is to bring pioneering insights into the core line of sustainable education research by investigating the multi-dimensional aspects of teachers’ readiness to design technology-enhanced learning environments. In order to achieve this goal, this study documents the experiences of pre-service English teachers in instructional Virtual Reality (herein, VR) content design of K–12 English digital textbooks. Furthermore, it examines how their VR creation can be linked to a metaverse platform for learning adaptivity and sustainable education. The data are collected by pre-/post-surveys as well as reflective papers. The pre-/post-survey responses are analyzed with a t-test to determine significance; the reflective paper entries are scrutinized with sentiment analysis and text mining. The study findings suggest that such transformative experiences of VR-Making (herein, VRM) for instructional contents are conducive to capacitate pre-service teachers’ technological readiness, 4Cs (Critical Thinking, Creativity, Collaboration, Communication) in digital citizenship, and perceived pedagogical benefits. Based on findings, this study continues to support the need for providing teaching practitioners with hands-on learning-to-teach opportunities with emerging technology as a tool to fulfill sustainable education.

One year of anatomy teaching and learning in the outbreak: Has the Covid-19 pandemic marked the end of a century-old practice? A systematic review

At the end of 2019, the Covid-19 pandemic spread caused restrictions in business and social spheres. Higher education was also severely affected: universities and medical schools moved online to distance learning and laboratory facilities closed. Questions arise about the long-term effects of this pandemic on anatomical education. In this systematic review, the authors investigated whether or not anatomical educators were able to deliver anatomical knowledge during this pandemic. They also discuss the challenges that anatomical education has faced over the last year. The search strategy was conducted between July 2020 and July 2021. Two hundred and one records were identified, and a total of 79 studies were finally included. How best to deliver anatomy to students remains a moot point. In the last years, the advent of new technologies has raised the question of the possible overcoming of dissection as the main instrument in anatomical education. The Covid-19 pandemic further sharpened the debate. Remote learning enhanced the use of technologies other than cadaveric dissection to teach anatomy. Moreover, from the analyzed records it appears that both from students' perspective as well as teachers' there is a clear tear between those who endorse dissection and those who believe it could be easily overcome or at least integrated by virtual reality and online learning. The authors strongly believe that the best anatomy teaching practice requires the careful adaptation of resources and methods. Nevertheless, they support cadaveric dissection and hope that it will not be replaced entirely as a result of this pandemic.

Virtual Reality for Surgical Planning – Evaluation Based on Two Liver Tumor Resections

Purpose

For complex cases, preoperative surgical planning is a standard procedure to ensure patient safety and keep the surgery time to a minimum. Based on the available information, such as MRI or CT images, and prior anatomical knowledge the surgeons create their own mental 3D model of the organ of interest. This is challenging, requires years of training and an inherent uncertainty remains even for experienced surgeons.

Goal

Virtual reality (VR) is by nature excellent in showing spatial relationships through its stereoscopic displays. Therefore, it is well suited to be used to support the understanding of individual anatomy of patient-specific 3D organ models generated from MRI or CT data. Utilizing this potential, we developed a VR surgical planning tool that provides a 3D view of the medical data for better spatial understanding and natural interaction with the data in 3D space. Following a user-centered design process, in this first user study, we focus on usability, usefulness, and target audience feedback. Thereby, we also investigate the individual impact the tool and the 3D presentation of the organ have on the understanding of the 3D structures for the surgical team.

Methods

We employed the VR prototype for surgical planning using a standard VR setup to two real cases of patients with liver tumors who were scheduled for surgery at a University Hospital for Visceral Surgery. Surgeons (N = 4) used the VR prototype before the surgery to plan the procedure in addition to their regular planning process. We used semi-structured interviews before and after the surgery to explore the benefits and pitfalls of VR surgical planning.

Results

The participants used on average 14.3 min (SD = 3.59) to plan the cases in VR. The reported usability was good. Results from the interviews and observations suggest that planning in VR can be very beneficial for surgeons. They reported an improved spatial understanding of the individual anatomical structures and better identification of anatomical variants. Additionally, as the surgeons mentioned an improved recall of the information and better identification of surgical relevant structures, the VR tool has the potential to improve the surgery and patient safety.