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

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

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

Perceptions regarding the use of a three-dimensionally-printed manufactured educational simulator for periodontal treatment of intraosseous and interradicular lesions

PURPOSE/OBJECTIVES

Treating intraosseous lesions (IOLs) and interradicular bone lesions (IRLs) is an extremely technical dental procedure in periodontics. Instrumentation of these lesions is often perceived as difficult by students and inexperienced dentists before they perform a certain number of procedures on patients in the clinic. The aim of this article is to evaluate a cost-effective three-dimensional (3D)-printed educational simulator for the periodontal treatment of IOLs/IRLs (including scaling, incisions and sutures).

METHODS

The simulators were first developed digitally, and then manufactured using printable resins and specific materials; finally, they were assembled using different bonding systems. To evaluate the simulators, assessments were gathered from two target populations: undergraduate students and periodontics experts. These individuals tested the simulator and completed a cross-sectional questionnaire based on a Likert scale with comparative and pedagogical items scored from one to five. The purpose of the questionnaire was to compare our simulator to clinical reality (i.e., operation on human jaws) and to an animal simulator (i.e., simulation of porcine jaws). The results are expressed as the mean and standard deviation and were statistically analyzed with the Wilcoxon signed-rank test.

RESULTS

Overall, the results were satisfactory for both groups of testers (4.70 and 4.61 out of five for students and experts, respectively, for global satisfaction).

CONCLUSIONS

The overall educational relevance of the simulator designed herein highlights the fact that 3D-printed educational simulators could enable efficient cognitive-functional learning for clinical IOL/IRL treatment.

A comparison of pre- and post-clinical education learning preferences among medical students who elected to dissect compared to those who did not during the COVID-19 pandemic

Anatomy instructional methods varied widely during the COVID-19 pandemic and programs are assessing innovations for retention. Learning preferences were assessed among medical students dichotomized as elective dissectors (ED) or non-dissectors (ND) during the COVID-19 partial re-opening in 2020 (preclinical) and again in 2022 after clinical exposure (post-clinical) to assess the viability of elective dissection post-pandemic. A mixed-method approach was used for the assessment of test scores, learning preference surveys, learning activities rankings, and thematic analyses. No significant differences occurred in anatomy examination scores. Dissection was considered useful by both preclinical groups but significantly more so by ED, while the presence of an instructor was significantly preferred by ED although a majority of ND agreed. Elective dissection was significantly preferred by ND but also by a large minority of ED students. Pre- and post-clinical ND believed that elective dissection offered more academic flexibility, did not hinder clinical learning, and did not negatively impact medical education. The corresponding ED stated that confidence improved, clinical experiences were enhanced, and dissection was irreplaceable. Preclinical ND preferred self-learning, while ED students preferred online learning, but these differences largely disappeared post-clinically. Learning activity rankings were not significantly different among all groups (ND, ED, preclinical, and post-clinical). A hybrid laboratory with a virtual learning environment ranked highest across groups and preferences increased over time suggesting that students benefited from this instructional method during clinical exposure. The absence of laboratory experience ranked lowest, and preference decreased over time suggesting that anatomy dissection is valued.

Undergraduate medical student perceptions and learning outcomes related to anatomy training using Thiel- and ethanol-glycerin-embalmed tissues

Anatomical dissection is known to serve as an integral tool in teaching gross anatomy, including postgraduate training. A variety of embalming techniques exist, resulting in different haptic and optical tissue properties. This study aimed to objectify learning outcomes and medical student perceptions related to the use of two widely used embalming techniques, namely Thiel and ethanol-glycerin embalming. Between 2020 and 2022, first- and second-year medical students enrolled in the course on topographic anatomy participated in this study. Objective structured practical examinations were carried out for the head, neck, thorax, abdomen, pelvis, and extremity regions following regional dissection just before the oral examinations began. Six to ten numbered tags were marked in prosections of each region in Thiel- and ethanol-glycerin-embalmed specimens. Following the examinations, the students were surveyed regarding the suitability of the two embalming techniques with respect to preservation, colorfastness, tissue pliability, and the suitability in preparing for their anatomy examinations. Consistently higher scores were achieved for the thoracic and abdominal regions in ethanol-glycerin-embalmed specimens when compared to Thiel. No benefit was found for Thiel-embalmed upper or lower extremities. Tissues embalmed with ethanol-glycerin were rated higher for preservation and suitability to achieve the learning objectives, tissue pliability was rated higher for Thiel-embalmed tissues. Ethanol-glycerin embalming appears to offer certain advantages for undergraduate students in recognizing visceral structures, which may align with students' ideas on tissue suitability for their learning. Consequently, the benefits reported for Thiel embalming for postgraduate study unlikely reflect its suitability for novices.

Learning by drawing and modeling: Teaching modalities for spinal anatomy in medical students

Ongoing research has attempted to discern the optimal way to teach surgical anatomy. This study investigated the relative effectiveness of drawing and clay modeling on learning spinal anatomy among medical students. Participants were recruited from a first-year medical school class to participate in an optional educational session in their regular course schedule. Seventy-eight students participated, and 62 completed pre- and post-session tests. Participants were randomized to one of three groups, either learning spinal anatomy by (1) drawing, (2) clay modeling, or (3) reviewing a 3D anatomy application (control). All groups referenced the anatomy application; the control group had no additional learning modality. Students had 15 min to learn major anatomical structures in the lumbar spine according to their assigned modality. Learning was evaluated in terms of score differential on pre- and post-session anatomy tests, with questions focused on anatomy applied in different contexts such as pathophysiology and radiology. Improved pre- to posttest scores were expected for the drawing and modeling groups compared to control. On average, the drawing group's scores significantly improved by 11% from pre- to posttest. Scores in the clay and control groups did not significantly improve. Drawing is thus an effective strategy for learning basic and applied spinal anatomy, and drawing and clay modeling (with adequate time) may be useful for teaching medical students to apply surgical anatomical knowledge in various contexts. These modalities are generalizable to any surgical anatomical education, and should be further explored among surgical residents given their efficacy, feasibility, and minimal use of resources.

3D printing as a pedagogical tool for teaching normal human anatomy: a systematic review

BACKGROUND

Three-dimensional-printed anatomical models (3DPAMs) appear to be a relevant tool due to their educational value and their feasibility. The objectives of this review were to describe and analyse the methods utilised for creating 3DPAMs used in teaching human anatomy and for evaluating its pedagogical contribution.

METHODS

An electronic search was conducted on PubMed using the following terms: education, school, learning, teaching, learn, teach, educational, three-dimensional, 3D, 3-dimensional, printing, printed, print, anatomy, anatomical, anatomically, and anatomic. Data retrieved included study characteristics, model design, morphological evaluation, educational performance, advantages, and disadvantages.

RESULTS

Of the 68 articles selected, the cephalic region was the most studied (33 articles); 51 articles mentioned bone printing. In 47 articles, the 3DPAM was designed from CT scans. Five printing processes were listed. Plastic and its derivatives were used in 48 studies. The cost per design ranged from 1.25 USD to 2800 USD. Thirty-seven studies compared 3DPAM to a reference model. Thirty-three articles investigated educational performance. The main advantages were visual and haptic qualities, effectiveness for teaching, reproducibility, customizability and manipulability, time savings, integration of functional anatomy, better mental rotation ability, knowledge retention, and educator/student satisfaction. The main disadvantages were related to the design: consistency, lack of detail or transparency, overly bright colours, long printing time, and high cost.

CONCLUSION

This systematic review demonstrates that 3DPAMs are feasible at a low cost and effective for teaching anatomy. More realistic models require access to more expensive 3D printing technologies and substantially longer design time, which would greatly increase the overall cost. Choosing an appropriate image acquisition modality is key. From a pedagogical viewpoint, 3DPAMs are effective tools for teaching anatomy, positively impacting the learning outcomes and satisfaction level. The pedagogical effectiveness of 3DPAMs seems to be best when they reproduce complex anatomical areas, and they are used by students early in their medical studies.

Distance versus face-to-face education of gross anatomy for dental hygiene students: Perceptions and academic achievements of learners

The provision of distance education has increased rapidly over the past few years owing to the COVID-19 pandemic. The core of gross anatomy distance education is three-dimensional (3D) visualization of anatomical structures, and the use of simple 3D visualization tools has increased as distance education has become more popular. The purpose of this study was to establish a more effective operation plan in dental hygiene by investigating learners' opinions about distance education of gross anatomy and 3D visualization tools, and by comparing and analyzing their academic achievements. The study involved 250 students and comprised an analysis of 120 students who took a head and neck anatomy class at the Department of Dental Hygiene at D University via distance learning during 2020-2022, and 130 graduates who had completed the class via face-to-face learning during 2015-2017. An online survey of 120 of the enrolled students comprised 10 questions asking for opinions on the head and neck anatomy distance learning classes, five questions on the 3D visualization tool, and five on general characteristics. Overall, the learners had positive perceptions of distance education for head and neck anatomy and the 3D visualization tool. Among the education methods compared, they generally preferred blended learning (n = 47, 39.2%). There was a significant preference for the distance learning method of asynchronous classes (n = 86, 94.5%). Analysis of academic achievements according to whether or not distance education was conducted revealed a significantly higher score in the face-to-face class group (P < 0.05). A blended learning method can be effective in increasing learner satisfaction and improving academic achievement in gross anatomy classes on dental hygiene. It is suggested that theoretical material should be learned through asynchronous content and knowledge expanded through small-group activities during face-to-face learning. This will help establish a standard model for teaching of gross anatomy in dental hygiene in the postpandemic era.

Protocol Development for Digisection: Making a Case for Standardizing Educational Technology Use for Digital Dissection and Anatomical Studies

The changes that have characterized advancements in anatomical sciences and medical education have significantly influenced pedagogies and the mode of delivery of teaching and training in the context of medical education. Another reality is the impact of educational technology (EdTech) penetration and integration into medical sciences and education. These events have undoubtedly influenced certain traditional practices and pedagogies including dissection. For example, EdTech and innovations have introduced virtual human images and three-dimensional (3D) human body representations for the purposes of teaching and dissection. Another instance includes the fact that the old dissection guides for gross anatomy, which follow the traditional regional anatomy approach, are often challenging to adapt to the relatively modern medical school curriculum that has embraced the integration philosophy. It is apparent that one practical and realistic way to provide an adapted and effective guide for anatomical dissections under various curricular philosophies and contexts would be to develop de novo protocols or adapt existing ones. Protocol development would be a vital component of the modern anatomist toolkit. This article presents the basic considerations and practical approach, including underpinning principles, to developing virtual dissection protocols using a digital 3D dissection facility, the Anatomage table (Anatomage Inc., California, United States of America), as a case study.

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.

Transforming musculoskeletal anatomy learning with haptic surface painting

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

Usage of Student-Created Anatomical Diagrams Shared on Social Media

Social media (SoMe) is a resource for electronic materials in medical education, but has been particularly relevant for anatomy education due to the visual nature of the discipline. Although the distribution of expert/faculty-created anatomy content has been documented, the usefulness of novice/student-created content distributed via SoMe remains undetermined. To address this, original anatomical diagrams (n = 127) created by a novice educator were disseminated via the Anatomy Adventures Instagram account and evaluated for their usefulness. Audience engagement was evaluated using descriptive statistics, with a mean number of likes for all posts (n = 61) of 62.54 + 15.70. Statistically significant differences in the number of likes across content topics were assessed using a Kruskal-Wallis test (H(41.09) = 4, p < 0.005). An 11-item survey (10.6% response rate) explored the (1) population demographics, (2) diagram utility, and (3) suggestions for improvement. Responses were converted to percent frequencies and assessed with chi-square. Descriptive codes were applied to open-ended responses according to published methods. Of the 111 survey responses, 95% of participants were 18-30 years, with the majority of participants being medical students (69.3%), undergraduate/graduate students (16.2%), and fully employed (12.6%). Participants report using the diagrams to study for coursework or board examinations (54%), while non-medical use (42.4%) included leisure viewing or reviewing for their occupation. The usefulness of the diagrams was attributed to their (1) simplicity (43%), (2) style (24.6%), and (3) color-coding (12.3%) (p = 0.0025). These data indicate that Instagram may be utilized by novice educators to provide accurate and accessible resources.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-023-01736-9.

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.