Augmented and Virtual Reality in Anatomical Education - A Systematic Review

Artificial intelligence in dentistry: A bibliometric analysis from 2000 to 2023

Background/purpose

Artificial intelligence (AI) is reshaping clinical practice in dentistry. This study aims to provide a comprehensive overview of global trends and research hotspots on the application of AI to dentistry.

Materials and methods

Studies on AI in dentistry published between 2000 and 2023 were retrieved from the Web of Science Core Collection. Bibliometric parameters were extracted and bibliometric analysis was conducted using VOSviewer, Pajek, and CiteSpace software.

Results

A total of 651 publications were identified, 88.7 % of which were published after 2019. Publications originating from the United States and China accounted for 34.5 % of the total. The Charité Medical University of Berlin was the institution with the highest number of publications, and Schwendicke and Krois were the most active authors in the field. The Journal of Dentistry had the highest citation count. The focus of AI in dentistry primarily centered on the analysis of imaging data and the dental diseases most frequently associated with AI were periodontitis, bone fractures, and dental caries. The dental AI applications most frequently discussed since 2019 included neural networks, medical devices, clinical decision support systems, head and neck cancer, support vector machine, geometric deep learning, and precision medicine.

Conclusion

Research on AI in dentistry is experiencing explosive growth. The prevailing research emphasis and anticipated future development involve the establishment of medical devices and clinical decision support systems based on innovative AI algorithms to advance precision dentistry. This study provides dentists with valuable insights into this field.

3D-SARC: A Pilot Study Testing the Use of a 3D Augmented-Reality Model with Conventional Imaging as a Preoperative Assessment Tool for Surgical Resection of Retroperitoneal Sarcoma

BACKGROUND

Retroperitoneal sarcomas (RPSs) present a surgical challenge, with complex anatomic relationships to organs and vascular structures. This pilot study investigated the role of three-dimensional (3D) augmented reality (3DAR) compared with standard imaging in preoperative planning and resection strategies.

METHODS

For the study, 13 patients who underwent surgical resection of their RPS were selected based on the location of their tumor (right, left, pelvis). From the patients' preoperative computed tomography (CT) scans, 3DAR models were created using a D2P program and projected by an augmented-reality (AR) glass (Hololens). The 3DAR models were evaluated by three experienced sarcoma surgeons and compared with the baseline two-dimensional (2D) contrast-enhanced CT scans.

RESULTS

Three members of the surgical team evaluated 13 models of retroperitoneal sarcomas, resulting in a total of 26 responses. When the surgical team was asked to evaluate whether the 3DAR better prepared the surgeon for planned surgical resection, 10 responses favored the 3DAR, 5 favored the 2D CT scans and 11 showed no difference (p = 0.074). According to 15 (57.6 %) of the 26 responses, the 3DAR offered additional value over standard imaging in the preoperative planning (median score of 4; range, 1-5). The median stated likelihood that the surgeons would consult the 3DAR was 5 (range, 2-5) for the preoperative setting and 3 (range, 1-5) for the intraoperative setting.

CONCLUSIONS

This pilot study suggests that the use of 3DAR may provide additional value over current standard imaging in the preoperative planning for surgical resection of RPS, and the technology merits further study.

Augmented Reality-Guided Extraction of Fully Impacted Lower Third Molars Based on Maxillofacial CBCT Scans

(1) Background: This study aimed to integrate an augmented reality (AR) image-guided surgery (IGS) system, based on preoperative cone beam computed tomography (CBCT) scans, into clinical practice. (2) Methods: In preclinical and clinical surgical setups, an AR-guided visualization system based on Microsoft's HoloLens 2 was assessed for complex lower third molar (LTM) extractions. In this study, the system's potential intraoperative feasibility and usability is described first. Preparation and operating times for each procedure were measured, as well as the system's usability, using the System Usability Scale (SUS). (3) Results: A total of six LTMs (n = 6) were analyzed, two extracted from human cadaver head specimens (n = 2) and four from clinical patients (n = 4). The average preparation time was 166 ± 44 s, while the operation time averaged 21 ± 5.9 min. The overall mean SUS score was 79.1 ± 9.3. When analyzed separately, the usability score categorized the AR-guidance system as "good" in clinical patients and "best imaginable" in human cadaver head procedures. (4) Conclusions: This translational study analyzed the first successful and functionally stable application of the HoloLens technology for complex LTM extraction in clinical patients. Further research is needed to refine the technology's integration into clinical practice to improve patient outcomes.

A Pilot Randomized Controlled Trial of Augmented Reality Just-in-Time Guidance for the Performance of Rugged Field Procedures

INTRODUCTION

Medical resuscitations in rugged prehospital settings require emergency personnel to perform high-risk procedures in low-resource conditions. Just-in-Time Guidance (JITG) utilizing augmented reality (AR) guidance may be a solution. There is little literature on the utility of AR-mediated JITG tools for facilitating the performance of emergent field care.

STUDY OBJECTIVE

The objective of this study was to investigate the feasibility and efficacy of a novel AR-mediated JITG tool for emergency field procedures.

METHODS

Emergency medical technician-basic (EMT-B) and paramedic cohorts were randomized to either video training (control) or JITG-AR guidance (intervention) groups for performing bag-valve-mask (BVM) ventilation, intraosseous (IO) line placement, and needle-decompression (Needle-d) in a medium-fidelity simulation environment. For the interventional condition, subjects used an AR technology platform to perform the tasks. The primary outcome was participant task performance; the secondary outcomes were participant-reported acceptability. Participant task score, task time, and acceptability ratings were reported descriptively and compared between the control and intervention groups using chi-square analysis for binary variables and unpaired t-testing for continuous variables.

RESULTS

Sixty participants were enrolled (mean age 34.8 years; 72% male). In the EMT-B cohort, there was no difference in average task performance score between the control and JITG groups for the BVM and IO tasks; however, the control group had higher performance scores for the Needle-d task (mean score difference 22%; P = .01). In the paramedic cohort, there was no difference in performance scores between the control and JITG group for the BVM and Needle-d tasks, but the control group had higher task scores for the IO task (mean score difference 23%; P = .01). For all task and participant types, the control group performed tasks more quickly than in the JITG group. There was no difference in participant usability or usefulness ratings between the JITG or control conditions for any of the tasks, although paramedics reported they were less likely to use the JITG equipment again (mean difference 1.96 rating points; P = .02).

CONCLUSIONS

This study demonstrated preliminary evidence that AR-mediated guidance for emergency medical procedures is feasible and acceptable. These observations, coupled with AR's promise for real-time interaction and on-going technological advancements, suggest the potential for this modality in training and practice that justifies future investigation.

[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.

AI and Ethics: A Systematic Review of the Ethical Considerations of Large Language Model Use in Surgery Research

INTRODUCTION

As large language models receive greater attention in medical research, the investigation of ethical considerations is warranted. This review aims to explore surgery literature to identify ethical concerns surrounding these artificial intelligence models and evaluate how autonomy, beneficence, nonmaleficence, and justice are represented within these ethical discussions to provide insights in order to guide further research and practice.

METHODS

A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Five electronic databases were searched in October 2023. Eligible studies included surgery-related articles that focused on large language models and contained adequate ethical discussion. Study details, including specialty and ethical concerns, were collected.

RESULTS

The literature search yielded 1179 articles, with 53 meeting the inclusion criteria. Plastic surgery, orthopedic surgery, and neurosurgery were the most represented surgical specialties. Autonomy was the most explicitly cited ethical principle. The most frequently discussed ethical concern was accuracy (n = 45, 84.9%), followed by bias, patient confidentiality, and responsibility.

CONCLUSION

The ethical implications of using large language models in surgery are complex and evolving. The integration of these models into surgery necessitates continuous ethical discourse to ensure responsible and ethical use, balancing technological advancement with human dignity and safety.

Incorporating Augmented Reality Into Anatomy Education in a Contemporary Medical School Curriculum

Anatomy education in the medical school curriculum has encountered considerable challenges during the last decade. The exponential growth of medical science has necessitated a review of the classical ways to teach anatomy to shorten the time students spend dissecting, allowing them to acquire critical, new knowledge in other disciplines. Augmented and mixed reality technologies have developed tremendously during the last few years, offering a wide variety of possibilities to deliver anatomy education to medical students. Here, we provide a methodology to develop, deliver, and assess an anatomy laboratory course using augmented reality applications. We suggest a novel approach, based on Microsoft® HoloLens II, to develop systematic sequences of holograms to reproduce human dissection. The laboratory sessions are prepared before classes and include a series of holograms revealing sequential layers of the human body, isolated structures, or a combination of structures forming a system or a functional unit. The in-class activities are conducted either as one group of students (n = 8-9) with a leading facilitator or small groups of students (n = 4) with facilitators (n = 4) joining the groups for discussion. The same or different sessions may be used for the assessment of students' knowledge. Although currently in its infancy, the use of holograms will soon become a substantial part of medical education. Currently, several companies are offering a range of useful learning platforms, from anatomy education to patient encounters. By describing the holographic program at our institution, we hope to provide a roadmap for other institutions looking to implement a systematic approach to teaching anatomy through holographic dissection. This approach has several benefits, including a sequential 3D presentation of the human body with varying layers of dissection, demonstrations of facilitator-selected three-dimensional (3D) anatomical regions or specific body units, and the option for classroom or remote facilitation, with the ability for students to review each session individually.

An old approach to a novel problem: effect of combined balance therapy on virtual reality induced motion sickness: a randomized, placebo controlled, double-blinded study

BACKGROUND

The objective of this study was to investigate the impact of a rehabilitation program aimed at addressing vestibular and proprioceptive deficits, which are believed to underlie the pathophysiology of motion sickness.

METHODS

A total of 121 medical students with motion sickness participated in this study and were randomly divided into intervention (n = 60) and placebo control (n = 61) groups. The intervention group underwent combined balance, proprioception, and vestibular training three times a week for 4 weeks, while the control group received placebo training. The study assessed various measurements, including the Virtual reality sickness questionnaire (VRSQ), tolerance duration, enjoyment level measured by VAS, stability levels using Biodex, and balance with the Flamingo balance test (FBT). All measurements were conducted both at baseline and 4 weeks later.

RESULTS

There was no significant difference in pre-test scores between the intervention and control groups, suggesting a similar baseline in both groups (p > 0.05). The results showed a significant improvement in VRSQ, tolerance duration, VAS, Biodex, and FBT scores in the intervention group (p < 0.05). While, the control group showed a significant increase only in VAS scores after 4 weeks of training (p < 0.05). A statistically significant improvement was found between the groups for VRSQ (p < 0.001), tolerance duration (p < 0.001), VAS (p < 0.001), Biodex (p = 0.015), and FBT scores (p < 0.05), in favor of the intervention group.

CONCLUSIONS

A combined balance training program for motion sickness proves to be effective in reducing motion sickness symptoms, enhancing user enjoyment, and extending the usage duration of virtual reality devices while improving balance and stability. In contrast, placebo training did not alter motion sickness levels. These findings offer valuable insights for expanding the usage of virtual reality, making it accessible to a broader population.

The role of extended reality in eloquent area lesions: a systematic review

OBJECTIVE

The surgical approach to lesions near eloquent areas continues to represent a challenge for neurosurgeons, despite all of the sophisticated tools currently used. The goal of surgery in eloquent areas is to maintain a good oncofunctional balance, that is, to preserve neurological function and ensure maximum tumor resection. Among all the available tools, extended reality (used to describe both virtual reality [VR] and mixed reality) is rapidly gaining a pivotal role in such delicate lesions, especially in preoperative planning, and recently, even during the surgical procedure. VR creates a completely new world in which only digital components are present. Augmented reality (AR), using software and hardware to introduce digital elements into the real-world environment, enhances the human experience. In addition, mixed reality, a more recent technique, combines VR and AR by projecting virtual objects into the real world, allowing the user to interact with them.

METHODS

A systematic literature review of the last 23.5 years was conducted (January 2000-June 2023) to investigate and discuss all progress related to the emerging role and use of these new technologies (VR, AR, and mixed reality), particularly in eloquent area lesions as a pre- and/or intraoperative tool.

RESULTS

Five hundred eighty-four published studies were identified. After removing duplicates and excluding articles that did not meet the inclusion criteria, 21 papers were included in the systematic review. The use of AR or VR was fully analyzed, considering their roles both intraoperatively and for surgical planning.

CONCLUSIONS

The increasing use of such innovative technologies has completely changed the way to approach a lesion, using 3D visualization to foster a better understanding of its anatomical and vascular characteristics.

TACTICS VR Stroke Telehealth Virtual Reality Training for Health Care Professionals Involved in Stroke Management at Telestroke Spoke Hospitals: Module Design and Implementation Study

BACKGROUND

Stroke management in rural areas is more variable and there is less access to reperfusion therapies, when compared with metropolitan areas. Delays in treatment contribute to worse patient outcomes. To improve stroke management in rural areas, health districts are implementing telestroke networks. The New South Wales Telestroke Service provides neurologist-led telehealth to 23 rural spoke hospitals aiming to improve treatment delivery and patient outcomes. The training of clinical staff was identified as a critical aspect for the successful implementation of this service. Virtual reality (VR) training has not previously been used in this context.

OBJECTIVE

We sought to develop an evidence-based VR training module specifically tailored for stroke telehealth. During implementation, we aimed to assess the feasibility of workplace deployment and collected feedback from spoke hospital staff involved in stroke management on training acceptability and usability as well as perceived training impact.

METHODS

The TACTICS VR Stroke Telehealth application was developed with subject matter experts. During implementation, both quantitative and qualitative data were documented, including VR use and survey feedback. VR hardware was deployed to 23 rural hospitals, and use data were captured via automated Wi-Fi transfer. At 7 hospitals in a single local health district, staff using TACTICS VR were invited to complete surveys before and after training.

RESULTS

TACTICS VR Stroke Telehealth was deployed to rural New South Wales hospitals starting on April 14, 2021. Through August 20, 2023, a total of 177 VR sessions were completed. Survey respondents (n=20) indicated a high level of acceptability, usability, and perceived training impact (eg, accuracy and knowledge transfer; mean scores 3.8-4.4; 5=strongly agree). Furthermore, respondents agreed that TACTICS VR increased confidence (13/18, 72%), improved understanding (16/18, 89%), and improved awareness (17/18, 94%) regarding stroke telehealth. A comparison of matched pre- and posttraining responses revealed that training improved the understanding of telehealth workflow practices (after training: mean 4.2, SD 0.6; before training: mean 3.2, SD 0.9; P<.001), knowledge on accessing stroke telehealth (mean 4.1, SD 0.6 vs mean 3.1, SD 1.0; P=.001), the awareness of stroke telehealth (mean 4.1, SD 0.6 vs mean 3.4, SD 0.9; P=.03), ability to optimally communicate with colleagues (mean 4.2, SD 0.6 vs mean 3.7, SD 0.9; P=.02), and ability to make improvements (mean 4.0, SD 0.6 vs mean 3.5, SD 0.9; P=.03). Remote training and deployment were feasible, and limited issues were identified, although uptake varied widely (0-66 sessions/site).

CONCLUSIONS

TACTICS VR Stroke Telehealth is a new VR application specifically tailored for stroke telehealth workflow training at spoke hospitals. Training was considered acceptable, usable, and useful and had positive perceived training impacts in a real-world clinical implementation context. Additional work is required to optimize training uptake and integrate training into existing education pathways.

Text-to-movie authoring of anatomy lessons

There is a need for a simple yet comprehensive tool to produce and edit pedagogical anatomy video courses, given the widespread usage of multimedia and 3D content in anatomy instruction. Anatomy teachers have minimal control over the present anatomical content generation pipeline. In this research, we provide an authoring tool for instructors that takes text written in the Anatomy Storyboard Language (ASL), a novel domain-specific language (DSL) and produces an animated video. ASL is a formal language that allows users to describe video shots as individual sentences while referencing anatomic structures from a large-scale ontology linked to 3D models. We describe an authoring tool that translates anatomy lessons written in ASL to finite state machines, which are then used to automatically generate 3D animation with the Unity 3D game engine. The proposed text-to-movie authoring tool was evaluated by four anatomy professors to create short lessons on the knee. Preliminary results demonstrate the ease of use and effectiveness of the tool for quickly drafting narrated video lessons in realistic medical anatomy teaching scenarios.

Application of flipped classroom combined with virtual simulation platform in clinical biochemistry practical course

BACKGROUND

The study explores an innovative teaching mode that integrates Icourse, DingTalk, and online experimental simulation platforms to provide online theoretical and experimental resources for clinical biochemistry practical courses. These platforms, combined with flipped classroom teaching, aim to increase student engagement and benefit in practical courses, ultimately improving the effectiveness of clinical biochemistry practical teaching.

METHODS

In a prospective cohort study, we examined the impact of integrating the Icourse and DingTalk platforms to provide theoretical knowledge resources and clinical cases to 48 medical laboratory science students from the 2019 and 2020 grades. Students were assigned to the experimental group using an overall sampling method, and had access to relevant videos through Icourse before and during class. Using a flipped classroom approach, students actively participated in the design, analysis, and discussion of the experimental technique. For the experimental operation part, students participated in virtual simulation experiments and actual experiments. Overall, the study aimed to evaluate students' theoretical and operational performance after completing the practical course. To collect feedback, we distributed a questionnaire to students in the experimental group. For comparison, we included 42 students from the grades of 2017 and 2018 who received traditional instruction and were evaluated using standard textbooks as the control group.

RESULTS

The experimental group scored significantly higher than the control group on both the theoretical and experimental operational tests (82.45 ± 3.76 vs. 76.36 ± 3.96, P = 0.0126; 92.03 ± 1.62 vs. 81.67 ± 4.19, P < 0.001). The survey revealed that the experimental group preferred the teaching mode that combined the flipped classroom with the virtual simulation platform. This mixed method effectively promoted understanding of basic knowledge (93.8%, 45/48), operative skills (89.6%, 43/48), learning interest (87.5%, 42/48), clinical thinking (85.4%, 41/48), self-learning ability (91.7%, 44/48), and overall satisfaction compared with traditional methods (P < 0.05). This study demonstrates that an innovative teaching approach significantly improves the quality of clinical biochemistry practical courses and promotes students' professional development and self-directed learning habits.

CONCLUSION

Incorporating virtual simulation with flipped classrooms into clinical biochemistry practical teaching is an efficient and well-received alternative to traditional methods.

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.

Survey of students' learning experience using a virtual slaughterhouse simulator in three UK veterinary schools during the COVID-19 pandemic

BACKGROUND

Although visiting an abattoir is mandatory for all UK veterinary students, this was challenging during the COVID-19 pandemic and virtual simulators were temporarily approved by the Royal College of Veterinary Surgeons. Subsequently, the virtual slaughterhouse simulator (VSS) was used by the University of Nottingham School of Veterinary Medicine and Science, the University of Liverpool School of Veterinary Science and the Royal (Dick) School of Veterinary Studies in Edinburgh. This study aimed to evaluate the student learning experience using the VSS.

METHODS

An online survey containing satisfaction and assessment questions was distributed to all final-year students who used the VSS from September 2020 to August 2021.

RESULTS

A total of 207 students completed the survey (n = 207/488, 42%). Students were mostly highly satisfied and found the VSS very useful for their learning (n = 164/207,79%); however, anxiety levels to visit a real abattoir lowered for less than half of the students (n = 97/207, 46%). Most students obtained an overall mark over 50% in the assessment questions (n = 197/207, 95%).

LIMITATIONS

Although the findings were very positive, extrapolation to other veterinary schools and postgraduate curricula should be done cautiously.

CONCLUSION

The VSS is a valid tool for training veterinary students. However, more research is advised to compare virtual and real experiences and assess students' long-term performance.

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.

Use of Mixed Reality in Neurosurgery Training: A Single Centre Experience

BACKGROUND

Mixed reality (MR) technology has opened new avenues for planning, visualization, and education in surgery. Neurosurgical pathologies require a very clear understanding of the relationships between pathology and critical neurovascular structures. The decline in cadaveric dissections and resource constraints has pushed the educators to find newer ways of rendering the same knowledge. The aim of this study was to determine the feasibility of employing a MR device in a high-volume center for neurosurgical teaching. The study also evaluated the results of the trainee experience in using the MR platform.

METHODS

Three neurosurgical consultants who are part of the teaching faculty were asked to facilitate the session. No prior training on utilizing the MR device was given to the trainees. HoloLens 2 was used as the MR device. Two questionnaires were used to understand the experience of the trainees.

RESULTS

Eight active neurosurgical trainees who are currently training at our institution were recruited for the purposes of this study. Despite having no prior training on a MR platform, the learning curve was short for most of the trainees. Whether MR replace current traditional methods of teaching neuroanatomy, the response was divided across the trainees. The results of the User Experience Questionnaire were positive with the trainees finding the device as attractive, dependable, novel, and user-friendly.

CONCLUSION

This study demonstrates the feasibility of using MR platform in neurosurgery training without significant preparation requirements. These data are required to justify the future investment in this technology for training institutions.

The Anatomage Table: A Promising Alternative in Anatomy Education

Anatomy is one of medical and nursing education's most prominent and crucial keynotes. For ages, conventional lectures and the analysis of actual human corpses were employed as predominant teaching techniques. However, the sphere of healthcare pedagogy has been greatly altered by the developing passion for technology over the past few years. Anatomage offers a life-size digital representation of the human body, allowing the visualization, manipulation, and virtual dissection of complex anatomical structures, using detailed 3D (three-dimensional) models. Academic institutions utilize Anatomage as a means to enhance and contemporize the acquisition of anatomy knowledge. This systematic review aims to present the educational role of Anatomage in anatomy and whether it can replace the use of cadaveric material in medical education entirely in the future.  A detailed search on PubMed, SCOPUS, Wiley Online Library, and Google Scholar databases was performed. The criteria for the selection were the English language and the year of publication between 2018 and 2023. We rejected publications that were irrelevant to the topic. Before applying the filters, we found 198 publications, from which 24 were finally chosen for the purpose of this review.  The results of this systematic review indicate that most students agree on the beneficial role of Anatomage in the thorough comprehension of anatomical knowledge, and they prefer it over traditional learning methods, such as the use of cadaveric material. Anatomage not only offers a deeper insight into the relations between inner formations, since it is a particularly easy-to-use and pleasant teaching tool, but also contributes to the improvement of learning outcomes in the classroom, which is proved by higher grades in the anatomy course. However, it can be an effective teaching method if it is used in addition to the classic method of cadaver training, rather than being the only educational practice.  Integrating the Anatomage Table (AT) into undergraduate courses is paramount to the comprehensive learning and application of human anatomy in students' future health careers. Learners who have utilized the table note it to be a beneficial and effective tool in preparing them to enter into the healthcare profession.

Validation of collaborative cyberspace virtual reality oculometry enhanced with near real-time spatial audio

Currently, most medical image data, such as optical coherence tomography (OCT) images, are displayed in two dimensions on a computer screen. Advances in computer information technology have contributed to the growing storage of these data in electronic form. However, the data are usually processed only locally on site. To overcome such hurdles, a cyberspace virtual reality (csVR) application was validated, in which interactive OCT data were presented simultaneously to geographically distant sites (Lucerne, London, and Barcelona) where three graders independently measured the ocular csVR OCT diameters. A total of 109 objects were measured, each three times, resulting in a total of 327 csVR measurements. A minor mean absolute difference of 5.3 µm was found among the 3 measurements of an object (standard deviation 4.2 µm, coefficient of variation 0.3% with respect to the mean object size). Despite the 5 h of online work, csVR was well tolerated and safe. Digital high-resolution OCT data can be remotely and collaboratively processed in csVR. With csVR, measurements and actions enhanced with spatial audio communication can be made consistently in near real time, even if the users are situated geographically far apart. The proposed visuo-auditory framework has the potential to further boost the convenience of digital medicine toward csVR precision and collaborative medicine.

FitJaw Mobile, a virtual reality device applied to dentistry: An analysis based on two patient treatments

STATEMENT OF PROBLEM

Virtual reality (VR) has improved significantly in the last decade and has been applied to different fields, including medicine, dentistry, and physiotherapy. VR has been used for the innovative treatment of painful conditions, especially when traditional exercise therapies were unsuccessful because of patient noncompliance.

PURPOSE

The purpose of this study was to analyze the use of VR as an aid when using exercises to manage temporomandibular disorders (TMDs).

MATERIAL AND METHODS

Two White women diagnosed with TMDs of muscular origin (one with muscular pain and the other with reduced mouth opening) were referred to the Department of Prosthodontics of the University of Seville, where they were enrolled in an exercise program using the VR software program FitJaw Mobile. Both had been treated the previous year with an occlusal device for TMD of muscular origin, but their symptoms had not improved.

RESULTS

For both patients, the functional movement limitation and the chronic pain improved noticeably.

CONCLUSIONS

The use of VR when doing jaw exercises can improve outcomes and compliance.

Taking the Pulse of the Current State of Simulation

Simulation in health-care professions has grown in the last few decades. We provide an overview of the history of simulation in other fields, the trajectory of simulation in health professions education, and research in medical education, including the learning theories and tools to assess and evaluate simulation programs. We also propose future directions for simulation and research in health professions education.

Use of 3-Dimensional Modeling and Augmented/Virtual Reality Applications in Microsurgical Neuroanatomy Training

BACKGROUND

Understanding the microsurgical neuroanatomy of the brain is challenging yet crucial for safe and effective surgery. Training on human cadavers provides an opportunity to practice approaches and learn about the brain's complex organization from a surgical view. Innovations in visual technology, such as virtual reality (VR) and augmented reality (AR), have immensely added a new dimension to neuroanatomy education. In this regard, a 3-dimensional (3D) model and AR/VR application may facilitate the understanding of the microsurgical neuroanatomy of the brain and improve spatial recognition during neurosurgical procedures by generating a better comprehension of interrelated neuroanatomic structures.

OBJECTIVE

To investigate the results of 3D volumetric modeling and AR/VR applications in showing the brain's complex organization during fiber dissection.

METHODS

Fiber dissection was applied to the specimen, and the 3D model was created with a new photogrammetry method. After photogrammetry, the 3D model was edited using 3D editing programs and viewed in AR. The 3D model was also viewed in VR using a head-mounted display device.

RESULTS

The 3D model was viewed in internet-based sites and AR/VR platforms with high resolution. The fibers could be panned, rotated, and moved freely on different planes and viewed from different angles on AR and VR platforms.

CONCLUSION

This study demonstrated that fiber dissections can be transformed and viewed digitally on AR/VR platforms. These models can be considered a powerful teaching tool for improving the surgical spatial recognition of interrelated neuroanatomic structures. Neurosurgeons worldwide can easily avail of these models on digital platforms.

Augmented Reality in HBP surgery. Technology at your fingertips

Augmented reality is a technology that opens new possibilities in surgery. We present our experience in a hepatobiliary-pancreatic surgery unit in terms of preoperative planning, intraoperative support and teaching. For surgical planning, we have used 3D CT and MRI reconstructions to evaluate complex cases, which has made the interpretation of the anatomy more precise and the planning of the technique simpler. At an intraoperative level, it provides for remote holographic connection between specialists, the substitution of physical elements for virtual elements, and the use of virtual consultation models and surgical guides. In teaching, new lessons include sharing live video of surgery with the support of virtual elements for a better student understanding. As the experience has been satisfactory, augmented reality could be applied in the future to improve the results of hepatobiliary-pancreatic surgery.

Use of Extended Reality in Medical Education: An Integrative Review

Extended reality (XR) has emerged as an innovative simulation-based learning modality. An integrative review was undertaken to explore the nature of evidence, usage, and effectiveness of XR modalities in medical education. One hundred and thirty-three (N = 133) studies and articles were reviewed. XR technologies are commonly reported in surgical and anatomical education, and the evidence suggests XR may be as effective as traditional medical education teaching methods and, potentially, a more cost-effective means of curriculum delivery. Further research to compare different variations of XR technologies and best applications in medical education and training are required to advance the field.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-022-01698-4.

Student Engagement Using HoloLens Mixed-Reality Technology in Human Anatomy Laboratories for Osteopathic Medical Students: an Instructional Model

Mixed-reality technology is a powerful tool used in healthcare and medical education to engage students in life-like scenarios. This blend of virtual and augmented reality images incorporates virtual projections with the real environment to allow real-time observation and interaction [1]. While this immersive technology offers advantages over cadaver dissections, it creates new challenges to keeping students engaged [2, 3]. Student engagement improves students' commitment to learning, critical thinking, and motivation and results in successful course outcomes [4, 5]. This paper provides an activity model using the HoloLens mixed-reality technology to deliver human gross anatomy laboratory sessions to first-year osteopathic medical students. The activity was designed using Gagne's model for instructional design and team-based learning to create an active learning model, which targets the behavioral, emotional, and cognitive dimensions of student engagement [6, 7]: behavioral engagement through autonomy and time on task, emotional engagement through providing the guiding exploration and narrative flow to accompany students' visual experience, and cognitive engagement by incorporating team-based learning (TBL) and case-based learning (CBL). The instructional model also answers the call for a new type of virtual reality instructor and pedagogical strategy that addresses the unique challenges and increases student engagement with this new technology. The effectiveness of this classroom activity was assessed by observing students for indicators or behaviors of student engagement, which are discussed. Further studies are required to measure the extent to which these indicators were exhibited and compare student engagement with this mixed-reality to didactic cadaver-based laboratory sessions.

Immersive virtual reality for pre-registration computed tomography education of radiographers: A narrative review

To be registered as a medical radiation practitioner, The Medical Radiation Practice Board of Australia (MRPBA) requires radiographers to be capable of performing computed tomography (CT) imaging examinations safely and effectively. Universities meet this requirement by offering practical CT training to radiography students on-campus and during clinical placements. However, institutions face challenges when facilitating on-campus CT practicum. Virtual reality (VR) has been suggested as a possible solution for radiography students to gain CT scanning experience. This narrative review explored relevant literature to investigate the potential for immersive VR to be incorporated into CT practicum. Benefits and limitations of this education technology are examined with resultant recommendations made for integration into the CT curriculum. Results found that VR enhances CT learning for students, increases confidence and raises motivation for the simulated CT task. CT simulation provides a viable alternative in the context of pandemic-imposed restrictions and reduced CT placement duration. However, it remains debatable as to whether immersive VR truly enhances student learning compared with other VR modalities, such as computer-based CT simulation. In addition, a lack of staff training, availability of resources and technical problems were flagged as limitations. We concluded that before immersive VR is integrated into CT education, significant optimisation of the simulation is needed. This includes ensuring VR scenarios are based on learning paradigms and feedback is integrated as part of simulation learning. Engaging clinical partners during the CT VR rollout is imperative to ensure successful transition of students from university learning to clinical placement.

Effect of interprofessional education on cadaver dissection seminar

In 2010, WHO published a "Framework for action on interprofessional education and collaborative practice." Interprofessional education (IPE) is now being conducted in various ways. We have been holding cadaver dissection seminars to provide opportunities for medical students, nursing students, and nurse practitioner (NP) students to learn together. In this study, we investigated the effect of learning about IPE in cadaver dissection seminars. The seminars were held for 5 days each in 2021 and 2022 (the number of days of participation was arbitrary). In the seminars, teams of 3-5 participants with the same theme collaborated to dissect a single donated cadaver. Teams were made up of participants with different departments: 29 medical students, 12 NP students, and 20 nursing students participated in the seminar, and participants were surveyed before and after the seminars. The Readiness for Interprofessional Learning Scale (RIPLS) scores before and after the dissection seminar increased significantly overall. The scores of medical and nursing students increased significantly, but those of NP students did not significantly change. In terms of the number of days of participation, a significant increase in scores was found for participants who participated for ≥ 2 days. Overall, a significant positive correlation was found between intrinsic motivation to learn and RIPLS scores. For medical students, a significant negative correlation was noted between extrinsic motivation and RIPLS scores. Cadaver dissection seminars conducted by medical, nursing, and NP students demonstrated IPE learning effect on medical students and undergraduate nursing students.

Mixed reality for extraction of maxillary mesiodens

BACKGROUND

Mesiodentes are the most common supernumerary teeth. The cause is not fully understood, although proliferations of genetic factors and the dental lamina have been implicated. Mesiodentes can cause delayed or ectopic eruption of permanent incisors, which can further alter occlusion and appearance. Careful attention should be paid to the position and direction of the mesiodentes because of possible damage to adjacent roots in the permanent dentition period, errant extraction in the deciduous and mixed dentition periods, and damage to the permanent tooth embryo. To avoid these complications, we applied mixed reality (MR) technology using the HoloLens® (Microsoft, California). In this study, we report on three cases of mesiodentes extraction under general anesthesia using MR technology.

RESULTS

The patients ranged in age from 6 to 11 years, all three were boys, and the direction of eruption was inverted in all cases. The extraction approach was palatal in two cases and labial in one case. The average operative time was 32 min, and bleeding was minimal in all cases. No intraoperative or postoperative complications occurred. An image was shared preoperatively with all the surgeons using an actual situation model. Three surgeons used Microsoft HoloLens® during surgery, shared MR, and operated while superimposing the application image in the surgical field.

CONCLUSIONS

The procedure was performed safely; further development of MR surgery support systems in the future is suggested.

The Third Dimension: 3D Printed Replicas and Other Alternatives to Cadaver-Based Learning

Capturing the 'third dimension' of complex human form or anatomy has been an objective of artists and anatomists from the renaissance in the fifteenth and sixteenth centuries onwards. Many of these drawings, paintings, and sculptures have had a profound influence on medical teaching and the learning resources we took for granted until around 40 years ago. Since then, the teaching of human anatomy has undergone significant change, especially in respect of the technologies available to augment or replace traditional cadaver-based dissection instruction. Whilst resources such as atlases, wall charts, plastic models, and images from the Internet have been around for many decades, institutions looking to reduce the reliance on dissection-based teaching in medical or health professional training programmes have in more recent times increasingly had access to a range of other options for classroom-based instruction. These include digital resources and software programmes and plastinated specimens, although the latter come with a range of ethical and cost considerations. However, the urge to recapitulate the 'third dimension' of anatomy has seen the recent advent of novel resources in the form of 3D printed replicas. These 3D printed replicas of normal human anatomy dissections are based on a combination of radiographic imaging and surface scanning that captures critical 3D anatomical information. The final 3D files can either be augmented with false colour or made to closely resemble traditional prosections prior to printing. This chapter details the journey we and others have taken in the search for the 'third dimension'. The future of a haptically identical, anatomically accurate replica of human cadaver specimens for surgical and medical training is nearly upon us. Indeed, the need for hard copy replicas may eventually be superseded by the opportunities afforded by virtual reality (VR) and augmented reality (AR).

Taking modern psychiatry into the metaverse: Integrating augmented, virtual, and mixed reality technologies into psychiatric care

The landscape of psychiatry is ever evolving and has recently begun to be influenced more heavily by new technologies. One novel technology which may have particular application to psychiatry is the metaverse, a three-dimensional digital social platform accessed via augmented, virtual, and mixed reality (AR/VR/MR). The metaverse allows the interaction of users in a virtual world which can be measured and manipulated, posing at once exciting new possibilities and significant potential challenges and risks. While the final form of the nascent metaverse is not yet clear, the immersive simulation and holographic mixed reality-based worlds made possible by the metaverse have the potential to redefine neuropsychiatric care for both patients and their providers. While a number of applications for this technology can be envisioned, this article will focus on leveraging the metaverse in three specific domains: medical education, brain stimulation, and biofeedback. Within medical education, the metaverse could allow for more precise feedback to students performing patient interviews as well as the ability to more easily disseminate highly specialized technical skills, such as those used in advanced neurostimulation paradigms. Examples of potential applications in brain stimulation and biofeedback range from using AR to improve precision targeting of non-invasive neuromodulation modalities to more innovative practices, such as using physiological and behavioral measures derived from interactions in VR environments to directly inform and personalize treatment parameters for patients. Along with promising future applications, we also discuss ethical implications and data security concerns that arise when considering the introduction of the metaverse and related AR/VR technologies to psychiatric research and care.

Validating the accuracy of a novel virtual reality platform for determining implant orientation in simulated primary total hip replacement

Introduction

Accurate acetabular cup and femoral stem component orientation are critical for optimising patient outcomes, reducing complications and increasing component longevity following total hip replacement (THR). This study aimed to determine the accuracy of a novel virtual reality (VR) platform in assessing component orientation in a simulated THR model.

Methods

The VR platform (HTC Vive Pro® system hardware) was compared against the validated Vicon® optical motion capture (MoCap) system. An acetabular cup and femoral stem were manually implanted across a range of orientations into pelvic and femur sawbones, respectively. Simultaneous readings of the acetabular cup operative anteversion (OA) and inclination (OI) and femoral stem alignment (FSA) and neck anteversion (FNA) were obtained from the VR and MoCap systems. Statistical analysis was performed using Pearson product-moment correlation coefficient (PPMCC) (Pearson’s r) and linear regression (R²).

Results

A total of 55 readings were obtained for the acetabular cup and 68 for the femoral stem model. The mean average differences in OA, OI, FSA and FNA between the systems were 3.44°, −0.01°, 0.01° and −0.04°, respectively. Strong positive correlations were demonstrated between both systems in OA, OI, FSA and FNA, with Pearson’s r = 0.92, 0.94, 0.99 and 0.99, and adjusted R² = 0.82, 0.9, 0.98 and 0.98, respectively.

Conclusion

The novel VR platform is highly accurate and reliable in determining both acetabular cup and femoral stem component orientations in simulated THR models. This adaptable and cost-effective digital tracking platform may be modified for use in a range of simulated surgical training and educational purposes, particularly in orthopaedic surgery.

Has pedagogy, technology, and Covid-19 killed the face-to-face lecture?

The lecture has been around for centuries and has featured as a popular and frequent component in higher education courses across many disciplines including anatomy. In more recent years, there has been a growing shift toward blended learning and related pedagogies that encourage active participation of students in both face-to-face and online learning environments. Unfortunately, in many cases, the lecture, which has typically focused on the transmission of information from educator to student has not been adapted to become a more learner-oriented approach with opportunities for students to actively interact and engage. As a result, the future of whether the lecture should continue has once again become a center of debate. The consequence of the Covid-19 pandemic and its aftermath have added to this with institutions now looking to stop all lectures or offer them in an online format only. This commentary argues that lecture-style components could still feature within face-to-face and online provision, but only if they are used sparingly within a blended curriculum, have a defined use that aligns well to learning outcomes, are assessed as the most effective method pedagogically, and importantly integrate approaches and activities that promote student engagement. Anatomy educators have demonstrated for years that they are able to be at the forefront of pedagogical change and evidenced during the pandemic their agile and innovative ability to adapt and do things differently. Therefore, the fate of the lecture, at least in anatomy, may well be in their hands.

Virtual Reality in Biomedical Education in the sense of the 3Rs

Article 23(2) of EU Directive 2010/63 on the protection of animals used for scientific purposes requires staff involved in the care and use of animals to be adequately educated and trained before carrying out procedures. Therefore, the 3Rs (refinement, reduction, and replacement) and knowledge of alternative methods should be part of the education and training itself. For this purpose, the digital learning concept "Virtual Reality (VR) in Biomedical Education" evolved, which successfully combines VR components with classical learning content. Procedures, such as anesthesia induction, substance application, and blood sampling in rats, as well as aspects of the laboratory environment were recorded in 360° videos. The generated VR teaching/learning modules (VR modules) were used to better prepare participants for hands-on training (refinement) or as a complete replacement for a live demonstration; thus, reducing the number of animals used for hands-on skills training (reduction). The current study evaluated users' experience of the VR modules. Despite little previous VR experience, participants strongly appreciated the VR modules and indicated that they believed VR has the potential to enhance delivery of procedures and demonstrations. Interestingly, participants with previous experience of laboratory animal science were more convinced about VR's potential to support the 3Rs principle, and endorsed its use for further educational purposes. In conclusion, VR appeared to be highly accepted as a learning/teaching method, indicating its great potential to further replace and reduce the use of animals in experimental animal courses.

Enhanced Visualisation of Normal Anatomy with Potential Use of Augmented Reality Superimposed on Three-Dimensional Printed Models

Anatomical knowledge underpins the practice of many healthcare professions. While cadaveric specimens are generally used to demonstrate realistic anatomy, high cost, ethical considerations and limited accessibility can often impede their suitability for use as teaching tools. This study aimed to develop an alternative to traditional teaching methods; a novel teaching tool using augmented reality (AR) and three-dimensional (3D) printed models to accurately demonstrate normal ankle and foot anatomy. An open-source software (3D Slicer) was used to segment a high-resolution magnetic resonance imaging (MRI) dataset of a healthy volunteer ankle and produce virtual bone and musculature objects. Bone and musculature were segmented using seed-planting and interpolation functions, respectively. Virtual models were imported into Unity 3D, which was used to develop user interface and achieve interactability prior to export to the Microsoft HoloLens 2. Three life-size models of bony anatomy were printed in yellow polylactic acid and thermoplastic polyurethane, with another model printed in white Visijet SL Flex with a supporting base attached to its plantar aspect. Interactive user interface with functional toggle switches was developed. Object recognition did not function as intended, with adequate tracking and AR superimposition not achieved. The models accurately demonstrate bony foot and ankle anatomy in relation to the associated musculature. Although segmentation outcomes were sufficient, the process was highly time consuming, with effective object recognition tools relatively inaccessible. This may limit the reproducibility of augmented reality learning tools on a larger scale. Research is required to determine the extent to which this tool accurately demonstrates anatomy and ascertain whether use of this tool improves learning outcomes and is effective for teaching anatomy.

Some Things Change, Some Things Stay the Same: Trends in Canadian Education in Paediatric Cardiology and the Cardiac Sciences

Education in paediatric cardiology has evolved along with clinical care. The availability and application of new technologies in education, in particular, have had a significant impact. Artificial intelligence; virtual, augmented, and mixed reality learning tools; and gamification of learning have all resulted in new opportunities for today's trainees compared with those of the past. A new training model is also being used. Though currently focused on residency education, competency-based medical education is also being applied to undergraduate education in some Canadian medical schools. Competency-based medical education offers a more transparent relationship between education and physicians' social contract with society. It provides greater accountability for programmes and learners to teach and learn the skills required to function as competent specialists. However, it has not come without challenges. Coincident with the application of this model for learners, there has been increased educational accountability for physicians in practice and for the institutions training them. Despite these changes, some things have remained the same. On the positive side, the importance of good clinical teachers to effective learning remains constant. Unfortunately, the mistreatment of learners within our education system also remains and is perhaps the most important challenge facing medical education in Canada today. Learning to be better teachers and learner advocates is an important goal for all of those involved in educating Canadian medical learners.

Instructional design and educational satisfaction for virtual environment simulation in undergraduate nursing education: the mediating effect of learning immersion

BACKGROUND

Schools were closed after the onset of COVID-19, with non-face-to-face practices or distance education in nursing education replacing video learning or simulation classes in nursing education clinical practicum. This led to an increase in interest in virtual environment simulation education. While technology-based teaching methods might feel new and intriguing to learners, it is necessary to evaluate learner satisfaction with such an educational method beyond its novelty value. Therefore, this study examined the mediating effect of learning immersion on the relationships between instructional design and educational satisfaction, for virtual environment simulation.

METHODS

A descriptive cross-sectional research design was used. The study sample included students in the third or fourth year of the nursing curriculum in South Korea. The participants were 164 nursing students, who had an experience with virtual environment simulation practices during the past year, prior to September 2021. Data were collected using an online questionnaire. The questionnaire addressed the characteristics of nursing students, instructional design, learning immersion, and educational satisfaction. The collected data were analyzed using path analysis.

RESULTS

The indirect effect of the path between instructional design and educational satisfaction, mediated through learning immersion in virtual environment simulation was found to be significant. Furthermore, the direct path was also statistically significant.

CONCLUSION

Educational content, based on virtual environment simulation, should be implemented based on instructional design. It is necessary to recognize the importance of instructional design that can promote learning immersion in virtual environment simulation, as well as to prepare consistent standards for such design.

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.

The impact of COVID-19 pandemic on hand surgery: a FESSH perspective

COVID-19 has affected us all. The following collection of short essays highlights various aspects of the pandemic and how it has impacted hand surgery and lessons learned, from the perspective of the Federation of European Societies for Surgery of the Hand (FESSH) Executive Committee members. A range of topics were individually chosen by each of the five committee members and presented.

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.

Modern and synchronized clinical anatomy teaching based on the BDIE method (board-digital dissection-imaging-evaluation)

PURPOSE

Anatomy has historically been taught via traditional medical school lectures and dissection. In many countries, practical or legal issues limit access to cadaveric dissection. New technologies are favored by students and could improve learning, complementing traditional teaching.

METHODS

All students in second-year medicine at a single medical school were submitted to a novel anatomical course with digital tool exposure. We explored a new combined teaching method: a physical blackboard lesson synchronized with digital dissection, imaging and direct evaluation (BDIE). Synchronized dissection is broadcast live in the classroom and in partner medical schools. Following the course, students completed a short survey about their perception of this new anatomic clinical course.

RESULTS

The survey included 183 students whom 178 completed the questionnaire, i.e., a 97% response rate. Ninety-nine percent of students thought this synchronized method useful to improve their understanding of anatomy and 90% stated it helped them retain this learning.

CONCLUSION

This BDIE method, in conjunction with teaching guidelines and dissection, is highly appreciated by students who consider it helps them to acquire lasting knowledge.

Digital Transformation Will Change Medical Education and Rehabilitation in Spine Surgery

The concept of minimally invasive spine therapy (MIST) has been proposed as a treatment strategy to reduce the need for overall patient care, including not only minimally invasive spine surgery (MISS) but also conservative treatment and rehabilitation. To maximize the effectiveness of patient care in spine surgery, the educational needs of medical students, residents, and patient rehabilitation can be enhanced by digital transformation (DX), including virtual reality (VR), augmented reality (AR), mixed reality (MR), and extended reality (XR), three-dimensional (3D) medical images and holograms; wearable sensors, high-performance video cameras, fifth-generation wireless system (5G) and wireless fidelity (Wi-Fi), artificial intelligence, and head-mounted displays (HMDs). Furthermore, to comply with the guidelines for social distancing due to the unexpected COVID-19 pandemic, the use of DX to maintain healthcare and education is becoming more innovative than ever before. In medical education, with the evolution of science and technology, it has become mandatory to provide a highly interactive educational environment and experience using DX technology for residents and medical students, known as digital natives. This study describes an approach to pre- and intraoperative medical education and postoperative rehabilitation using DX in the field of spine surgery that was implemented during the COVID-19 pandemic and will be utilized thereafter.

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

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

How, for Whom, and in Which Contexts or Conditions Augmented and Virtual Reality Training Works in Upskilling Health Care Workers: Realist Synthesis

Background

Using traditional simulators (eg, cadavers, animals, or actors) to upskill health workers is becoming less common because of ethical issues, commitment to patient safety, and cost and resource restrictions. Virtual reality (VR) and augmented reality (AR) may help to overcome these barriers. However, their effectiveness is often contested and poorly understood and warrants further investigation.

Objective

The aim of this review is to develop, test, and refine an evidence-informed program theory on how, for whom, and to what extent training using AR or VR works for upskilling health care workers and to understand what facilitates or constrains their implementation and maintenance.

Methods

We conducted a realist synthesis using the following 3-step process: theory elicitation, theory testing, and theory refinement. We first searched 7 databases and 11 practitioner journals for literature on AR or VR used to train health care staff. In total, 80 papers were identified, and information regarding context-mechanism-outcome (CMO) was extracted. We conducted a narrative synthesis to form an initial program theory comprising of CMO configurations. To refine and test this theory, we identified empirical studies through a second search of the same databases used in the first search. We used the Mixed Methods Appraisal Tool to assess the quality of the studies and to determine our confidence in each CMO configuration.

Results

Of the 41 CMO configurations identified, we had moderate to high confidence in 9 (22%) based on 46 empirical studies reporting on VR, AR, or mixed simulation training programs. These stated that realistic (high-fidelity) simulations trigger perceptions of realism, easier visualization of patient anatomy, and an interactive experience, which result in increased learner satisfaction and more effective learning. Immersive VR or AR engages learners in deep immersion and improves learning and skill performance. When transferable skills and knowledge are taught using VR or AR, skills are enhanced and practiced in a safe environment, leading to knowledge and skill transfer to clinical practice. Finally, for novices, VR or AR enables repeated practice, resulting in technical proficiency, skill acquisition, and improved performance. The most common barriers to implementation were up-front costs, negative attitudes and experiences (ie, cybersickness), developmental and logistical considerations, and the complexity of creating a curriculum. Facilitating factors included decreasing costs through commercialization, increasing the cost-effectiveness of training, a cultural shift toward acceptance, access to training, and leadership and collaboration.

Conclusions

Technical and nontechnical skills training programs using AR or VR for health care staff may trigger perceptions of realism and deep immersion and enable easier visualization, interactivity, enhanced skills, and repeated practice in a safe environment. This may improve skills and increase learning, knowledge, and learner satisfaction. The future testing of these mechanisms using hypothesis-driven approaches is required. Research is also required to explore implementation considerations.

New Approach to Accelerated Image Annotation by Leveraging Virtual Reality and Cloud Computing

Three-dimensional imaging is at the core of medical imaging and is becoming a standard in biological research. As a result, there is an increasing need to visualize, analyze and interact with data in a natural three-dimensional context. By combining stereoscopy and motion tracking, commercial virtual reality (VR) headsets provide a solution to this critical visualization challenge by allowing users to view volumetric image stacks in a highly intuitive fashion. While optimizing the visualization and interaction process in VR remains an active topic, one of the most pressing issue is how to utilize VR for annotation and analysis of data. Annotating data is often a required step for training machine learning algorithms. For example, enhancing the ability to annotate complex three-dimensional data in biological research as newly acquired data may come in limited quantities. Similarly, medical data annotation is often time-consuming and requires expert knowledge to identify structures of interest correctly. Moreover, simultaneous data analysis and visualization in VR is computationally demanding. Here, we introduce a new procedure to visualize, interact, annotate and analyze data by combining VR with cloud computing. VR is leveraged to provide natural interactions with volumetric representations of experimental imaging data. In parallel, cloud computing performs costly computations to accelerate the data annotation with minimal input required from the user. We demonstrate multiple proof-of-concept applications of our approach on volumetric fluorescent microscopy images of mouse neurons and tumor or organ annotations in medical images.

Augmented, Virtual and Mixed Reality in Dentistry: A Narrative Review on the Existing Platforms and Future Challenges

The recent advancements in digital technologies have led to exponential progress in dentistry. This narrative review aims to summarize the applications of Augmented Reality, Virtual Reality and Mixed Reality in dentistry and describes future challenges in digitalization, such as Artificial Intelligence and Robotics. Augmented Reality, Virtual Reality and Mixed Reality represent effective tools in the educational technology, as they can enhance students’ learning and clinical training. Augmented Reality and Virtual Reality and can also be useful aids during clinical practice. Augmented Reality can be used to add digital data to real life clinical data. Clinicians can apply Virtual Reality for a digital wax-up that provides a pre-visualization of the final post treatment result. In addition, both these technologies may also be employed to eradicate dental phobia in patients and further enhance patient’s education. Similarly, they can be used to enhance communication between the dentist, patient, and technician. Artificial Intelligence and Robotics can also improve clinical practice. Artificial Intelligence is currently developed to improve dental diagnosis and provide more precise prognoses of dental diseases, whereas Robotics may be used to assist in daily practice.

Placenta accreta: Virtual reality from 3D images of magnetic resonance imaging

Image from a fragment of the video of virtual reality model evaluating a case of placenta accreta spectrum and placental invasion. In this image, the placenta (purple) goes through the uterus and reaches the bladder muscle and mucosa (pink).

Development and Pilot Implementation of TACTICS VR: A Virtual Reality-Based Stroke Management Workflow Training Application and Training Framework

Delays in acute stroke treatment contribute to severe and negative impacts for patients and significant healthcare costs. Variability in clinical care is a contributor to delayed treatment, particularly in rural, regional and remote (RRR) areas. Targeted approaches to improve stroke workflow processes improve outcomes, but numerous challenges exist particularly in RRR settings. Virtual reality (VR) applications can provide immersive and engaging training and overcome some existing training barriers. We recently initiated the TACTICS trial, which is assessing a "package intervention" to support advanced CT imaging and streamlined stroke workflow training. As part of the educational component of the intervention we developed TACTICS VR, a novel VR-based training application to upskill healthcare professionals in optimal stroke workflow processes. In the current manuscript, we describe development of the TACTICS VR platform which includes the VR-based training application, a user-facing website and an automated back-end data analytics portal. TACTICS VR was developed via an extensive and structured scoping and consultation process, to ensure content was evidence-based, represented best-practice and is tailored for the target audience. Further, we report on pilot implementation in 7 Australian hospitals to assess the feasibility of workplace-based VR training. A total of 104 healthcare professionals completed TACTICS VR training. Users indicated a high level of usability, acceptability and utility of TACTICS VR, including aspects of hardware, software design, educational content, training feedback and implementation strategy. Further, users self-reported increased confidence in their ability to make improvements in stroke management after TACTICS VR training (post-training mean ± SD = 4.1 ± 0.6; pre-training = 3.6 ± 0.9; 1 = strongly disagree, 5 = strongly agree). Very few technical issues were identified, supporting the feasibility of this training approach. Thus, we propose that TACTICS VR is a fit-for-purpose, evidence-based training application for stroke workflow optimisation that can be readily deployed on-site in a clinical setting.