The role of 3D printed models in the teaching of human anatomy: a systematic review and meta-analysis

Applying 3D surface scanning technology to create photorealistic three-dimensional printed replicas of human anatomy

Aim: To describe advances in 3D data capture and printing that allow photorealistic replicas of human anatomical specimens for education and research, and discuss advantages of current generation printing for replica design and manufacture. Materials & methods: We combine surface scanning and computerized tomography datasets that maximize precise color and geometric capture with ultra violet (UV) curable resin printing to replicate human anatomical specimens. Results: We describe the process for color control, print design and translation of photorealistic 3D meshes into 3D prints in durable resins. Conclusion: Current technologies allow previously unachievable ability to capture and reproduce anatomical specimens, and provide a platform for a new generation of 3D printed teaching materials to be designed and used in anatomy education environments.

Development, implementation, and perceptions of a 3D-printed human skull in a large dental gross anatomy course

Skull anatomy is a difficult region for anatomy students to learn and understand but is necessary for a variety of health professional students. To improve learning, a 3D-printed human skull was developed, produced, and distributed to a course of 83 dental students for use as a take-home study tool over the 10-week anatomy course. The 70% scale human skull derived from CT data had a fully articulating mandible, simulated temporomandibular joint, and accurate cranial structures. At the course end, students completed a perception survey and responses were compared with those who made a grade of A, B, or C in the course. Students overall reported using the model less than 3 h per week, but those who scored an A in the course reported using the model more frequently than those who scored a B or C. Free responses revealed that students used the model in a variety of ways, but found that the model was quick and easily accessible to check understanding while studying at home in the absence of direct observation by faculty. Overall, this study provides evidence on the feasibility of large-scale 3D printing and the benefits of the use of a 3D-printed model as a take-home study aid.

Use of 3D foot and ankle puzzle enhances student understanding of the skeletal anatomy in the early years of medical school

PURPOSE

3D visualization is an important part of learning anatomy with cadavers generally used to effectuate this. However, high cost, ethical considerations, and limited accessibility can often limit the suitability of cadavers as teaching tools. Anatomical 3D printed models offer an alternative tool for teaching gross anatomy due to their low cost and accessibility. This study aims to investigate if combing gamification with 3D printed models can enhance the learning experience and be effective for teaching anatomy.

METHODS

3D printed models of the bones of the foot and ankle were generated, and 267 first-year medical students from 2 consecutive cohorts worked in groups to put it together as a puzzle. Participants completed a questionnaire regarding perceptions of 3D models and their knowledge of foot anatomy, before and after the session and were asked to provide comments.

RESULTS

Analysis of the responses showed a significant increase in the confidence of the learners in their anatomy knowledge and an increased appreciation of the role that 3D models have in enhancing the learning experience. After the session, there were many comments saying how enjoyable and engaging 3D models were.

CONCLUSION

Through the puzzle element of the session, the students were challenged mentally to work out the anatomical features of the foot and ankle. The combined elements of the puzzle and the features of the 3D model assembly made the activity fun and conducive to active learning. The possibility of having fun was not something the students had considered before the session.

Haptic experience to significantly motivate anatomy learning in medical students

BACKGROUND

Currently, multiple tools exist to teach and learn anatomy, but finding an adequate activity is challenging. However, it can be achieved through haptic experiences, where motivation is the means of a significant learning process. This study aimed to evaluate a haptic experience to determine if a tactile and painting with color marker interactive experience, established a better learning process in comparison to the traditional 2D workshop on printed paper with photographs.

METHODS

Plaster bone models of the scapulae, humerus and clavicle were elaborated from a computerized scan tomography. Second year undergraduate medical students were invited to participate, where subjects were randomly assigned to the traditional 2D method or the 3D plaster bone model. A third group decided not to join any workshop. Following, all three groups were evaluated on bone landmarks and view, laterality, muscle insertions and functions. 2D and 3D workshop students were asked their opinion in a focus group and answered a survey regarding the overall perception and learning experience. Evaluation grades are presented as mean ± standard deviation, and answers from the survey are presented as percentages.

RESULTS

The survey demonstrated the students in the 3D model graded the experience as outstanding, and in five out of the six questions, answers were very good or excellent. In contrast, for students participating in the 2D workshop the most common answers were fair or good. The exception was the answer regarding the quiz, where both groups considered it good, despite the average among all groups not being a passing grade.

CONCLUSIONS

To learn the anatomy of the shoulder, the conventional methodology was compared with a haptic experience, where plaster bone models were used, enabling students to touch and paint on them. Based on the focus group and survey this study revealed the 3D workshop was an interactive experience where, the sense of touch and painting greatly contributed to their learning process. Even though this activity was useful in terms of learning bone landmarks, view muscle insertions, and establish relations, further activities must be developed to increase their understanding regarding their function, and its relevance in a clinical setting.

Pilot Evaluation of Silicone Surrogates for Oral Mucosa Simulation in Craniofacial Surgical Training

Surgical simulators are crucial in early craniofacial and plastic surgical training, necessitating synthetic materials that accurately replicate tissue properties. Recent critiques of our lab's currently deployed silicone surrogate have highlighted numerous areas for improvement. To further refine our models, our group's objective is to find a composition of materials that is closest in fidelity to native oral mucosa during surgical rehearsal by expert craniofacial surgeons. Fifteen platinum silicone-based surrogate samples were constructed with variable hardness and slacker percentages. These samples underwent evaluation of tactile sensation, hardness, needle puncture, cut resistance, suture retention, defect repair, and tensile elasticity. Expert craniofacial surgeon evaluators provided focused qualitative feedback on selected top-performing samples for further assessment and statistical comparisons. An evaluation revealed surrogate characteristics that were satisfactory and exhibited good performance. Sample 977 exhibited the highest performance, and comparison with the original surrogate (sample 810) demonstrated significant improvements in critical areas, emphasizing the efficacy of the refined composition. The study identified a silicone composition that directly addresses the feedback received by our team's original silicone surrogate. The study underscores the delicate balance between biofidelity and practicality in surgical simulation. The need for ongoing refinement in surrogate materials is evident to optimize training experiences for early surgical learners.

Predicting performance in a doctor of physical therapy gross anatomy course based on an exploratory factor analysis of the anatomical self-efficacy instrument

Measuring self-efficacy can be a valuable means for instructors to predict student performance. However, it is crucial to measure self-efficacy within specific contexts to effectively gauge students' perceptions of their capabilities. This study evaluated the factors comprising the Anatomical Self-Efficacy Instrument (ASEI) and determined whether these factors could predict performance in gross anatomy. Three cohorts of Doctor Physical Therapy (DPT) students completed the ASEI at the start of gross anatomy. An exploratory factor analysis (EFA) analyzed the ASEI's dimensionality, and Cronbach's alpha evaluated the internal consistency of the extracted factors. Linear regression was used to determine whether ASEI's total or subdomain scores predicted final anatomy course performance scores. In total, 142 of 287 (49.5%) DPT students completed the ASEI. EFA revealed three distinct factors, including "cognitive," "psychomotor," and "clinical anatomy self-efficacy", and explained 44.9%, 13.7%, and 5.2% of the total variance, respectively. Only cognitive self-efficacy predicted final gross anatomy course performance (β = 0.34; R2 = 0.071; F(3,138) = 3.51; p < 0.05). Overall, the ASEI's 3-factor solution implies its multidimensionality, a finding that could inform the development of more comprehensive self-efficacy measures. Notably, "cognitive self-efficacy" was the only subdomain that predicted DPT student performance in anatomy, suggesting its potential as a tool for identifying students in need of additional learning support. The ASEI's practical usability should be further explored through additional psychometric testing.

Accuracy and feasibility in building a personalized 3D printed femoral pseudoaneurysm model for endovascular training

BACKGROUND

The use of three-dimensional(3D) printing is broadly across many medical specialties. It is an innovative, and rapidly growing technology to produce custom anatomical models and medical conditions models for medical teaching, surgical planning, and patient education. This study aimed to evaluate the accuracy and feasibility of 3D printing in creating a superficial femoral artery pseudoaneurysm model based on CT scans for endovascular training.

METHODS

A case of a left superficial femoral artery pseudoaneurysm was selected, and the 3D model was created using DICOM files imported into Materialise Mimics 22.0 and Materialise 3-Matic software, then printed using vat polymerization technology. Two 3D-printed models were created, and a series of comparisons were conducted between the 3D segmented images from CT scans and these two 3D-printed models. Ten comparisons involving internal diameters and angles of the specific anatomical location were measured.

RESULTS

The study found that the absolute mean difference in diameter between the 3D segmented images and the 3D printed models was 0.179±0.145 mm and 0.216±0.143mm, respectively, with no significant difference between the two sets of models. Additionally, the absolute mean difference in angle was 0.99±0.65° and 1.00±0.91°, respectively, and the absolute mean difference in angle between the two sets of data was not significant. Bland-Altman analysis confirmed a high correlation in dimension measurements between the 3D-printed models and segmented images. Furthermore, the accuracy of a 3D-printed femoral pseudoaneurysm model was further tested through the simulation of a superficial femoral artery pseudoaneurysm coiling procedure using the Philips Azurion7 in the angiography room.

CONCLUSIONS

3D printing is a reliable technique for producing a high accuracy 3D anatomical model that closely resemble a patient's anatomy based on CT images. Additionally, 3D printing is a feasible and viable option for use in endovascular training and medical education. In general, 3D printing is an encouraging technology with diverse possibilities in medicine, including surgical planning, medical education, and medical device advancement.

The effectiveness of three-dimensional printing in undergraduate and postgraduate anatomy education: A review of reviews

PURPOSE

Several reviews and meta-analyses about the value of three-dimensional (3D) printing in anatomy education have been published in the last years, with variable-and sometimes confusing- outcomes. We performed a review of those reviews, in order to shed light on the results concerning the effectiveness of 3D printing in anatomy education, compared to specific traditional methods and other technologies.

METHODS

The electronic databases PubMed, ERIC and Cochrane library were searched for reviews or meta-analyses with purpose to investigate the effectiveness of 3D printing in undergraduate and postgraduate anatomy education.

RESULTS

Seven papers were included: four systematic reviews with meta-analysis, one narrative, one scoping and one systematic review. Overall, it has been shown that 3D printing is more effective than two-dimensional (2D) images for undergraduate health science students, but not for medical residents. Also, it seems to be more effective than 2D methods for teaching anatomy of some relatively complex structures, such as the nervous system. However, there is generally lack of evidence about the effectiveness of 3D printing in comparison with other 3D visualization methods.

CONCLUSIONS

For students, the effectiveness of 3D printing in anatomy education is higher than 2D methods. There is need for studies to investigate the effectiveness of 3D printing in comparison with other 3D visualization methods, such as cadaveric dissection, prosection and virtual reality. There is also need for research to explore if 3D printing is effective as a supplementary tool in a blended anatomy learning approach.

A Brief Review of Anatomy Education in Korea, Encompassing Its Past, Present, and Future Direction

Anatomy is a foundational subject in medicine and serves as its language. Hippocrates highlighted its importance, while Herophilus pioneered human dissection, earning him the title of the founder of anatomy. Vesalius later established modern anatomy, which has since evolved historically. In Korea, formal anatomy education for medical training began with the introduction of Western medicine during the late Joseon Dynasty. Before and after the Japanese occupation, anatomy education was conducted in the German style, and after liberation, it was maintained and developed by a small number of domestic anatomists. Medicine in Korea has grown alongside the country's rapid economic and social development. Today, 40 medical colleges produce world-class doctors to provide the best medical care service in the country. However, the societal demand for more doctors is growing in order to proactively address to challenges such as public healthcare issues, essential healthcare provision, regional medical service disparities, and an aging population. This study examines the history, current state, and challenges of anatomy education in Korea, emphasizing the availability of medical educators, support staff, and cadavers for gross anatomy instruction. While variations exist between Seoul and provincial medical colleges, each manages to deliver adequate education under challenging conditions. However, the rapid increase in medical student enrollment threatens to strain existing anatomy education resources, potentially compromising educational quality. To address these concerns, we propose strategies for training qualified gross anatomy educators, ensuring a sustainable cadaver supply, and enhancing infrastructure.

3D visualization technology for Learning human anatomy among medical students and residents: a meta- and regression analysis

BACKGROUND

3D visualization technology applies computers and other devices to create a realistic virtual world for individuals with various sensory experiences such as 3D vision, touch, and smell to gain a more effective understanding of the relationships between real spatial structures and organizations. The purpose of this study was to comprehensively evaluate the effectiveness of 3D visualization technology in human anatomy teaching/training and explore the potential factors that affect the training effects to better guide the teaching of classroom/laboratory anatomy.

METHODS

We conducted a meta-analysis of randomized controlled studies on teaching human anatomy using 3D visualization technology. We extensively searched three authoritative databases, PubMed, Web of Science, and Embase; the main outcomes were the participants' test scores and satisfaction, while the secondary outcomes were time consumption and enjoyment. Heterogeneity by I² was statistically determined because I²> 50%; therefore, a random-effects model was employed, using data processing software such as RevMan, Stata, and VOSviewer to process data, apply standardized mean difference and 95% confidence interval, and subgroup analysis to evaluate test results, and then conduct research through sensitivity analysis and meta-regression analysis.

RESULTS

Thirty-nine randomized controlled trials (2,959 participants) were screened and included in this study. The system analysis of the main results showed that compared with other methods, including data from all regions 3D visualization technology moderately improved test scores as well as satisfaction and enjoyment; however, the time that students took to complete the test was not significantly reduced. Meta-regression analysis also showed that regional factorsaffected test scores, whereas other factors had no significant impact. When the literature from China was excluded, the satisfaction and happiness of the 3D virtual-reality group were statistically significant compared to those of the traditional group; however, the test results and time consumption were not statistically significant.

CONCLUSION

3D visualization technology is an effective way to improve learners' satisfaction with and enjoyment of human anatomical learning, but it cannot reduce the time required for testers to complete the test. 3D visualization technology may struggle to improve the testers' scores. The literature test results from China are more prone to positive results and affected by regional bias.

Development of a Cost-Effective 3D-Printed Airway Suction Simulator for Respiratory Therapy Students

BACKGROUND

Three-dimensional (3D)-printed models are cost-effective and can be customized by trainers. This study designed a 3D-printed airway suction simulator for use by respiratory therapy (RT) students. The objective was to demonstrate the cost-effectiveness and application of 3D-printed models in respiratory care training, aiming to enhance the educational experience for RT students.

METHODS

This study developed a 3D-printed airway suction simulator that was cost-effective. A randomized controlled trial was conducted involving RT students to compare effectiveness in a 3D-model group and a control group. Skill assessments and written examinations were used to evaluate the participants' knowledge and skills.

RESULTS

A total of 38 second-year RT students were randomly assigned to either the 3D-model group (n = 19) or the control group (n = 19). One participant in the 3D-model group was lost to follow-up during the planned direct observation of procedural skills (DOPS) assessment and satisfaction questionnaire completion. The posttest written examination scores were significantly higher in the 3D-model group than in the control group (100% vs 80%, P = .02). The scores from the DOPS and satisfaction questionnaire were comparable in the 2 groups.

CONCLUSIONS

This study demonstrated that 3D printing can be used to create a safe and cost-effective airway suction simulator for use by RT students, with potential to enhance training methods. Further research is necessary.

Pilot Study on the Development and Integration of Anthropomorphic Models within the Dental Technician Curriculum

The effectiveness of modern medical education largely depends on the integration and utilization of digital technologies in teaching various disciplines. In this pilot usability study, we introduced 3D printed anthropomorphic dental models, specifically designed for the elective discipline "Digital and Metal-Free Techniques in Dental Technology" from the curriculum of the Dental Technician specialty in the Medical University of Varna. The evaluation focused on dental technician students' perception of this novel learning environment, its influence on their performance, and the potential for future application of these models and related 3D technologies in their professional practice. A validated satisfaction questionnaire was distributed among 80 students, comprising the total cohort. The results indicated a high acceptance rate, with nearly 95% of participants finding the use of digitally created 3D-printed dental models beneficial. More than 90% believed that exploring digital technologies would enhance their skills. The well-trained instructor's competence in technology use convinced students of its value, with more than 98% expressing a willingness to incorporate these technologies into their future work for improved precision in dental models. However, due to the current high cost of needed equipment, only 10% of participants may practicably introduce this novel technology into their practical work. The use of anatomically accurate 3D printed models is a valuable addition to the current dental technician curriculum in medical colleges.

From 2D slices to a 3D model: Training students in digital microanatomy analysis techniques through a 3D printed neuron project

The reconstruction of two-dimensional (2D) slices to three-dimensional (3D) digital anatomical models requires technical skills and software that are becoming increasingly important to the modern anatomist, but these skills are rarely taught in undergraduate science classrooms. Furthermore, learning opportunities that allow students to simultaneously explore anatomy in both 2D and 3D space are increasingly valuable. This report describes a novel learning activity that trains students to digitally trace a serially imaged neuron from a confocal stack and to model that neuron in 3D space for 3D printing. By engaging students in the production of a 3D digital model, this learning activity is designed to provide students a novel way to enhance their understanding of the content, including didactic knowledge of neuron morphology, technical research skills in image analysis, and career exploration of neuroanatomy research. Moreover, students engage with microanatomy in a way that starts in 2D but results in a 3D object they can see, touch, and keep. This discursive article presents the learning activity, including videos, instructional guides, and learning objectives designed to engage students on all six levels of Bloom's Taxonomy. Furthermore, this work is a proof of principle modeling workflow that is approachable, inexpensive, achievable, and adaptable to cell types in other organ systems. This work is designed to motivate the expansion of 3D printing technology into microanatomy and neuroanatomy education.

The role of 3D technology in the practical education of congenital coarctation and its treatment-a feasibility pilot study

BACKGROUND

Coarctation of the aorta (CoA) is a congenital disease with an incidence of 4 out of 10,000 live births, therefore proper education of its treatment is essential. Understanding the disease and the wide array of treatment options is often difficult. Additive manufacturing technology can be used to produce 3D printed hands-on surgical training tools (HOSTT), which can be used for the education and practical training of CoA. This study aimed to investigate the effectiveness of a 3D printable HOSTT for the simulation of coarctation surgery, and it' possible role in practical education.

METHODS

Participants were medical students of Semmelweis University between the second and sixth academic year. A virtual 3D model of an aorta with CoA was generated from a computed tomography angiography scan. Each participant received a 3D-printed aorta phantom and performed either one of four surgical treatment modalities. The simulated surgeries included end-to-end anastomosis, end-to-side anastomosis, prosthetic patch, and subclavian flap aortoplasty. Participants provided feedback, evaluating their understanding of the disease and its treatment by the four surgical reconstruction modalities on a seven-point Likert scale before and after the sessions.

RESULTS

21 medical students participated in this study. Participants' average rating of their understanding of CoA disease and it treatment options before practical training was 4.62 ± 1.07. After training, their average rating increased to 6.19 ± 1.08, showing statistically significant difference.

CONCLUSIONS

Within this study's limitations, the applied HOSTT, manufactured using 3D printing, was effective for the practical training of CoA's surgical treatment methods for medical students.

Show them what they can't see! An evaluation of the use of customized 3D printed models in head and neck anatomy

Difficulty in visualizing anatomical structures has been identified as a challenge in anatomy learning and the emergence of three-dimensional printed models (3DPMs) offers a potential solution. This study evaluated the effectiveness of 3DPMs for learning the arterial supply of the head and neck region. One hundred eighty-four undergraduate medical students were randomly assigned to one of four learning modalities including wet specimen, digital model, 3DPM, and textbook image. Posttest scores indicated that all four modalities supported participants' knowledge acquisition, most significantly in the wet specimen group. While the participants rated 3DPMs lower for helping correct identification of structures than wet specimens, they praised 3DPMs for their ability to demonstrate topographical relationships between the arterial supply and adjacent structures. The data further suggested that the biggest limitation of the 3DPMs was their simplicity, thus making it more difficult for users to recognize the equivalent structures on the wet specimens. It was concluded that future designs of 3DPMs will need to consider the balance between the ease of visualization of anatomical structures and the degree of complexity required for successful transfer of learning. Overall, this study presented some conflicting evidence of the favorable outcomes of 3DPMs reported in other similar studies. While effective for anatomy learning as a standalone modality, educators must identify the position 3DPM models hold relative to other modalities in the continuum of undergraduate anatomy education in order to maximize their advantages for students.

Are 3D-printed anatomical models of the ear effective for teaching anatomy? A comparative pilot study versus cadaveric models

PURPOSE

Despite the combination of chalkboard lectures and cadaveric models, the ear remains a complex anatomical structure that is difficult for medical students to grasp. The aim of this study was to evaluate the contribution of a 3D-printed ear model for educating undergraduate medical students by comparing it with a conventional cadaveric model.

METHODS

Models of the ear comprising the outer ear, tympanic membrane, ossicles and inner ear were modeled and then 3D-printed at 6:1 and 10:1 scales based on cadaveric dissection and CT, cone-beam CT and micro/nano CT scans. Cadaveric models included two partially dissected dry temporal bones and ossicles. Twenty-four 3rd year medical students were given separate access to cadaveric models (n = 12) or 3D-printed models (n = 12). A pre-test and two post-tests were carried out to assess knowledge (n = 24). A satisfaction questionnaire focusing solely on the 3D-printed model, comprising 17 items assessed on a 5-point Likert scale, was completed by all study participants. A 5-point Likert scale questionnaire comprising four items (realism, color, quality and satisfaction with the 3D-printed ear model) was given to three expert anatomy Professors.

RESULTS

The test scores on the first post-test were higher for the students who had used the 3D-printed models (p < 0.05). Overall satisfaction among the students and the experts was very high, averaging 4.7 on a 5-point Likert-type satisfaction scale.

CONCLUSION

This study highlights the overall pedagogical value of a 3D-printed model for learning ear anatomy.

Shaping the Future of Cardiovascular Disease by 3D Printing Applications in Stent Technology and its Clinical Outcomes

Cardiovascular disease (CVD) is a leading cause of death worldwide. In recent years, 3D printing technology has ushered in a new era of innovation in cardiovascular medicine. 3D printing in CVD management encompasses various aspects, from patient-specific models and preoperative planning to customized medical devices and novel therapeutic approaches. In-stent technology, 3D printing has revolutionized the design and fabrication of intravascular stents, offering tailored solutions for complex anatomies and individualized patient needs. The advantages of 3D-printed stents, such as improved biocompatibility, enhanced mechanical properties, and reduced risk of in-stent restenosis. Moreover, the clinical trials and case studies that shed light on the potential of 3D printing technology to improve patient outcomes and revolutionize the field has been comprehensively discussed. Furthermore, regulatory considerations, and challenges in implementing 3D-printed stents in clinical practice are also addressed, underscoring the need for standardization and quality assurance to ensure patient safety and device reliability. This review highlights a comprehensive resource for clinicians, researchers, and policymakers seeking to harness the full potential of 3D printing technology in the fight against CVD.

The Educational Impact of Radiology in Anatomy Teaching: A Field Study Using Cross-Sectional Imaging and 3D Printing for the Study of the Spine

INTRODUCTION

Cross-sectional imaging and 3D printing represent state-of-the-art approaches to improve anatomy teaching compared to traditional learning, but their use in medical schools remains limited. This study explores the utility of these educational tools for teaching normal and pathological spinal anatomy, aiming to improve undergraduate medical education.

MATERIALS AND METHODS

A field study was conducted on a cohort of undergraduate medical students who were exposed to anatomy lessons of the spine considering three learning paradigms: traditional learning, cross-sectional imaging examinations, and 3D printed models. 20 students (intervention group) received the three approaches, and other 20 students (control group) received the conventional (traditional) approach. The students were examined through a multiple-choice test and their results were compared to those of a control group exposed to traditional learning matched by age, sex and anatomy grades. In addition, students in the experimental group were assessed for their satisfaction with each learning method by means of an ad hoc questionnaire.

RESULTS

Students exposed to cross-sectional imaging and 3D printing demonstrated better knowledge outcomes compared to the control group. They showed high satisfaction rates and reported that these technologies enhanced spatial understanding and facilitated visualization of specific pathologies. However, limitations such as the representativeness of non-bone conditions in 3D printed models and the need for further knowledge on imaging fundamentals were highlighted.

CONCLUSION

Cross-sectional imaging and 3D printing offer valuable tools for enhancing the teaching of spinal anatomy in undergraduate medical education. Radiologists are well positioned to lead the integration of these technologies, and further research should explore their potential in teaching anatomy across different anatomical regions.

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

OBJECTIVES

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

METHODS

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

RESULTS AND CONCLUSIONS

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

Additive manufacturing and three-dimensional printing in obstetrics and gynecology: a comprehensive review

Three-dimensional (3D) printing, also known as additive manufacturing, is a technology used to create complex 3D structures out of a digital model that can be almost any shape. Additive manufacturing allows the creation of customized, finely detailed constructs. Improvements in 3D printing, increased 3D printer availability, decreasing costs, development of biomaterials, and improved cell culture techniques have enabled complex, novel, and customized medical applications to develop. There have been rapid development and utilization of 3D printing technologies in orthopedics, dentistry, urology, reconstructive surgery, and other health care areas. Obstetrics and Gynecology (OBGYN) is an emerging application field for 3D printing. This technology can be utilized in OBGYN for preventive medicine, early diagnosis, and timely treatment of women-and-fetus-specific health issues. Moreover, 3D printed simulations of surgical procedures enable the training of physicians according to the needs of any given procedure. Herein, we summarize the technology and materials behind additive manufacturing and review the most recent advancements in the application of 3D printing in OBGYN studies, such as diagnosis, surgical planning, training, simulation, and customized prosthesis. Furthermore, we aim to give a future perspective on the integration of 3D printing and OBGYN applications and to provide insight into the potential applications.

3D printed skulls in court - a benefit to stakeholders?

Forensic pathologists may use 3D prints as demonstrative aids when providing expert testimony in court of law, but the effects remain unclear despite many assumed benefits. In this qualitative study, the effects of using a 3D print, demonstrating a blunt force skull fracture, in court were explored by thematic analysis of interviews with judges, prosecutors, defence counsels, and forensic pathologists with the aim of improving the expert testimony. Five semi-structured focus groups and eight one-to-one interviews with a total of 29 stakeholders were transcribed ad verbatim and analysed using thematic analysis. The study found that a highly accurate 3D print of a skull demonstrated autopsy findings in detail and provided a quick overview, but sense of touch was of little benefit as the 3D print had different material characteristics than the human skull. Virtual 3D models were expected to provide all the benefits of 3D prints, be less emotionally confronting, and be logistically feasible. Both 3D prints and virtual 3D models were expected to be less emotionally confronting than autopsy photos. Regardless of fidelity, an expert witness was necessary to translate technical language and explain autopsy findings, and low-fidelity models may be equally suited as demonstrative aids. The court infrequently challenged the expert witnesses' conclusions and, therefore, rarely had a need for viewing autopsy findings in detail, therefore rarely needing a 3D print.

Assessing the impact of 3D image segmentation workshops on anatomical education and image interpretation: A prospective pilot study

Three-dimensional (3D) segmentation, a process involving digitally marking anatomical structures on cross-sectional images such as computed tomography (CT), and 3D printing (3DP) are being increasingly utilized in medical education. Exposure to this technology within medical schools and hospitals remains limited in the United Kingdom. M3dicube UK, a national medical student, and junior doctor-led 3DP interest group piloted a 3D image segmentation workshop to gauge the impact of incorporating 3D segmentation technology on anatomical education. The workshop, piloted with medical students and doctors within the United Kingdom between September 2020 and 2021, introduced participants to 3D segmentation and offered practical experience segmenting anatomical models. Thirty-three participants were recruited, with 33 pre-workshop and 24 post-workshop surveys completed. Two-tailed t-tests were used to compare mean scores. From pre- to post-workshop, increases were noted in participants' confidence in interpreting CT scans (2.36 to 3.13, p = 0.010) and interacting with 3D printing technology (2.15 to 3.33, p = 0.00053), perceived utility of creating 3D models to aid image interpretation (4.18 to 4.45, p = 0.0027), improved anatomical understanding (4.2 to 4.7, p = 0.0018), and utility in medical education (4.45 to 4.79, p = 0.077). This pilot study provides early evidence of the utility of exposing medical students and healthcare professionals in the United Kingdom to 3D segmentation as part of their anatomical education, with additional benefit in imaging interpretation ability.

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.

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.

An Opportunity to See the Heart Defect Physically: Medical Student Experiences of Technology-Enhanced Learning with 3D Printed Models of Congenital Heart Disease

Three-dimensional (3D) printing is increasingly used in medical education and paediatric cardiology. A technology-enhanced learning (TEL) module was designed to accompany 3D printed models of congenital heart disease (CHD) to aid in the teaching of medical students. There are few studies evaluating the attitudes and perceptions of medical students regarding their experience of learning about CHD using 3D printing. This study aimed to explore senior medical students' experiences in learning about paediatric cardiology through a workshop involving 3D printed models of CHD supported by TEL in the form of online case-based learning. A mixed-methods evaluation was undertaken involving a post-workshop questionnaire (n = 94 students), and focus groups (n = 16 students). Focus group and free-text questionnaire responses underwent thematic analysis. Questionnaire responses demonstrated widespread user satisfaction; 91 (97%) students agreed that the workshop was a valuable experience. The highest-level satisfaction was for the physical 3D printed models, the clinical case-based learning, and opportunity for peer collaboration. Thematic analysis identified five key themes: a variable experience of prior learning, interplay between physical and online models, flexible and novel workshop structure, workshop supported the learning outcomes, and future opportunities for learning using 3D printing. A key novel finding was that students indicated the module increased their confidence to teach others about CHD and recommended expansion to other parts of the curriculum. 3D printed models of CHD are a valuable learning resource and contribute to the richness and enjoyment of medical student learning, with widespread satisfaction.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-023-01840-w.

Application of a Low-cost, High-fidelity Proximal Phalangeal Dislocation Reduction Model for Clinician Training

Introduction: Patients present to the emergency department (ED) relatively commonly with traumatic closed proximal interphalangeal joint (PIPJ) dislocations, an orthopedic emergency. There is a paucity of teaching models and training simulations for clinicians to learn either the closed dislocated dorsal or volar interphalangeal joint reduction technique. We implemented a teaching model to demonstrate the utility of a novel reduction model designed from three-dimensional (3D) printable components that are easy to connect and do not require further machining or resin models to complete. Methods: Students watched a two-minute video and a model demonstration by the authors. Learners including emergency medicine (EM) residents and physician assistant fellows assessed model fidelity, convenience, perceived competency, and observed competency. Results: Seventeen of 21 (81%) participants agreed the model mimicked dorsal and volar PIPJ dislocations. Nineteen of 21 (90%) agreed the model was easy to use, 21/21 (100%) agreed the dorsal PIPJ model and 20/21 (95%) agreed the volar PIPJ model improved their competency. Conclusion: Our 3D-printed, dorsal and volar dislocation reduction model is easy to use and affordable, and it improved perceived competency among EM learners at an academic ED.

Contribution of 3D printing for the surgical management of jaws cysts and benign tumors: A systematic review of the literature

BACKGROUND

Three-dimensional (3D) printing is now a widely recognized surgical tool in oral and maxillofacial surgery. However, little is known about its benefits for the surgical management of benign maxillary and mandibular tumors and cysts.

PURPOSE

The objective of this systematic review was to assess the contribution of 3D printing in the management of benign jaw lesions.

METHODS

A systematic review, registered in PROSPERO, was conducted using PubMed and Scopus databases, up to December 2022, by following PRISMA guidelines. Studies reporting 3D printing applications for the surgical management of benign jaw lesions were considered.

RESULTS

This review included thirteen studies involving 74 patients. The principal use of 3D printing was to produce anatomical models, intraoperative surgical guides, or both, allowing for the successful removal of maxillary and mandibular lesions. The greatest reported benefits of printed models were the visualization of the lesion and its anatomical relationships to anticipate intraoperative risks. Surgical guides were designed as drilling locating guides or osteotomy cutting guides and contributed to decreasing operating time and improving the accuracy of the surgery.

CONCLUSION

Using 3D printing technologies to manage benign jaw lesions results in less invasive procedures by facilitating precise osteotomies, reducing operating times, and complications. More studies with higher levels of evidence are needed to confirm our results.

Effects of the individual three-dimensional printed craniofacial bones with a quick response code on the skull spatial knowledge of undergraduate medical students

Understanding the three-dimensional (3D) structure of the human skull is imperative for medical courses. However, medical students are overwhelmed by the spatial complexity of the skull. Separated polyvinyl chloride (PVC) bone models have advantages as learning tools, but they are fragile and expensive. This study aimed to reconstruct 3D-printed skull bone models (3D-PSBs) using polylactic acid (PLA) with anatomical characteristics for spatial recognition of the skull. Student responses to 3D-PSB application were investigated through a questionnaire and tests to understand the requirement of these models as a learning tool. The students were randomly divided into 3D-PSB (n = 63) and skull (n = 67) groups to analyze pre- and post-test scores. Their knowledge was improved, with the gain scores of the 3D-PSB group (50.0 ± 3.0) higher than that of the skull group (37.3 ± 5.2). Most students agreed that using 3D-PSBs with quick response codes could improve immediate feedback on teaching (88%; 4.41 ± 0.75), while 85.9% of the students agreed that individual 3D-PSBs clarified the structures hidden within the skull (4.41 ± 0.75). The ball drop test revealed that the mechanical strength of the cement/PLA model was significantly greater than that of the cement or PLA model. The prices of the PVC, cement, and cement/PLA models were 234, 1.9, and 10 times higher than that of the 3D-PSB model, respectively. These findings imply that low-cost 3D-PSB models could revolutionize skull anatomical education by incorporating digital technologies like the QR system into the anatomical teaching repertoire.

Full-sized realistic 3D printed models of liver and tumour anatomy: a useful tool for the clinical medicine education of beginning trainees

BACKGROUND

Simulation-based medical education (SBME) and three-dimensional printed (3DP) models are increasingly used in continuing medical education and clinical training. However, our understanding of their role and value in improving trainees' understanding of the anatomical and surgical procedures associated with liver surgery remains limited. Furthermore, gender bias is also a potential factor in the evaluation of medical education. Therefore, the aim of this study was to evaluate the educational benefits trainees receive from the use of novel 3DP liver models while considering trainees' experience and gender.

METHODS

Full-sized 3DP liver models were developed and printed using transparent material based on anonymous CT scans. We used printed 3D models and conventional 2D CT scans of the liver to investigate thirty trainees with various levels of experience and different genders in the context of both small group teaching and formative assessment. We adopted a mixed methods approach involving both questionnaires and focus groups to collect the views of different trainees and monitors to assess trainees' educational benefits and perceptions after progressing through different training programs. We used Objective Structured Clinical Examination (OSCE) and Likert scales to support thematic analysis of the responses to the questionnaires by trainees and monitors, respectively. Descriptive analyses were conducted using SPSS statistical software version 21.0.

RESULTS

Overall, a 3DP model of the liver is of great significance for improving trainees' understanding of surgical procedures and cooperation during operation. After viewing the personalized full-sized 3DP liver model, all trainees at the various levels exhibited significant improvements in their understanding of the key points of surgery (p < 0.05), especially regarding the planned surgical procedure and key details of the surgical procedures. More importantly, the trainees exhibited higher levels of satisfaction and self-confidence during the operation regardless of gender. However, with regard to gender, the results showed that the improvement of male trainees after training with the 3DP liver model was more significant than that of female trainees in understanding and cooperation during the surgical procedure, while no such trend was found with regard to their understanding of the base knowledge.

CONCLUSION

Trainees and monitors agreed that the use of 3DP liver models was acceptable. The improvement of the learning effect for practical skills and theoretical understanding after training with the 3DP liver models was significant. This study also indicated that training with personalized 3DP liver models can improve all trainees' presurgical understanding of liver tumours and surgery and males show more advantage in understanding and cooperation during the surgical procedure as compared to females. Full-sized realistic 3DP models of the liver are an effective auxiliary teaching tool for SBME teaching in Chinese continuing medical education.

A workflow for the creation of photorealistic 3D cadaveric models using photogrammetry

Three-dimensional (3D) representations of anatomical specimens are increasingly used as learning resources. Photogrammetry is a well-established technique that can be used to generate 3D models and has only been recently applied to produce visualisations of cadaveric specimens. This study has developed a semi-standardised photogrammetry workflow to produce photorealistic models of human specimens. Eight specimens, each with unique anatomical characteristics, were successfully digitised into interactive 3D models using the described workflow and the strengths and limitations of the technique are described. Various tissue types were reconstructed with apparent preservation of geometry and texture which visually resembled the original specimen. Using this workflow, an institution could digitise their existing cadaveric resources, facilitating the delivery of novel educational experiences.

Three Dimensional Printing as a Tool For Anatomical Training in Lung Surgery

Objective

Pulmonary anatomy is challenging, due to the high variability and its three-dimensional (3D) shape. While demands in thoracic oncologic surgery are increasing, the transition from open to thoracoscopic surgery is hampering anatomical understanding. This study analyzed the value of a 3D printed lung model in understanding and teaching anatomy.

Methods

A 3D pulmonary model was created and tested among different levels of proficiency: 10 experienced surgeons, 10 fellow surgeons and 10 junior residents. They were tested in interpretation of anatomy based on thoracic CT-scans, either using the 3D model or a 2D anatomical atlas. Accuracy of the given answers, time to complete the task and the self-reported level of certainty were scored in each group.

Results

In the experienced surgeons group there was no difference in between the 2D-model or 3D-model with a high rate of correct answers in both groups, and no differences in time or certainty. Fellow surgeons highly benefitted from the 3D-model with an improved accuracy from 26.6% to 70.0% (p = 0.001). Time to complete the task was shorter (207 versus 122 s, p < 0.0001) and participants were more secure (median of 4 versus 3, p = 0.007). For junior residents time to complete the task was shorter, the level of certainty was higher, but there was no improvement in accuracy.

Conclusions

3D printing may benefit in understanding anatomical relations in the complex anatomy of the bronchiopulmonary tree, especially for surgeons in training and could benefit in teaching anatomy.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-023-01807-x.

A Novel Teaching-Learning Method of Utilizing Ultrasonography as a Tool to Enhance Clinical Examination Skills of House Surgeons in Evaluating Cervical Lymph Nodes

Aim

A study was conducted to ascertain if ultrasonography assisted learning facilitates the House Surgeons to enhance their clinical skill of identifying enlarged cervical lymph nodes.

Materials and Methods

A prospective, cross-sectional analytical study was conducted in the in a Medical College for 6 months from May to October 2021. It included 50 house surgeons posted to the department of ENT on rotation and patients with one or more enlarged cervical lymph nodes. Initially an ENT teacher demonstrated clinical examination of neck for lymph nodes to the House Surgeons. Each House Surgeon examined 10 patients and their findings were matched with those of ENT specialist & Ultrasonography findings (pre TL score). Further they underwent Ultrasonography assisted learning and subsequently post TL scores were found for each House Surgeon based on their findings in 10 more patients. Paired T Test was done to ascertain statistical significance between pre TL and post TL scores.

Result

Fifty House Surgeons (mean age 23.3 years) and 258 patients (mean age 43.5 years) were included in the study. There was significant improvement in the post TL scores of the House Surgeons obtained after ultrasonography assisted learning in comparison with pre TL scores (p < 0.001).

Conclusion

Ultrasonography assisted learning enhances the clinical examination skills of assessing for enlarged cervical lymph nodes.

Application of 3D-printed pulmonary segment specimens in experimental teaching of sectional anatomy

BACKGROUND

Lung cross-section is one of the emphases and challenges in sectional anatomy. Identification of the complex arrangement of intrapulmonary tubes such as bronchi, arteries, and veins in the lungs requires the spatial imagination of students. Three-dimensional (3D) printing has become increasingly used in anatomy education. This study aimed to analyze the effectiveness of 3D-printed specimens used for the experimental teaching of sectional anatomy.

METHODS

A digital thoracic dataset was obtained and input into a 3D printer to print multicolor specimens of the pulmonary segment after software processing. As research subjects, 119 undergraduate students majoring in medical imaging from classes 5-8 in the second-year were chosen. In the lung cross-section experiment course, 59 students utilized 3D printed specimens in conjunction with traditional instruction as the study group, while 60 students received traditional teaching as the control group. Preclass and postclass tests, course grading, and questionnaire surveys were used to assess instructional efficacy.

RESULTS

We obtained a set of pulmonary segment specimens for teaching. The students in the study group scored better in the postclass test than those in the control group (P < 0.05), and the students in the study group scored higher in satisfaction with the teaching content and spatial thinking for sectional anatomy than those in the control group (P < 0.05). The course grades and excellence rates in the study group exceeded those in the control group (P < 0.05).

CONCLUSION

The application of high-precision multicolor 3D-printed specimens of lung segments in experimental teaching of sectional anatomy can improve teaching effectiveness and is worth adopting and promoting in sectional anatomy courses.

Anatomical variability of kidney arterial vasculature based on zonal and segmental topography

Introduction

To date, there is no unified approach to the lobar, zonal, and segmental structure of the kidney vasculature. There is no recognizable approach to define basic characteristics in regard to the lobes and segments identifying of the kidney. The branching of the renal artery has often been the subject of scientific research. This study aimed to analyze the arterial anatomy on the basis of zonal and segmental topography.

Materials and methods

This study is a prospective cadaver study on autopsy material using corrosion casting and CT imaging techniques. The arterial vasculature was visualized using corrosive casting. In this study, 116 vascular casts were included. We identified the number of arteries in the kidney hilum, their topography, branching variations of the renal artery, and local blood supply zones of renal masses considering second- and third-order renal artery branches. We used a micro-CT BRUKER SkyScan 1178, digital camera, Mimics-8.1, and R.

Results

This study has shown that RA divides into two or three zonal arteries, forming a two- or three-zonal vascular supply system. In the case of the two-zonal system, 54.3% of cases accounted for RA branching into ventral and dorsal arteries, whereas 15.5% of cases referred to superior polar and inferior polar zonal arteries. The three-zonal system implies 4 types of RA branching: 1) superior polar, ventral, and dorsal zonal branches (12.9%); 2) ventral, dorsal, and inferior polar zonal branches (9.5%); 3) two ventral and one dorsal zonal branches (5.2%), and 4) superior polar, central, and inferior polar zonal branches (2.5%).

Conclusions

The results of this research make us reconsider Grave's classification theory.

A systematic review of the application of 3D-printed models to colorectal surgical training

BACKGROUND

The aim of this review was to explore the role of three-dimensional (3D) printing in colorectal surgical education and procedural simulation, and to assess the effectiveness of 3D-printed models in anatomic and operative education in colorectal surgery.

METHODS

A systematic review of the literature was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify relevant publications relating to the use of 3D-printed models in colorectal surgery in an educational context. The search encompassed OVID Medline, Web of Science and EMBASE including papers in English published from 1 January 1995 to 1 January 2023. A total of 1018 publications were screened, and 5 met the criteria for inclusion in this review.

RESULTS

Four distinct 3D models were described across five studies. Two models demonstrated objective benefits in the use of 3D-printed models in anatomical education in academic outcomes at all levels of learner medical experience and were well accepted by learners. One model utilised for preoperative visualisation demonstrated improved operative outcomes in complete mesocolic excision compared with preoperative imaging review, with a 22.1% reduction in operative time (p < 0.001), 9.2% reduction in surgical duration (p = 0.035) and 37.3% reduction in intraoperative bleeding volume amongst novice surgeons (p < 0.01). Technical simulation has been demonstrated in a feasibility context in one model but remains limited in scope and application on account of the characteristics of available printing materials.

CONCLUSIONS

3D printing is well accepted and effective for anatomic education and preoperative procedural planning amongst colorectal surgeons, trainees and medical students but remains a technology in the early stages of its possible application. Technological advancements are required to improve the tissue realism of 3D-printed organ models to achieve greater fidelity and provide realistic colorectal surgical simulations.

Assessment of post-infarct ventricular septal defects through 3D printing and statistical shape analysis

BACKGROUND

Post-infarct ventricular septal defect (PIVSD) is a serious complication of myocardial infarction. We evaluated 3D-printing models in PIVSD clinical assessment and the feasibility of statistical shape modeling for morphological analysis of the defects.

METHODS

Models (n = 15) reconstructed from computed tomography data were evaluated by clinicians (n = 8). Statistical shape modeling was performed on 3D meshes to calculate the mean morphological configuration of the defects.

RESULTS

Clinicians' evaluation highlighted the models' utility in displaying defects for interventional/surgical planning, education/training and device development. However, models lack dynamic representation. Morphological analysis was feasible and revealed oval-shaped (n = 12) and complex channel-like (n = 3) defects.

CONCLUSION

3D-PIVSD models can complement imaging data for teaching and procedural planning. Statistical shape modeling is feasible in this scenario.

Development of a Pedicle Screw Fixation Simulation Model for Surgical Training Using a 3-Dimensional Printer

OBJECTIVE

Training surgeons in pedicle screw fixation (PSF) techniques during actual surgery is limited because of patient safety, complications, and surgical efficiency issues. Recent technical developments are leading the world to an era of personalized three-dimensional (3D) printing. This study aimed to evaluate the educational effect of using a 3D-printed spine model to train beginners in PSF techniques to improve screw accuracy and procedure time.

METHODS

Computed tomography (CT) scan data were used in a 3D printer to produce a life-size lumbar spine replica of L1-3 vertebrae. Four residents performed PSF thrice. Each resident performed 18 screw fixations on both sides (6 screws per trial). The time to complete the procedure and pedicle violation was recorded.

RESULTS

The average time for the 3 procedures was 42.1±2.9 minutes, 38.8±3.3 minutes, and 32.1±2.5 minutes, respectively. Furthermore, the average pedicle screw score for the 3 procedures was 13.0±0.8, 14.5±0.6, and 16.0±0.8, respectively. As the trial was repeated, the procedure time decreased and the accuracy of screw fixation tended to be more accurate.

CONCLUSIONS

It was possible to decrease the procedure time and increase accuracy through repeated training using the 3D-printed spine model. By implementing a 3Dprinted spine model based on the patient's actual CT data, surgeons can perform simulation surgery before the actual surgery. Therefore, this technology can be useful in educating residents to improve their surgical skills.

Meta-analyzing the efficacy of 3D printed models in anatomy education

Three-dimensional printing models (3DPs) have been widely used in medical anatomy training. However, the 3DPs evaluation results differ depending on such factors as the training objects, experimental design, organ parts, and test content. Thus, this systematic evaluation was carried out to better understand the role of 3DPs in different populations and different experimental designs. Controlled (CON) studies of 3DPs were retrieved from PubMed and Web of Science databases, where the participants were medical students or residents. The teaching content is the anatomical knowledge of human organs. One evaluation indicator is the mastery of anatomical knowledge after training, and the other is the satisfaction of participants with 3DPs. On the whole, the performance of the 3DPs group was higher than that of the CON group; however, there was no statistical difference in the resident subgroup, and there was no statistical difference for 3DPs vs. 3D visual imaging (3DI). In terms of satisfaction rate, the summary data showed that the difference between the 3DPs group (83.6%) vs. the CON group (69.6%) (binary variable) was not statistically significant, with p > 0.05. 3DPs has a positive effect on anatomy teaching, although there are no statistical differences in the performance tests of individual subgroups; participants generally had good evaluations and satisfaction with 3DPs. 3DPs still faces challenges in production cost, raw material source, authenticity, durability, etc. The future of 3D-printing-model-assisted anatomy teaching is worthy of expectation.

Visualization in Anatomy Education

In the post-pandemic era, one of the significant challenges for anatomy teachers is to reciprocate the experience of practical exposure while teaching the subject to undergraduates. These challenges span from conducting cadaveric dissections to handling real human bones, museum specimens, and tissue sections in the histology lab. Such exposures help the instructors to develop interactive communication with their fellow students and thus help to enhance communication skills among them. Recently, anatomy teachers all over the world started using cutting-edge educational technologies to make teaching-learning experiences for students more engaging, interesting, and interactive. Utilizing such cutting-edge educational technologies was an "option" prior to the pandemic, but the pandemic has significantly altered the situation. What was previously an "option" is now a "compulsion." Despite the fact that the majority of medical schools have resumed their regular on-campus classes, body donation and the availability of cadavers remain extremely limited, resulting in a deadlock. Anatomy teachers must incorporate cutting-edge educational technologies into their teaching and learning activities to make the subject more visual. In this chapter, we have attempted to discuss various new technologies which can provide a near-realistic perception of anatomical structures as a complementary tool for dissection/cadaver, various visualization techniques currently available and explore their importance as a pedagogic alternative in learning anatomy. We also discussed the recent advancement in visualization techniques and the pros and cons of technology-based visualization. This chapter identifies the limitations of technology-based visualization as a supplement and discusses effective utilization as an adjunct to the conventional pedagogical approaches to undergraduate anatomy education.

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.

Three-Dimensional Printing in Neurosurgery: A Review of Current Indications and Applications and a Basic Methodology for Creating a Three-Dimensional Printed Model for the Neurosurgical Practice

Introduction Three-dimensional (3D) printing is an affordable aid that is useful in neurosurgery. It allows for better visualization and tactile appreciation of the individual anatomy and regions of interest and therefore potentially lowers the risk of complications. There are various applications of this technology in the field of neurosurgery. Materials and methods In this paper, we present a basic methodology for the creation of a 3D printed model using only open-source software for medical image editing, model generation, pre-printing preparation, and analysis of the literature concerning the practical use of this methodology. Results The literature review on the current applications of 3D printed models in neurosurgery shows that they are mostly used for preoperative planning, surgical training, and simulation, closely followed by their use in patient-specific implants and instrumentation and medical education. Materialise^TM Mimics is the most frequently used commercial software for a 3D modeling for preoperative planning and surgical simulation, while the most popular open-source software for the same applications is 3D Slicer. In this paper, we present the algorithm that we employ for 3D printing using Horos^TM, Blender, and Cura software packages which are all free and open-source. Conclusion Three-dimensional printing is becoming widely available and of significance to neurosurgical practice. Currently, there are various applications of this technology that are less demanding in terms of technical knowledge and required fluency in medical imaging software. These predispositions open the field for further research on the possible use of 3D printing in neurosurgery.

Utility of 3D Printed Models Versus Cadaveric Pathology for Learning: Challenging Stated Preferences

INTRODUCTION

3D printing has recently emerged as an alternative to cadaveric models in medical education. A growing body of research supports the use of 3D printing in this context and details the beneficial educational outcomes. Prevailing studies rely on participants' stated preferences, but little is known about actual student preferences.

METHODS

A mixed methods approach, consisting of structured observation and computer vision, was used to investigate medical students' preferences and handling patterns when using 3D printed versus cadaveric models in a cardiac pathology practical skills workshop. Participants were presented with cadaveric samples and 3D printed replicas of congenital heart deformities.

RESULTS

Analysis with computer vision found that students held cadaveric hearts for longer than 3D printed models (7.71 vs. 6.73 h), but this was not significant when comparing across the four workshops. Structured observation found that student preferences changed over the workshop, shifting from 3D printed to cadaveric over time. Interactions with the heart models (e.g., pipecleaners) were comparable.

CONCLUSION

We found that students had a slight preference for cadaveric hearts over 3D printed hearts. Notably, our study contrasts with other studies that report student preferences for 3D printed learning materials. Given the relative equivalence of the models, there is opportunity to leverage 3D printed learning materials (which are not scarce, unlike cadaveric materials) to provide equitable educational opportunities (e.g., in rural settings, where access to cadaveric hearts is less likely).

Organs in Color: Utilizing Free Software and Emerging Multi Jet Fusion Technology to Color and Surface Label 3D-Printed Anatomical Models

3D printing (3DP) is a rapidly evolving innovative technology that has already been utilized for the development of educational anatomic models. Until recently, it was difficult and tedious to create multi-colored models and especially labels due to technological constraints. In this technical note, a comprehensive guide for creating labeled and color-coded anatomic models was created using free software, Blender. We have composed a step-by-step process for taking an existing 3D model and adding labeling and color that is compatible with modern high-quality 3D printing technologies (Multi Jet Fusion). We provided colored and labeled 3D renderings of the surface anatomy of the brain, ventricular system of the brain, the segments of the liver, and coronary arteries as examples of the diverse potential of this technology. Additionally, we 3D printed actual models of the surface anatomy of the brain and ventricles of the brain using HP Multi Jet Fusion to demonstrate the potential of this technology in the creation of anatomic models.

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.

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

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

Investigating the effectiveness of three-dimensionally printed anatomical models compared with plastinated human specimens in learning cardiac and neck anatomy: A randomized crossover study

Three-dimensional printing (3DP) technology has been increasingly applied in health profession education. Yet, 3DP anatomical models compared with the plastinated specimens as learning scaffolds are unclear. A randomized-controlled crossover study was used to evaluate the objective outcomes of 3DP models compared with the plastinated specimens through an introductory lecture and team study for learning relatively simple (cardiac) and complex (neck) anatomies. Given the novel multimaterial and multicolored 3DP models are replicas of the plastinated specimens, it is hypothesized that 3DP models have the same educational benefits to plastinated specimens. This study was conducted in two phases in which participants were randomly assigned to 3DP (n = 31) and plastinated cardiac groups (n = 32) in the first phase, whereas same groups (3DP, n = 15; plastinated, n = 18) used switched materials in the second phase for learning neck anatomy. The pretest, educational activities and posttest were conducted for each phase. Miller's framework was used to assess the cognitive outcomes. There was a significant improvement in students' baseline knowledge by 29.7% and 31.3% for Phase 1; 31.7% and 31.3% for Phase 2 plastinated and 3DP models. Posttest scores for cardiac (plastinated, 3DP mean ± SD: 57.0 ± 13.3 and 60.8 ± 13.6, P = 0.27) and neck (70.3 ± 15.6 and 68.3 ± 9.9, P = 0.68) phases showed no significant difference. In addition, no difference observed when cognitive domains compared for both cases. These results reflect that introductory lecture plus either the plastinated or 3DP modes were effective for learning cardiac and neck anatomy.

Effectiveness of 3D-printed models prepared from radiological data for anatomy education: A meta-analysis and trial sequential analysis of 22 randomized, controlled, crossover trials

BACKGROUND

Many academicians suggested the supplementary use of 3D-printed models reconstructed from radiological images for optimal anatomy education. 3D-printed model is newer technology available to us. The purpose of this systematic review was to capture the usefulness or effectiveness of this newer technology in anatomy education.

MATERIALS AND METHODS

Twenty-two studies met the inclusion and exclusion criteria for quantitative synthesis. The included studies were sub-grouped according to the interventions and participants. No restrictions were applied based on geographical location, language and publication years. Randomized, controlled trial, cross-sectional and cross-over designs were included. The effect size of each intervention in both participants was computed as a standardized mean difference (SMD).

RESULTS

Twenty-two randomized, controlled trials were included for quantitative estimation of effect size of knowledge acquisition as standardized mean difference in 1435 participants. The pooled effect size for 3D-printed model was 0.77 (0.45-1.09, 95% CI, P < 0.0001) with 86% heterogeneity. The accuracy score was measured in only three studies and estimated effect size was 2.81 (1.08-4.54, 95% CI, P = 0.001) with 92% heterogeneity. The satisfaction score was examined by questionnaire in 6 studies. The estimated effect size was 2.00 (0.69-3.32, 95% CI, P = 0.003) with significant heterogeneity.

CONCLUSION

The participants exposed to the 3D-printed model performed better than participants who used traditional methodologies. Thus, the 3D-printed model is a potential tool for anatomy education.