Impact of compulsory participation of medical students in a multiuser online game to learn radiological anatomy and radiological signs within the virtual world Second Life

Competitive game-based learning within Second Life enables effective teaching of basic radiological anatomy and radiological signs to medical students, with good acceptance and results when students participate voluntarily, but unknown in a compulsory context. The objectives of this study were to reproduce a competitive online game based on self-guided presentations and multiple-choice tests in a mandatory format, to evaluate its development and student perceptions compared to a voluntary edition in 2015 (N = 90). In 2016 and 2017, respectively, 191 and 182 third-year medical students participated in the game as a mandatory course activity. The mean (±SD) score of the game was 74.7% (±19.5%) in 2015, 71.2% (±21.5%) in 2016, and 67.5% (±21.5%) in 2017 (P < 0.01). Participants valued positively the organization and educational contents but found the virtual world less attractive and the game less interesting than in the voluntary edition. The experience globally was rated with 8.2 (±1.5), 7.8 (±1.5), and 7.1 (±1.7) mean points (±SD) in a ten-point scale, in the 2015, 2016, and 2017 editions, respectively (P < 0.05). Competitive learning games within virtual worlds like Second Life have great learning potential in radiology, but the mean score in the game decreased, acceptance of virtual world technology was lower, and opinion about the game was worse with a compulsory participation, and even worse when dropouts were not allowed. Under the conditions in which this study was conducted, learning games in three-dimensional virtual environments should be voluntary to maintain adequate motivation and engagement of medical students.     

Real Or Not Real: The Impact of the Physical Fidelity of Virtual Learning Resources on Learning Anatomy

Technological advancements have made it possible to create realistic virtual representations of the real world, although it is unclear in medical education whether high physical fidelity is required in virtual learning resources (VLRs). This study, therefore, aimed to compare the effectiveness of high-fidelity (HF) and low-fidelity (LF) VLRs for learning anatomy. For this study, HF and LF VLRs were developed for liver anatomy and participants were voluntarily recruited from two cohorts (cohorts 1 and 2). Knowledge outcomes were measured through pre- and post-tests, task outcomes including activity score and completion time were recorded and participants' perceptions of the VLRs were surveyed. A total of 333 participants (165 HF and 168 LF) took part in this study. Knowledge outcomes were higher for the HF activity in cohort 1 and for the LF activity in cohort 2, although not significantly. There were no significant differences in activity score within either cohort, although completion time was significantly longer for the HF activity in cohort 1 (P = 0.001). There were no significant differences within either cohort in perceptions of the VLRs regarding usefulness for reviewing conceptual knowledge, esthetics, quality, mental effort experienced, or future use, although the LF VLR was scored significantly higher regarding the value for understanding in cohort 1 (P = 0.027).This study suggests that high physical fidelity is not necessarily required for anatomy VLRs, although may potentially be valuable for improving knowledge outcomes. Also, level of prior knowledge may be an important factor when considering the physical fidelity of anatomy VLRs.     

The Use of a Mobile Learning Tool by Medical Students in Undergraduate Anatomy and its Effects on Assessment Outcomes

Hand-held devices have revolutionized communication and education in the last decade. Consequently, mobile learning (m-learning) has become popular among medical students. Nevertheless, there are relatively few studies assessing students' learning outcomes using m-learning devices. This observational study presents an anatomy m-learning tool (eMed-App), an application developed to accompany an anatomy seminar and support medical students' self-directed learning of the skeletal system. Questionnaire data describe where, how frequently, and why students used the app. Multiple choice examination results were analyzed to evaluate whether usage of the app had an effect on test scores. The eMed-App application was used by 77.5% of the students, mainly accessed by Android smartphones, and at students' homes (62.2%) in order to prepare themselves for seminar sessions (60.8%), or to review learning content (67%). Most commonly, students logged on for less than 15 minutes each time (67.8%). Frequent app users showed better test results on items covering eMed-App learning content. In addition, users also achieved better results on items that were not related to the content of the app and, thus, gained better overall test results and lower failure rates. The top quartile of test performers used the eMed-App more frequently compared to students in lower quartiles. This study demonstrated that many students, especially the high-performing ones, made use of the eMed-App. However, the app itself did not result in better outcomes, suggesting that top students might have been more motivated to use the app than students who were generally weak in anatomy.     

Three-dimensional Visualization Software Assists Learning in Students with Diverse Spatial Intelligence in Medical Education

This study evaluated effect of mental rotation (MR) training on learning outcomes and explored effectiveness of teaching via three-dimensional (3D) software among medical students with diverse spatial intelligence. Data from n = 67 student volunteers were included. A preliminary test was conducted to obtain baseline level of MR competency and was utilized to assign participants to two experimental conditions, i.e., trained group (n = 25) and untrained group (n = 42). Data on the effectiveness of training were collected to measure participants’ speed and accuracy in performing various MR activities. Six weeks later, a large class format (LCF) session was conducted for all students using 3D software. The usefulness of technology-assisted learning at the LCF was evaluated via a pre- and post-test. Students’ feedback regarding MR training and use of 3D software was acquired through questionnaires. MR scores of the trainees improved from 25.9±4.6 points to 28.1±4.4 (P = 0.011) while time taken to complete the tasks reduced from 20.9±3.9 to 12.2±4.4 minutes. Males scored higher than females in all components (P = 0.016). Further, higher pre- and post-test scores were observed in trained (9.0±1.9 and 12.3±1.6) versus untrained group (7.8±1.8; 10.8±1.8). Although mixed-design analysis of variance suggested significant difference in their test scores (P < 0.001), both groups reported similar trend in improvement by means of 3D software (P = 0.54). Ninety-seven percent of students reported technology-assisted learning as an effective means of instruction and found use of 3D software superior to plastic models. Software based on 3D technologies could be adopted as an effective teaching pedagogy to support learning across students with diverse levels of mental rotation abilities.     

Virtual Microscopy as a Learning Tool in Brazilian Medical Education

Virtual microscopy (VM) is a widely used teaching method in Medical Education in many developed countries. In Brazil, however, this is not the case for most medical schools, considering Brazilian social inequality and uneven access to technology. Recently, the Covid-19 pandemic has also challenged Universities to seek and make a transition toward more effective methods of full-time online education. Thus, the main goal of this work was to verify student's perception and academic performance, assessed upon VM implementation in a Brazilian Medical School. Ribeirao Preto Medical School students answered a 26-question survey with regards to optical microscopy (OM) and VM. Academic performance was compared between participants that were (year of 2019) or were not (year of 2015) exposed to VM. Taken the results together, subjective impressions such as handling, suitability, learning effectiveness, and pleasure using the tools, have shown a higher score for virtual microscopy (median = 29), when compared to optical microscopy (median = 24) with a P-value < 0.001 by Wilcoxon rank test, upon measurement using an ordinal scale. Regarding academic performance, no statistically significant differences were found between groups (P-value = 0.38, Cohen's d = 0.19). Therefore, VM proved to be adequate to the Brazilian medical education in light of Brazilian social contexts and Covid-19 pandemic.     

How Computer-Assisted Learning Influences Medical Students' Performance in Anatomy Courses

Anatomy is an essential subject of the medical curriculum. Despite its relevance, the curricular time and logistical resources devoted to teaching anatomy are in decline, favoring the introduction of new pedagogical approaches based on computer-assisted learning (CAL). This new pedagogical approach provides an insight into students' learning profiles and features, which are correlated with knowledge acquisition. The aim of this study was to understand how training with CAL platforms can influence medical students' anatomy performance. A total of 611 medical students attending Musculoskeletal Anatomy (MA) and Cardiovascular Anatomy (CA) courses were allocated to one of three groups (MA Group, CA Group, and MA + CA Group). An association between the performance in these anatomy courses and the number of CAL training sessions was detected. In the MA Group (r = 0.761, P < 0.001) and the MA + CA Group (r = 0.786, P < 0.001), a large positive correlation was observed between musculoskeletal anatomy performance and the number of CAL training sessions. Similarly, in the CA Group (r = 0.670, P < 0.001) and the MA + CA Group (r = 0.772, P < 0.001), a large positive correlation was observed between cardiovascular anatomy performance and the number of CAL training sessions. Multiple linear regression models were performed, considering either musculoskeletal or cardiovascular anatomy performance as the dependent variable. The results suggest that using CAL platforms to study has a positive dose-dependent effect on anatomy performance. Understanding students' individual features and academic background may contribute to the optimization of the learning process.     

National Survey on Canadian Undergraduate Medical Programs: The Decline of the Anatomical Sciences in Canadian Medical Education

The anatomical sciences have always been regarded as an essential component of medical education. In Canada, the methodology and time dedicated to anatomy teaching are currently unknown. Two surveys were administered to course directors and discipline leaders to gain a comprehensive view of anatomical education in Canadian medical schools. Participants were queried about contact hours (classroom and laboratory), content delivery and assessment methods for gross anatomy, histology, and embryology. Twelve schools responded to both surveys, for an overall response rate of 64%. Overall, Canadian medical students spend 92.8 (± 45.4) hours (mean ± SD) studying gross anatomy, 25.2 (± 21.0) hours for histology, and 7.4 (± 4.3) hours for embryology. Gross anatomy contact hours statistically significantly exceeded those for histology and embryology. Results show that most content is delivered in the first year of medical school, as anatomy is a foundational building block for upper-year courses. Laboratory contact time for gross anatomy was 56.8 (± 30.7) hours, histology was 11.4 (± 16.2) hours, and embryology was 0.25 (± 0.6) hours. Additionally, 42% of programs predominantly used instructor/technician-made prosections, another 33% used a mix of dissection and prosections and 25% have their students complete cadaveric dissections. Teaching is either completely or partially integrated into all Canadian medical curricula. This integration trend in Canada parallels those of other medical schools around the world where programs have begun to decrease contact time in anatomy and increase integration of the anatomical sciences into other courses. Compared to published American data, Canadian schools offer less contact time. The reason for this gap is unknown. Further investigation is required to determine if the amount of anatomical science education within medical school affects students' performance in clerkship, residency and beyond.     

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

In order to improve learning efficiency and memory retention in medical teaching, furthering active learning seems to be an effective alternative to classical teaching. One option to make active exploration of the subject matter possible is the use of virtual reality (VR) technology. The authors developed an immersive anatomy atlas which allows users to explore human anatomical structures interactively through virtual dissection. Thirty-two senior-class students from two German high schools with no prior formal medical training were separated into two groups and tasked with answering an anatomical questionnaire. One group used traditional anatomical textbooks and the other used the immersive virtual reality atlas. The time needed to answer the questions was measured. Several weeks later, the participants answered a similar questionnaire with different anatomical questions in order to test memory retention. The VR group took significantly less time to answer the questionnaire, and participants from the VR group had significantly better results over both tests. Based on the results of this study, VR learning seems to be more efficient and to have better long-term effects for the study of anatomy. The reason for that could lie in the VR environment's high immersion, and the possibility to freely and interactively explore a realistic representation of human anatomy. Immersive VR technology offers many possibilities for medical teaching and training, especially as a support for cadaver dissection courses.     

Undergraduate Medical Students' Usage and Perceptions of Anatomical Case-Based Learning: Comparison of Facilitated Small Group Discussions and eLearning Resources

While case-based discussions can empower students to apply knowledge to contextual clinical situations, scheduling these activities is a challenge in crowded curricula. Case-based eLearning activities, derived from existing cases discussed within anatomy small group tutorials, were created incorporating principles such as interactivity, reinforcement, and feedback. Over half of the students accessed one or more of these online cases, with 18% accessing all eight online cases provided. Access increased as the semester progressed, particularly just before summative examinations, implying students used these primarily as revision aides. Students rated both formats highly, but favored the online format with regard to enjoyment (P = 0.048), learning (P = 0.101), and feedback (P = 0.086). However, more students discussed these cases in small group tutorials within the anatomy dissecting room than completed them online (122 vs. 67) and themes emerging from free text comments included a desire to have more time dedicated to these cases during small group tutorials, and an appreciation for the opportunity for discussion with staff and learning through doing. Additionally, native English speakers rated the anatomy room discussions significantly higher in all aspects than non-native English speakers, suggesting that non-native speakers may be hesitant or reluctant to fully participate in front of peers. While online case-based learning activities are a useful adjunct to anatomy teaching, particularly for revision, assumptions that “digital natives” have an innate preference for digital resources require critical evaluation, as students still place a high value on opportunities for discussion with staff during their studies.     

The Critical Role of Stereopsis in Virtual and Mixed Reality Learning Environments

Anatomy education has been revolutionized through digital media, resulting in major advances in realism, portability, scalability, and user satisfaction. However, while such approaches may well be more portable, realistic, or satisfying than traditional photographic presentations, it is less clear that they have any superiority in terms of student learning. In this study, it was hypothesized that virtual and mixed reality presentations of pelvic anatomy will have an advantage over two-dimensional (2D) presentations and perform approximately equal to physical models and that this advantage over 2D presentations will be reduced when stereopsis is decreased by covering the non-dominant eye. Groups of 20 undergraduate students learned pelvic anatomy under seven conditions: physical model with and without stereo vision, mixed reality with and without stereo vision, virtual reality with and without stereo vision, and key views on a computer monitor. All were tested with a cadaveric pelvis and a 15-item, short-answer recognition test. Compared to the key views, the physical model had a 70% increase in accuracy in structure identification; the virtual reality a 25% increase, and the mixed reality a non-significant 2.5% change. Blocking stereopsis reduced performance on the physical model by 15%, on virtual reality by 60%, but by only 2.5% on the mixed reality technology. The data show that virtual and mixed reality technologies tested are inferior to physical models and that true stereopsis is critical in learning anatomy.     

Developing Student Metacognition through Reflective Writing in an Upper Level Undergraduate Anatomy Course

Incorporating metacognitive strategies in the classroom helps students monitor and adjust their learning strategies throughout the semester, and helps students progress from novice to expert learners in a subject. Journaling (i.e., reflective writing) is one metacognitive task that allows students to contemplate and articulate their skill development as they learn a new subject. The research reported here examines the use of ‘blogs’ (i.e., online journals) in an upper level undergraduate human anatomy course. The blogs both facilitated development of students' metacognitive skills and provided researchers insight into student metacognitive process. Data were examined from 92 students from three successive semesters (spring 2010, 2012 and 2014). Each student reviewed 10 radiology online cases throughout the semester and then reflected on their understanding of anatomy and radiology in an online blog for each case. A total of 927 blogs were examined for this research. The researchers used a grounded theory approach to analyze the blog narratives and develop a codebook based on common themes. The 927 blogs yielded 11,082 statements that were coded with the codebook. As the semester progressed, the blog entries showed that students demonstrated greater self-confidence in their abilities to understand the subject matter, expressed greater enthusiasm for anatomy in general, and they improved their metacognitive skills. This research illustrates that reflective writing in an undergraduate anatomy course not only facilitates improvement in student metacognitive skills, but also provides the instructor with evidence how a student progresses from novice to more experienced learner in anatomy.     

Interactive radiological anatomy eLearning solution for first year medical students: Development,integration, and impact on learning

A technology enhanced learning and teaching (TELT) solution, radiological anatomy (RA) eLearning, composed of a range of identification‐based and guided learning activities related to normal and pathological X‐ray images, was devised for the Year 1 nervous and locomotor course at the Faculty of Medicine, University of Southampton. Its effectiveness was evaluated using a questionnaire, pre‐ and post‐tests, focus groups, summative assessment, and tracking data. Since introduced in 2009, a total of 781 students have used RA eLearning, and among them 167 Year 1 students in 2011, of whom 116 participated in the evaluation study. Students enjoyed learning (77%) with RA eLearning, found it was easy to use (81%) and actively engaged them in their learning (75%), all of which were associated to the usability, learning design of the TELT solution and its integration in the curriculum; 80% of students reported RA eLearning helped their revision of anatomy and 69% stated that it facilitated their application of anatomy in a clinical context, both of which were associated with the benefits offered by the learning and activities design. At the end of course summative assessment, student knowledge of RA eLearning relevant topics (mean 80%; SD ±16) was significantly better as compared to topics not relevant to RA eLearning (mean 63%; SD ±15) (mean difference 18%; 95% CI 15% to 20%; P < 0.001). A well designed and integrated TELT solution can be an efficient method for facilitating the application, integration, and contextualization of anatomy and radiology to create a blended learning environment. Anat Sci Educ 7: 350–360. © 2013 American Association of Anatomists.     

Not Just a Specimen: A Qualitative Study of Emotion,Morality, and Professionalism in One Medical School Gross Anatomy Laboratory

Medical schools are increasingly integrating professionalism training into their gross anatomy courses, teaching ethical behavior and humanistic attitudes through the dissection experience. However, many schools continue to take a traditional, technical approach to anatomical education while teaching professionalism in separate courses. This interview-based study explored how students viewed the body donor and the professional lessons they learned through dissection at one such medical school. All students oscillated involuntarily between seeing the cadaver as a specimen for learning and seeing the cadaver as a person, with some students intentionally cultivating one of these ways of seeing over the other. These views shaped students’ emotional and moral responses to the experiences of dissection. The “specimen” view facilitated a technical, detached approach to dissection, while the “person” view made students engage emotionally. Further, students who intentionally cultivated a “specimen” view generally felt less moral distress about dissection than students who intentionally cultivated a “person” view. The concept of respect gave students permission to perform dissections, but “person-minded” students developed more complex rules around what constituted respectful behavior. Both groups of students connected the gross anatomy experience to their professional development, but in different ways. “Specimen-minded” students intentionally objectified the body to learn the emotional control physicians need, while “person-minded” students humanized the body donor to promote the emotional engagement required of physicians. These findings support efforts to integrate professionalism teaching into gross anatomy courses, particularly content, addressing the balance between professional detachment and concern.     

Physician opinions about an anatomy core curriculum: A case for medical imaging and vertical integration

Pre‐clinical anatomy curricula must provide medical students with the knowledge needed in a variety of medical and surgical specialties. But do physicians within specialties agree about what anatomical knowledge is most important in their practices? And, what is the common core of anatomical knowledge deemed essential by physicians in different specialties? Answers to these questions would be useful in designing pre‐clinical anatomy courses. The primary aim of this study was to assess the importance of a human gross anatomy course by soliciting the opinions of physicians from a range of specialties. We surveyed 93 physicians to determine the importance of specific anatomical topics in their own practices. Their responses were analyzed to assess variation in intra‐ and inter‐departmental attitudes toward the importance of anatomy. Nearly all of the topics taught in the course were deemed important by the clinicians as a group, but respondents showed little agreement on the rank order of importance of anatomical topics. Overall, only medical imaging received high importance by nearly all respondents, and lower importance was attached to embryology and lymphatic anatomy. Our survey data, however, also suggested distinct hierarchies in the importance assigned to anatomical topics within specialties. Given that physicians view the importance of anatomy differently, we suggest that students revisit anatomy through a vertically integrated curriculum tailored to provide specialty‐specific anatomical training to advanced students based on their areas of clinical interest. Integration of medical imaging into pre‐clinical anatomy courses, already underway in many medical schools, is of high clinical relevance. Anat Sci Educ 7: 251–261. © 2013 American Association of Anatomists.     

Voice in Digital Education: The Impact of Instructor's Perceived Age and Gender on Student Learning and Evaluation

Instructor evaluations are influenced by implicit age and gender bias, with lower ratings and negative feedback given to instructors believed to stray from stereotypical age and gender norms. Female instructors exhibiting typically male-associated qualities such as leadership and authority, are often negatively impacted. Implicit bias also influences evaluation of digital resources and instructors, regardless of students' positive learning outcomes. As digital learning resources become the norm in education, it is crucial to explore the impact of implicit bias at various educational levels. In this study, undergraduate and graduate students were randomly exposed to one of five digital tutorials; four experimental tutorials presenting identical anatomy content with narrators of different gender and age, and a control tutorial featuring origami (paper folding) instructions without audio. Learning outcomes were measured by pre-quiz vs. post-quiz comparisons using repeated measures MANOVA. Implicit bias was analyzed by evaluation response comparisons using repeated measures MANOVA and three-way MANOVA. Post-quiz scores increased significantly in the four experimental groups (P < 0.05) but not in the control (P = 0.99). The increased performance was not statistically different across the four experimental groups (P > 0.26), suggesting that learning occurred irrespective of the instructor gender and age. Students' evaluations were consistently higher for the experimental resources than the control. There was no significant difference in evaluations across the four experimental groups but compared to the control, younger male and younger female narrators received significantly higher ratings for approachability, acceptance, inclusivity, and care for student learning. The study highlights important considerations for digital resources development and interpretation of student evaluations.     

Higher-Order Assessment in Gross Anatomy: A Comparison of Performance on Higher- Versus Lower-Order Anatomy Questions between Undergraduate and First-Year Medical Students

Gross anatomy is considered by many the backbone of medical education. While learning anatomy has a reputation of requiring mainly rote memorization, modern day anatomy education often involves instruction and assessment at cognitive levels that foster higher-order thinking. In many instances, these higher-order anatomical concepts are taught to graduate students in healthcare-related fields, such as medicine. At this level, students are expected to apply and analyze anatomical information since that is what will ultimately be expected of them as professionals. In contrast, undergraduate anatomy education is typically more introductory in nature and often takes place in the setting of a large-enrollment course that serves as a prerequisite for many health sciences degree programs. In this study, variables related to the assessment of higher-order concepts in clinical anatomy were compared between first-year medical students and undergraduate students enrolled in an upper-level human gross anatomy course. Results demonstrate that undergraduate students perform lower than medical students overall, but the degree of difference in how they perform on higher- versus lower-order questions is comparable. The most notable exception is on practical examinations, where undergraduate students tend to struggle more with applying and analyzing information. Exploration of additional variables provides insight into how the cognitive level being assessed affects the time it takes to answer a question and how different practical examination question types and formats influence student performance. Findings presented in this study have implications for designing anatomy courses and underscore the importance of blueprinting assessments.     

Spatial Abilities Training in Anatomy Education: A Systematic Review

Spatial abilities have been correlated to anatomy knowledge assessment and spatial training has been found to improve spatial abilities in previous systematic reviews. The objective of this systematic review was to evaluate spatial abilities training in anatomy education. A literature search was done from inception to 3 August 2017 in Scopus^® and several databases on the EBSCOhost platform. Citations were reviewed and those involving anatomy education, an intervention, and a spatial abilities test were retained and the corresponding full-text articles were reviewed for inclusion. Before and after training studies, as well as comparative training programs, relating a spatial training intervention to spatial abilities were eligible. Of the 2,405 citations obtained, 52 articles were identified and reviewed, yielding eight eligible articles. Instruction in anatomy and mental rotations training were found to improve spatial abilities. For the seven studies retained for the meta-analysis that included the effect of interventions on spatial abilities test scores, the pooled treatment effect difference was 0.49 (95% CI [0.17; 0.82]; n = 11) improvement. For the two studies that included the practice effect on spatial abilities test scores in a control group, the pooled treatment effect difference was 0.47 (95% CI [−0.03; 0.97]; n = 2) improvement. In these two studies, the impact of the intervention on spatial abilities test scores was found despite the practice effect. Evidence was found for improvement of spatial abilities in anatomy education using instruction in anatomy and mental rotations training.