Computer visualizations: factors that influence spatial anatomy comprehension

Computer visualizations are increasingly common in education across a range of subject disciplines, including anatomy. Despite optimism about their educational potential, students sometime have difficulty learning from these visualizations. The purpose of this study was to explore a range of factors that influence spatial anatomy comprehension before and after instruction with different computer visualizations. Three major factors were considered: (1) visualization ability (VZ) of learners, (2) dynamism of the visual display, and (3) interactivity of the system. Participants (N = 60) of differing VZs (high, low) studied a group of anatomical structures in one of three visual conditions (control, static, dynamic) and one of two interactive conditions (interactive, non-interactive). Before and after the study phase, participants' comprehension of spatial anatomical information was assessed using a multiple-choice spatial anatomy task (SAT) involving the mental rotation of the anatomical structures, identification of the structures in 2D cross-sections, and localization of planes corresponding to given cross-sections. Results indicate that VZ had a positive influence on SAT performance but instruction with different computer visualizations could modulate the effect of VZ on task performance.     

Learning anatomy enhances spatial ability

Spatial ability is an important factor in learning anatomy. Students with high scores on a mental rotation test (MRT) systematically score higher on anatomy examinations. This study aims to investigate if learning anatomy also oppositely improves the MRT‐score. Five hundred first year students of medicine (n = 242, intervention) and educational sciences (n = 258, control) participated in a pretest and posttest MRT, 1 month apart. During this month, the intervention group studied anatomy and the control group studied research methods for the social sciences. In the pretest, the intervention group scored 14.40 (SD: ± 3.37) and the control group 13.17 (SD: ± 3.36) on a scale of 20, which is a significant difference (t‐test, t = 4.07, df = 498, P < 0.001). Both groups show an improvement on the posttest compared to the pretest (paired samples t‐test, t = 12.21/14.71, df = 257/241, P < 0.001). The improvement in the intervention group is significantly higher (ANCOVA, F = 16.59, df = 1;497, P < 0.001). It is concluded that (1) medical students studying anatomy show greater improvement between two consecutive MRTs than educational science students; (2) medical students have a higher spatial ability than educational sciences students; and (3) if a MRT is repeated there seems to be a test effect. It is concluded that spatial ability may be trained by studying anatomy. The overarching message for anatomy teachers is that a good spatial ability is beneficial for learning anatomy and learning anatomy may be beneficial for students' spatial ability. This reciprocal advantage implies that challenging students on spatial aspects of anatomical knowledge could have a twofold effect on their learning. Anat Sci Educ 6: 257–262. © 2013 American Association of Anatomists.     

Time limits in testing: An analysis of eye movements and visual attention in spatial problem solving

Individuals with an aptitude for interpreting spatial information (high mental rotation ability: HMRA) typically master anatomy with more ease, and more quickly, than those with low mental rotation ability (LMRA). This article explores how visual attention differs with time limits on spatial reasoning tests. Participants were assorted to two groups based on their mental rotation ability scores and their eye movements were collected during these tests. Analysis of salience during testing revealed similarities between MRA groups in untimed conditions but significant differences between the groups in the timed one. Question‐by‐question analyses demonstrate that HMRA individuals were more consistent across the two timing conditions (κ = 0.25), than the LMRA (κ = 0.013). It is clear that the groups respond to time limits differently and their apprehension of images during spatial problem solving differs significantly. Without time restrictions, salience analysis suggests LMRA individuals attended to similar aspects of the images as HMRA and their test scores rose concomitantly. Under timed conditions however, LMRA diverge from HMRA attention patterns, adopting inflexible approaches to visual search and attaining lower test scores. With this in mind, anatomical educators may wish to revisit some evaluations and teaching approaches in their own practice. Although examinations need to evaluate understanding of anatomical relationships, the addition of time limits may induce an unforeseen interaction of spatial reasoning and anatomical knowledge. Anat Sci Educ 10: 528–537. © 2017 American Association of Anatomists.     

Computed tomography‐enhanced anatomy course using enterprise visualization

Rapid changes in medical knowledge are forcing continuous adaptation of the basic science courses in medical schools. This article discusses a three‐year experience developing a new Computed Tomography (CT)‐based anatomy curriculum at the Sackler School of Medicine, Tel Aviv University, including describing the motivations and reasoning for the new curriculum, the CT‐based learning system itself, practical examples of visual dissections, and student assessments of the new curriculum. At the heart of this new curriculum is the emphasis on studying anatomy by navigating inside the bodies of various living individuals utilizing a CT viewer. To assess the students’ experience with the new CT‐based learning method, an anonymous questionnaire was administered at the end of the course for three consecutive academic years: 2008/2009, 2009/2010, 2010/2011. Based upon the results, modifications were made to the curriculum in the summers of 2009 and 2010. Results showed that: (1) during these three years the number of students extensively using the CT system quadrupled (from 11% to 46%); (2) students' satisfaction from radiologists involvement increased by 150%; and (3) student appreciation of the CT‐based learning method significantly increased (from 13% to 68%). It was concluded that discouraging results (mainly negative feedback from students) during the first years and a priori opposition from the teaching staff should not weaken efforts to develop new teaching methods in the field of anatomy. Incorporating a new curriculum requires time and patience. Student and staff satisfaction, along with utilization of the new system, will increase with the improvement of impeding factors. Anat Sci Educ 6: 332–341. © 2013 American Association of Anatomists.     

Spatial abilities in an elective course of applied anatomy after a problem‐based learning curriculum

A concern on the level of anatomy knowledge reached after a problem‐based learning curriculum has been documented in the literature. Spatial anatomy, arguably the highest level in anatomy knowledge, has been related to spatial abilities. Our first objective was to test the hypothesis that residents are interested in a course of applied anatomy after a problem‐based learning curriculum. Our second objective was to test the hypothesis that the interest of residents is driven by innate higher spatial abilities. Fifty‐nine residents were invited to take an elective applied anatomy course in a prospective study. Spatial abilities were measured with a redrawn Vandenberg and Kuse Mental Rotations Test in two (MRT A) and three (MRT C) dimensions. A need for a greater knowledge in anatomy was expressed by 25 residents after a problem‐based learning curriculum. MRT A and C scores obtained by those choosing (n = 25) and not choosing (n = 34) applied anatomy was not different (P = 0.46 and P = 0.38, respectively). Percentage of residents in each residency program choosing applied anatomy was different [23 vs. 31 vs. 100 vs. 100% in Family Medicine, Internal Medicine, Surgery, and Anesthesia, respectively; P < 0.0001]. The interest of residents in applied anatomy was not driven by innate higher spatial abilities. Our applied anatomy course was chosen by many residents because of training needs rather than innate spatial abilities. Future research will need to assess the relationship of individual differences in spatial abilities to learning spatial anatomy. Anat Sci Ed 2:107–112, 2009. © 2009 American Association of Anatomists.     

Effect of visual-spatial ability on medical students' performance in a gross anatomy course

The ability to mentally manipulate objects in three dimensions is essential to the practice of many clinical medical specialties. The relationship between this type of visual-spatial ability and performance in preclinical courses such as medical gross anatomy is poorly understood. This study determined if visual-spatial ability is associated with performance on practical examinations, and if students' visual-spatial ability improves during medical gross anatomy. Three hundred and fifty-two first-year medical students completed the Mental Rotations Test (MRT) before the gross anatomy course and 255 at its completion in 2008 and 2009. Hypotheses were tested using logistic regression analysis and Student's t-test. Compared with students in the lowest quartile of the MRT, students who scored in the highest quartile of the MRT were 2.2 [95% confidence interval (CI) 1.2 and 3.8] and 2.1 (95% CI 1.2 and 3.5) times more likely to score greater than 90% on practical examinations and on both practical and written examinations, respectively. MRT scores for males and females increased significantly (P < 0.0001). Measurement of students' pre-existing visual-spatial ability is predictive of performance in medical gross anatomy, and early intervention may be useful for students with low visual-spatial ability on entry to medical school. Participation in medical gross anatomy increases students' visual-spatial ability, although the mechanism for this phenomenon is unknown.     

Evaluation of computer‐aided instruction in a gross anatomy course: A six‐year study

Web‐based computer‐aided instruction (CAI) has become increasingly important to medical curricula. This multi‐year study investigated the effectiveness of CAI and the factors affecting level of individual use. Three CAI were tested that differed in specificity of applicability to the curriculum and in the level of student interaction with the CAI. Student personality preferences and learning styles were measured using the Meyers Briggs Type Indicator (MBTI) and Kolb's Learning Style Inventory (LSI). Information on “computer literacy” and use of CAI was collected from student surveys. Server logs were used to quantify individual use of respective CAI. There was considerable variability in the level of utilization of each CAI by individual students. Individual use of each CAI differed and was associated with gender, MBTI preferences and learning style, but not with “computer literacy.” The majority of students found the CAI useful for learning and used the CAI by themselves. Students who accessed the CAI resources most frequently scored significantly higher on exams compared with students who never accessed the resources. Our results show that medical students do not uniformly use CAI developed for their curriculum and this variability is associated with various attributes of individual students. Our data also provide evidence of the importance of understanding student preferences and learning styles when implementing CAI into the curriculum. Anat Sci Ed 2:2–8, 2009. © 2009 American Association of Anatomists.     

The anatomy of self‐defense

The following study describes a creative application of anatomical principles in the instruction of self‐defense. Undergraduates at the University of Kentucky were invited to a special lecture that featured a series of self‐defense moves introduced by a local police officer. Following a demonstration of each self‐defense tactic, the students were briefed on the anatomy of both the victim and the assailant that contributed to the overall effectiveness of each move. This approach was unique in that students learned critical knowledge of self‐defense while reinforcing anatomical principles previously introduced in class. Moreover, this integration of topics prompted students to think about their response to potentially dangerous situations on campus. Anat Sci Ed 1:130–132, 2008. © 2008 American Association of Anatomists.     

A cross‐cultural comparison of anatomy learning: Learning styles and strategies

Cultural influences on anatomy teaching and learning have been investigated by application of a questionnaire to medical students in British and Chinese Medical Schools. Results from the responses from students of the two countries were analyzed. Both groups found it easier to understand anatomy in a clinical context, and in both countries, student learning was driven by assessment. Curriculum design differences may have contributed to the British view wherein students were less likely to feel time pressure and enjoyed studying anatomy more than their Chinese counterparts. Different teaching approaches resulted in British students being more likely to recite definitions to learn, and the Chinese students found learning from cross‐sectional images easy. Cultural differences may account for the observation that British students were more inclined to ask questions in class, and the preference of Chinese students to study in small groups. The findings give evidence to show how ‘cultures of learning’ influence students' approaches and indicate the importance of cultural influences as factors amongst international and home learner groups. Anat Sci Ed 2:49–60, 2009. © 2009 American Association of Anatomists.     

Improvements in anatomy knowledge when utilizing a novel cyclical “Observe‐Reflect‐Draw‐Edit‐Repeat” learning process

Innovative educational strategies can provide variety and enhance student learning while addressing complex logistical and financial issues facing modern anatomy education. Observe‐Reflect‐Draw‐Edit‐Repeat (ORDER), a novel cyclical artistic process, has been designed based on cognitivist and constructivist learning theories, and on processes of critical observation, reflection and drawing in anatomy learning. ORDER was initially investigated in the context of a compulsory first year surface anatomy practical (ORDER‐SAP) at a United Kingdom medical school in which a cross‐over trial with pre‐post anatomy knowledge testing was utilized and student perceptions were identified. Despite positive perceptions of ORDER‐SAP, medical student (n = 154) pre‐post knowledge test scores were significantly greater (P < 0.001) with standard anatomy learning methods (3.26, SD = ±2.25) than with ORDER‐SAP (2.17, ±2.30). Based on these findings, ORDER was modified and evaluated in the context of an optional self‐directed gross anatomy online interactive tutorial (ORDER‐IT) for participating first year medical students (n = 55). Student performance was significantly greater (P < 0.001) with ORDER‐IT (2.71 ± 2.17) when compared to a control tutorial (1.31 ± 2.03). Performances of students with visual and artistic preferences when using ORDER were not significantly different (P > 0.05) to those students without these characteristics. These findings will be of value to anatomy instructors seeking to engage students from diverse learning backgrounds in a research‐led, innovative, time and cost‐effective learning method, in the context of contrasting learning environments. Anat Sci Educ 10: 7–22. © 2016 American Association of Anatomists.     

Problem‐based learning in regional anatomy education at Peking University

Problem‐based learning (PBL) has been introduced to medical schools around the world and has increasingly become a popular pedagogical technique in Asian countries since 1990. Gross anatomy is a fundamental basic science course in virtually all medical training programs, and the methods used to teach it are under frequent scrutiny and revision. Students often struggle with the vast collection of new terms and complex relationships between structures that they must learn. To help students with this process, our department teaches separate systemic and regional anatomy courses, the latter in a PBL format. After three years of using PBL in our regional anatomy course, we have worked out a set of effective instructions that we would like to share with other medical schools. We report here evidence that our clinical PBL approach stimulates students' interest in learning and enhances anatomy education in a way that can foster better practices in our future medical work force. Anat Sci Educ. © 2010 American Association of Anatomists.     

Constructive,collaborative, contextual,and self‐directed learning in surface anatomy education

Anatomy education often consists of a combination of lectures and laboratory sessions, the latter frequently including surface anatomy. Studying surface anatomy enables students to elaborate on their knowledge of the cadaver's static anatomy by enabling the visualization of structures, especially those of the musculoskeletal system, move and function in a living human being. A recent development in teaching methods for surface anatomy is body painting, which several studies suggest increases both student motivation and knowledge acquisition. This article focuses on a teaching approach and is a translational contribution to existing literature. In line with best evidence medical education, the aim of this article is twofold: to briefly inform teachers about constructivist learning theory and elaborate on the principles of constructive, collaborative, contextual, and self‐directed learning; and to provide teachers with an example of how to implement these learning principles to change the approach to teaching surface anatomy. Student evaluations of this new approach demonstrate that the application of these learning principles leads to higher student satisfaction. However, research suggests that even better results could be achieved by further adjustments in the application of contextual and self‐directed learning principles. Successful implementation and guidance of peer physical examination is crucial for the described approach, but research shows that other options, like using life models, seem to work equally well. Future research on surface anatomy should focus on increasing the students' ability to apply anatomical knowledge and defining the setting in which certain teaching methods and approaches have a positive effect. Anat Sci Educ 6: 114–124. © 2012 American Association of Anatomists.     

Computer‐assisted learning in anatomy at the International Medical School in Debrecen,Hungary: A preliminary report

The University of Debrecen's Faculty of Medicine has an international, multilingual student population with anatomy courses taught in English to all but Hungarian students. An elective computer‐assisted gross anatomy course, the Computer Human Anatomy (CHA), has been taught in English at the Anatomy Department since 2008. This course focuses on an introduction to anatomical digital images along with clinical cases. This low‐budget course has a large visual component using images from magnetic resonance imaging and computer axial tomogram scans, ultrasound clinical studies, and readily available anatomy software that presents topics which run in parallel to the university's core anatomy curriculum. From the combined computer images and CHA lecture information, students are asked to solve computer‐based clinical anatomy problems in the CHA computer laboratory. A statistical comparison was undertaken of core anatomy oral examination performances of English program first‐year medical students who took the elective CHA course and those who did not in the three academic years 2007–2008, 2008–2009, and 2009–2010. The results of this study indicate that the CHA‐enrolled students improved their performance on required anatomy core curriculum oral examinations (P < 0.001), suggesting that computer‐assisted learning may play an active role in anatomy curriculum improvement. These preliminary results have prompted ongoing evaluation of what specific aspects of CHA are valuable and which students benefit from computer‐assisted learning in a multilingual and diverse cultural environment. Anat Sci Educ. © 2012 American Association of Anatomists.     

Evaluation of an innovative hands‐on anatomy‐centered ultrasound curriculum to supplement graduate gross anatomy education

Ultrasound (US) can enhance anatomy education, yet is incorporated into few non‐medical anatomy programs. This study is the first to evaluate the impact of US training in gross anatomy for non‐medical students in the United States. All 32 master's students enrolled in gross anatomy with the anatomy‐centered ultrasound (ACUS) curriculum were recruited. Mean Likert ratings on pre‐ and post‐course surveys (100% response rates) were compared to evaluate the effectiveness of the ACUS curriculum in developing US confidence, and gauge its impact on views of US. Post‐course, students reported significantly higher (P < 0.001) mean confidence ratings in five US skills (pre‐course versus post‐course mean): obtaining scans (3.13 ±1.04 versus 4.03 ±0.78), optimizing images (2.78 ±1.07 versus 3.75 ±0.92), recognizing artifacts (2.94 ±0.95 versus 3.97 ±0.69), distinguishing tissue types (2.88 ±0.98 versus 4.09 ±0.69), and identifying structures (2.97 ±0.86 versus 4.03 ±0.59), demonstrating the success of the ACUS curriculum in students with limited prior experience. Views on the value of US to anatomy education and to students' future careers remained positive after the course. End‐of‐semester quiz performance (91% response rate) provided data on educational outcomes. The average score was 79%, with a 90% average on questions about distinguishing tissues/artifacts, demonstrating positive learning outcomes and retention. The anatomy‐centered ultrasound curriculum significantly increased confidence with and knowledge of US among non‐medical anatomy students with limited prior training. Non‐medical students greatly value the contributions that US makes to anatomy education and to their future careers. It is feasible to enhance anatomy education outside of medical training by incorporating US. Anat Sci Educ 10: 348–362. © 2016 American Association of Anatomists.     

The development of clinical reasoning skills: A major objective of the anatomy course

Traditional medical school curricula have made a clear demarcation between the basic biomedical sciences and the clinical years. It is our view that a comprehensive medical education necessarily involves an increased correlation between basic science knowledge and its clinical applications. A basic anatomy course should have two main objectives: for the student to successfully gain a solid knowledge base of human anatomy and to develop and hone clinical reasoning skills. In a basic anatomy course, clinical case discussions based on underlying anatomic anomalies or abnormalities are the major means to teach students clinical reasoning skills. By identifying, classifying, and analyzing the clinical data given, a student learns to methodically approach a clinical case and formulate plausible diagnoses. Practicing and perfecting clinical problem‐solving skills should be a major objective of the anatomy curriculum. Such clinical reasoning skills are indeed crucial for the successful and expert practice of medicine. Anat Sci Ed 1:267–268, 2008. © 2008 American Association of Anatomists.     

Building a low‐cost gross anatomy laboratory: A big step for a small university

This article illustrates details of the planning, building, and improvement phases of a cost‐efficient, full‐dissection gross anatomy laboratory on a campus of an historically design‐centric university. Special considerations were given throughout the project to the nature of hosting cadavers in a building shared amongst all undergraduate majors. The article addresses these needs along with discussion of relevant furnishings and infrastructure that went into the creation of a fully outfitted gross anatomy laboratory (ten cadavers) completed within a significantly constrained timeline and $210,000 budget. Anat Sci Educ. © 2010 American Association of Anatomists.     

Team-based learning in anatomy: an efficient, effective, and economical strategy

Team-based learning (TBL) strategy is being adopted in medical education to implement interactive small group learning. We have modified classical TBL to fit our curricular needs and approach. Anatomy lectures were replaced with TBL that required preparation of assigned content specific discussion topics (in the text referred as "discussion topics"), an individual self-assessment quiz (IRAT), analysis of the discussion topics, and then the team retaking the same quiz (GRAT) for discussion and deeper learning. Embryology and clinical correlations were given as lectures. Unit examinations consisted of graded IRAT and GRAT. The National Board of Medical Examiners (NBME) Subject Examination was the comprehensive final examination. To evaluate the effect of TBL on student performance we compared the departmental and NBME subject examination scores between the traditional and TBL curricula. We collected five years of data on student performance in TBL-based anatomy and lecture-based preclinical courses. Our results show that departmental and NBME subject examination scores for TBL-based anatomy were higher than those for lecture-based anatomy. We subsequently compared average NBME scores for anatomy with those in other preclinical courses that were lecture-based. Average NBME anatomy scores were significantly higher than those for all the lecture-based preclinical courses. Since the introduction of TBL in anatomy, student performance has progressively improved in the NBME subject examination. Students perceived TBL as a motivator to be a responsible team member and to contribute to collective learning by the team. Further, it reinforced self-directed learning and fostered an appreciation for peer respect. Interestingly, these perceptions were uniform irrespective of student course performance.     

The role of dynamic spatial ability in geoscience text comprehension

The current experiment investigated the effects of a dynamic spatial ability on comprehension of a geoscience text on plate tectonics and the causes of volcanic activity. 162 undergraduates (54% female) from a large public university who had little prior knowledge of this science content area were asked to learn about plate tectonics. Measures of spatial ability and working memory capacity were used to predict comprehension from a text that contained either no images, static images, or animated versions of the static images. Only the dynamic spatial ability measure interacted with the type of illustrations contained in the text, and was shown to be especially relevant for comprehension when readers did not receive animations. These results demonstrate a novel influence of individual differences in dynamic spatial ability on comprehension of text describing dynamic spatial phenomena.     

Reflections as near‐peer facilitators of an inquiry project for undergraduate anatomy: Successes and challenges from a term of trial‐and‐error

Near‐peer facilitators (senior students serving as facilitators to their more junior peers) bring a unique student‐based perspective to teaching. With fewer years of teaching experience however, students who become involved in a facilitator role typically develop related skills quickly through a process of trial‐and‐error within the classroom. The aim of this paper is to report on the authors' own experiences and reflections as student near‐peer facilitators for an inquiry‐based project in an undergraduate anatomy course. Three areas of the facilitator experience are explored: (1) offering adequate guidance as facilitators of inquiry, (2) motivating students to engage in the inquiry process, and (3) fostering creativity in learning. A practical framework for providing guidance to students is discussed which offers facilitators a scaffold for asking questions and assisting students through the inquiry process. Considerations for stimulating intrinsic motivations toward inquiry learning are made, paying attention to ways in which facilitators might influence feelings of motivation towards learning. Also, the role of creativity in inquiry learning is explored by highlighting the actions facilitators can take to foster a creative learning environment. Finally, recommendations are made for the development of formalized training programs that aid near‐peer facilitators in the acquisition of facilitation skills before entering into a process of trial‐and‐error within the classroom. Anat Sci Educ. 7: 64–70. © 2013 American Association of Anatomists.     

The role of spatial ability in mixed reality learning with the HoloLens

The use of mixed reality in science education has been increasing and as such it has become more important to understand how information is learned in these virtual environments. Spatial ability is important in many learning contexts, but especially in neuroanatomy education where learning the locations and spatial relationships between brain regions is paramount. It is currently unclear what role spatial ability plays in mixed reality learning environments, and whether it is different compared to traditional physical environments. To test this, a learning experiment was conducted where students learned neuroanatomy using both mixed reality and a physical plastic model of a brain (N = 27). Spatial ability was assessed and analyzed to determine its effect on performance across the two learning modalities. The results showed that spatial ability facilitated learning in mixed reality (β = 0.21, P = 0.003), but not when using a plastic model (β = 0.08, P = 0.318). A non-significant difference was observed between the modalities in terms of knowledge test performance (d = 0.39, P = 0.052); however, mixed reality was more engaging (d = 0.59, P = 0.005) and learners were more confident in the information they learned compared to using a physical model (d = 0.56, P = 0.007). Overall, these findings suggest that spatial ability is more relevant in virtual learning environments, where the ability to manipulate and interact with an object is diminished or abstracted through a virtual user interface.