Anatomy Teaching,a “Model” Answer? Evaluating “Geoff”, a Painted Anatomical Horse,as a Tool for Enhancing Topographical Anatomy Learning

Development of new methods for anatomy teaching is increasingly important as we look to modernize and supplement traditional teaching methods. In this study, a life-sized equine model, “Geoff,” was painted with surface and deep anatomical structures with the aim of improving students’ ability to convert theoretical knowledge into improved topographical anatomy knowledge on the live horse. Third and fourth year veterinary medicine students (n = 45) were randomly allocated into experimental (used “Geoff”) and control (used textbook) groups. The efficacy of the model was evaluated through a structured oral exam using a live horse. Questionnaires gathered information on student confidence and enjoyment of the task. There was no significant difference in the performance of experimental and control groups either immediately (44±20% vs. 40±21%; P = 0.504) or 9 weeks after the learning intervention (55±17% vs. 55±20%; P = 0.980). There were however specific questions on which the experimental group performed better than controls, and for which gender effects were apparent. The students using “Geoff” showed a transient gain in confidence following the session (Likert scale 2.7 to 3.6) however the initial increase was no longer present at the second test. There was a significant influence of gender on confidence with greater confidence gains in females in the Experimental group. The students found the model to be extremely useful and both groups found the sessions enjoyable. The model will be of benefit as a complementary learning tool for students.     

Design and validation of a novel learning tool, the "Anato-Rug," for teaching equine topographical anatomy

Recognition of anatomical landmarks in live animals (and humans) is key for clinical practice, but students often find it difficult to translate knowledge from dissection‐based anatomy onto the live animal and struggle to acquire this vital skill. The purpose of this study was to create and evaluate the use of an equine anatomy rug (“Anato‐Rug”) depicting topographical anatomy and key areas of lung, heart, and gastrointestinal auscultation, which could be used together with a live horse to aid learning of “live animal” anatomy. Over the course of 2 weeks, 38 third year veterinary students were randomly allocated into an experimental group, revising topographical anatomy from the “Anato‐Rug,” or a control group, learning topographical anatomy from a textbook. Immediately post activity, both groups underwent a test on live anatomy knowledge and were retested 1 week later. Both groups then completed a questionnaire to ascertain their perceptions of their learning experiences. Results showed that the experimental groups scored significantly higher than the control group at the first testing session, experienced more enjoyment during the activity and gained more confidence in identifying anatomical landmarks than the control group. There was not a significant difference in scores between groups at the second testing session. The findings indicate that the anatomy rug is an effective learning tool that aids understanding, confidence, and enjoyment in learning equine thorax and abdominal anatomy; however it was not better than traditional methods with regards to longer term memory recall. Anat SciEduc. © 2012 American Association of Anatomists.     

Take away body parts! An investigation into the use of 3D‐printed anatomical models in undergraduate anatomy education

Understanding the three‐dimensional (3D) nature of the human form is imperative for effective medical practice and the emergence of 3D printing creates numerous opportunities to enhance aspects of medical and healthcare training. A recently deceased, un‐embalmed donor was scanned through high‐resolution computed tomography. The scan data underwent segmentation and post‐processing and a range of 3D‐printed anatomical models were produced. A four‐stage mixed‐methods study was conducted to evaluate the educational value of the models in a medical program. (1) A quantitative pre/post‐test to assess change in learner knowledge following 3D‐printed model usage in a small group tutorial; (2) student focus group (3) a qualitative student questionnaire regarding personal student model usage (4) teaching faculty evaluation. The use of 3D‐printed models in small‐group anatomy teaching session resulted in a significant increase in knowledge (P = 0.0001) when compared to didactic 2D‐image based teaching methods. Student focus groups yielded six key themes regarding the use of 3D‐printed anatomical models: model properties, teaching integration, resource integration, assessment, clinical imaging, and pathology and anatomical variation. Questionnaires detailed how students used the models in the home environment and integrated them with anatomical learning resources such as textbooks and anatomy lectures. In conclusion, 3D‐printed anatomical models can be successfully produced from the CT data set of a recently deceased donor. These models can be used in anatomy education as a teaching tool in their own right, as well as a method for augmenting the curriculum and complementing established learning modalities, such as dissection‐based teaching. Anat Sci Educ 11: 44–53. © 2017 American Association of Anatomists.     

Learning in Stereo: The Relationship Between Spatial Ability and 3D Digital Anatomy Models

Three-dimensional (3D) digital anatomical models show potential to demonstrate complex anatomical relationships; however, the literature is inconsistent as to whether they are effective in improving the anatomy performance, particularly for students with low spatial visualization ability (Vz). This study investigated the educational effectiveness of a 3D stereoscopic model of the pelvis, and the relationship between learning with 3D models and Vz. It was hypothesized that participants learning with a 3D pelvis model would outperform participants learning with a two-dimensional (2D) visualization or cadaveric specimen on a spatial anatomy test, particularly when comparing those with low Vz. Participants (n = 64) were stratified into three experimental groups, who each attended a learning session with either a 3D stereoscopic model (n = 21), 2D visualization (n = 21), or cadaveric specimen (n = 22) of the pelvis. Medical and pre-medical student participants completed a multiple-choice pre-test and post-test during their respective learning session, and a long-term retention (LTR) test 2 months later. Results showed no difference in anatomy test improvement or LTR performance between the experimental groups. A simple linear regression analysis showed that within the 3D group, participants with high Vz tended to retain more than those with low Vz on the LTR test (R² = 0.31, P = 0.01). The low Vz participants may be cognitively overloaded by the complex spatial cues from the 3D stereoscopic model. Results of this study should inform resource selection and curriculum design for health professional students, with attention to the impact of Vz on learning.     

Teaching bovine abdominal anatomy: Use of a haptic simulator

Traditional methods of teaching anatomy to undergraduate medical and veterinary students are being challenged and need to adapt to modern concerns and requirements. There is a move away from the use of cadavers to new technologies as a way of complementing the traditional approaches and addressing resource and ethical problems. Haptic (touch) technology, which allows the student to feel a 3D computer‐generated virtual environment, provides a novel way to address some of these challenges. To evaluate the practicalities and usefulness of a haptic simulator, first year veterinary students at the Royal Veterinary College, University of London, were taught basic bovine abdominal anatomy using a rectal palpation simulator: “The Haptic Cow.” Over two days, 186 students were taught in small groups and 184 provided feedback via a questionnaire. The results were positive; the majority of students considered that the simulator had been useful for appreciating both the feel and location of key internal anatomical structures, had helped with their understanding of bovine abdominal anatomy and 3D visualization, and the tutorial had been enjoyable. The students were mostly in favor of the small group tutorial format, but some requested more time on the simulator. The findings indicate that the haptic simulator is an engaging way of teaching bovine abdominal anatomy to a large number of students in an efficient manner without using cadavers, thereby addressing some of the current challenges in anatomy teaching. Anat Sci Educ 2: 280–285, 2009. © 2009 American Association of Anatomists     

How Can We Show You,If You Can't See It? Trialing the Use of an Interactive Three-Dimensional Micro-CT Model in Medical Education

Teaching internal structures obscured from direct view is a major challenge of anatomy education. High-fidelity interactive three-dimensional (3D) micro-computed tomography (CT) models with virtual dissection present a possible solution. However, their utility for teaching complex internal structures of the human body is unclear. The purpose of this study was to investigate the use of a realistic 3D micro-CT interactive visualization computer model to teach paranasal sinus anatomy in a laboratory setting during pre-clinical medical training. Year 1 (n = 79) and Year 2 (n = 59) medical students undertook self-directed activities focused on paranasal sinus anatomy in one of two laboratories (traditional laboratory and 3D model). All participants completed pre and posttests before and after the laboratory session. Results of regression analyses predicting post-laboratory knowledge indicate that, when students were inexperienced with the 3D computer technology, use of the model was detrimental to learning for students with greater prior knowledge of the relevant anatomy (P < 0.05). For participants experienced with the 3D computer technology, however, the use of the model was detrimental for students with less prior knowledge of the relevant anatomy (P < 0.001). These results emphasize that several factors need to be considered in the design and effective implementation of such models in the classroom. Under the right conditions, the 3D model is equal to traditional laboratory resources when used as a learning tool. This paper discusses the importance of preparatory training for students and the technical consideration necessary to successfully integrate such models into medical anatomical curricula.     

Production of accurate skeletal models of domestic animals using three‐dimensional scanning and printing technology

Access to adequate anatomical specimens can be an important aspect in learning the anatomy of domestic animals. In this study, the authors utilized a structured light scanner and fused deposition modeling (FDM) printer to produce highly accurate animal skeletal models. First, various components of the bovine skeleton, including the femur, the fifth rib, and the sixth cervical (C6) vertebra were used to produce digital models. These were then used to produce 1:1 scale physical models with the FDM printer. The anatomical features of the digital models and three‐dimensional (3D) printed models were then compared with those of the original skeletal specimens. The results of this study demonstrated that both digital and physical scale models of animal skeletal components could be rapidly produced using 3D printing technology. In terms of accuracy between models and original specimens, the standard deviations of the femur and the fifth rib measurements were 0.0351 and 0.0572, respectively. All of the features except the nutrient foramina on the original bone specimens could be identified in the digital and 3D printed models. Moreover, the 3D printed models could serve as a viable alternative to original bone specimens when used in anatomy education, as determined from student surveys. This study demonstrated an important example of reproducing bone models to be used in anatomy education and veterinary clinical training. Anat Sci Educ 11: 73–80. © 2017 American Association of Anatomists.     

Doing dissections differently: A structured,peer‐assisted learning approach to maximizing learning in dissections

Areas of difficulty faced by our veterinary medicine students, with respect to their learning in dissection classes, were identified. These challenges were both general adult‐learning related and specific to the discipline of anatomy. Our aim was to design, implement, and evaluate a modified reciprocal peer‐assisted/team‐based learning format—Doing Dissections Differently (DDD)—to complement existing dissection classes, with the intention of enhancing both student learning and the student learning experience. Second year veterinary medicine students (n = 193), in their usual dissection groups, were randomly assigned to one of four roles: anatomist, clinician, radiologist, and learning resources manager. Students attended a preparatory workshop outlining the skills required for effective execution of their role. They were then asked to perform their roles throughout five consecutive musculoskeletal dissection classes. Student attitudes to dissection classes before and after DDD were evaluated by questionnaire (146 respondents). There was a significant (P = 0.0001) improvement after DDD in a number of areas: increased perceived value of dissection classes as an anatomy learning aid; improved appreciation of the clinical relevance of anatomy; increased use of resources before and during dissection classes; and longer preparation time for dissection classes. Before DDD, 45% of students felt that at least one peer did not contribute usefully to the group during dissection classes; no improvement was seen in this measure after DDD. Although the new format highlighted a potential need to improve teamwork, most students actively engaged with DDD, with dissection classes valued more highly and utilized more effectively. © 2012 American Association of Anatomists.     

Web‐based interactive 3D visualization as a tool for improved anatomy learning

Despite a long tradition, conventional anatomy education based on dissection is declining. This study tested a new virtual reality (VR) technique for anatomy learning based on virtual contrast injection. The aim was to assess whether students value this new three‐dimensional (3D) visualization method as a learning tool and what value they gain from its use in reaching their anatomical learning objectives. Several 3D vascular VR models were created using an interactive segmentation tool based on the “virtual contrast injection” method. This method allows users, with relative ease, to convert computer tomography or magnetic resonance images into vivid 3D VR movies using the OsiriX software equipped with the CMIV CTA plug‐in. Once created using the segmentation tool, the image series were exported in Quick Time Virtual Reality (QTVR) format and integrated within a web framework of the Educational Virtual Anatomy (EVA) program. A total of nine QTVR movies were produced encompassing most of the major arteries of the body. These movies were supplemented with associated information, color keys, and notes. The results indicate that, in general, students' attitudes towards the EVA‐program were positive when compared with anatomy textbooks, but results were not the same with dissections. Additionally, knowledge tests suggest a potentially beneficial effect on learning. Anat Sci Ed 2:61–68, 2009. © 2009 American Association of Anatomists.     

Criss-cross heart three-dimensional printed models in medical education: A multicenter study on their value as a supporting tool to conventional imaging

The utility of three-dimensional (3D) printed models for medical education in complex congenital heart disease (CHD) is sparse and limited. The purpose of this study was to evaluate the utility of 3D printed models for medical education in criss-cross hearts covering a wide range of participants with different levels of knowledge and experience, from medical students, clinical fellows up to senior medical personnel. Study participants were enrolled from four dedicated imaging workshops developed between 2016 and 2019. The study design was a non-randomized cross-over study to evaluate 127 participants' level of understanding of the criss-cross heart anatomy. This was evaluated using the scores obtained following teaching with conventional images (echocardiography and magnetic resonance imaging) versus a 3D printed model learning approach. A significant improvement in anatomical knowledge of criss-cross heart anatomy was observed when comparing conventional imaging test scores to 3D printed model tests [76.9% (61.5%–87.8%) vs. 84.6% (76.9%–96.2%), P < 0.001]. The increase in the questionnaire marks was statistically significant across all academic groups (consultants in pediatric cardiology, fellows in pediatric cardiology, and medical students). Ninety-four percent (120) and 95.2% (121) of the participants agreed or strongly agreed, respectively, that 3D models helped them to better understand the medical images. Participants scored their overall satisfaction with the 3D printed models as 9.1 out of 10 points. In complex CHD such as criss-cross hearts, 3D printed replicas improve the understanding of cardiovascular anatomy. They enhanced the teaching experience especially when approaching medical students.     

“Applying anatomy to something I care about”: Authentic inquiry learning and student experiences of an inquiry project

Despite advances to move anatomy education away from its didactic history, there is a continued need for students to contextualize their studies to make learning more meaningful. This article investigates authentic learning in the context of an inquiry‐based approach to learning human gross anatomy. Utilizing a case‐study design with three groups of students (n = 18) and their facilitators (n = 3), methods of classroom observations, interviews, and artifact collection were utilized to investigate students' experiences of learning through an inquiry project. Qualitative data analysis through open and selective coding produced common meaningful themes of group and student experiences. Overall results demonstrate how the project served as a unique learning experience where learners engaged in the opportunity to make sense of anatomy in context of their interests and wider interdisciplinary considerations through collaborative, group‐based investigation. Results were further considered in context of theoretical frameworks of inquiry‐based and authentic learning. Results from this study demonstrate how students can engage anatomical understandings to inquire and apply disciplinary considerations to their personal lives and the world around them. Anat Sci Educ 10: 538–548. © 2017 American Association of Anatomists.     

Comparison of traditional methods with 3D computer models in the instruction of hepatobiliary anatomy

This study was designed to determine whether an interactive three-dimensional presentation depicting liver and biliary anatomy is more effective for teaching medical students than a traditional textbook format presentation of the same material. Forty-six medical students volunteered for participation in this study. Baseline demographic information, spatial ability, and knowledge of relevant anatomy were measured. Participants were randomized into two groups and presented with a computer-based interactive learning module comprised of animations and still images to highlight various anatomical structures (3D group), or a computer-based text document containing the same images and text without animation or interactive features (2D group). Following each teaching module, students completed a satisfaction survey and nine-item anatomic knowledge post-test. The 3D group scored higher on the post-test than the 2D group, with a mean score of 74% and 64%, respectively; however, when baseline differences in pretest scores were accounted for, this difference was not statistically significant (P = 0.33). Spatial ability did not statistically significantly correlate with post-test scores for the 3D group or the 2D group. In the post-test satisfaction survey the 3D group expressed a statistically significantly higher overall satisfaction rating compared to students in the 2D control group (4.5 versus 3.7 out of 5, P = 0.02). While the interactive 3D multimedia module received higher satisfaction ratings from students, it neither enhanced nor inhibited learning of complex hepatobiliary anatomy compared to an informationally equivalent traditional textbook style approach. .     

Virtual reality anatomy: Is it comparable with traditional methods in the teaching of human forearm musculoskeletal anatomy?

The use of cadavers to teach anatomy is well established, but limitations with this approach have led to the introduction of alternative teaching methods. One such method is the use of three-dimensional virtual reality computer models. An interactive, three-dimensional computer model of human forearm anterior compartment musculoskeletal anatomy was produced using the open source 3D imaging program "Blender." The aim was to evaluate the use of 3D virtual reality when compared with traditional anatomy teaching methods. Three groups were identified from the University of Manchester second year Human Anatomy Research Skills Module class: a "control" group (no prior knowledge of forearm anatomy), a "traditional methods" group (taught using dissection and textbooks), and a "model" group (taught solely using e-resource). The groups were assessed on anatomy of the forearm by a ten question practical examination. ANOVA analysis showed the model group mean test score to be significantly higher than the control group (mean 7.25 vs. 1.46, P < 0.001) and not significantly different to the traditional methods group (mean 6.87, P > 0.5). Feedback from all users of the e-resource was positive. Virtual reality anatomy learning can be used to compliment traditional teaching methods effectively.     

The cranial nerve skywalk: A 3D tutorial of cranial nerves in a virtual platform

Visualization of the complex courses of the cranial nerves by students in the health‐related professions is challenging through either diagrams in books or plastic models in the gross laboratory. Furthermore, dissection of the cranial nerves in the gross laboratory is an extremely meticulous task. Teaching and learning the cranial nerve pathways is difficult using two‐dimensional (2D) illustrations alone. Three‐dimensional (3D) models aid the teacher in describing intricate and complex anatomical structures and help students visualize them. The study of the cranial nerves can be supplemented with 3D, which permits the students to fully visualize their distribution within the craniofacial complex. This article describes the construction and usage of a virtual anatomy platform in Second Life?, which contains 3D models of the cranial nerves III, V, VII, and IX. The Cranial Nerve Skywalk features select cranial nerves and the associated autonomic pathways in an immersive online environment. This teaching supplement was introduced to groups of pre‐healthcare professional students in gross anatomy courses at both institutions and student feedback is included. Anat Sci Educ 7: 469–478. © 2014 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.     

The effect of image quality,repeated study,and assessment method on anatomy learning

The use of two‐dimensional (2D) images is consistently used to prepare anatomy students for handling real specimen. This study examined whether the quality of 2D images is a critical component in anatomy learning. The visual clarity and consistency of 2D anatomical images was systematically manipulated to produce low‐quality and high‐quality images of the human hand and human eye. On day 0, participants learned about each anatomical specimen from paper booklets using either low‐quality or high‐quality images, and then completed a comprehension test using either 2D images or three‐dimensional (3D) cadaveric specimens. On day 1, participants relearned each booklet, and on day 2 participants completed a final comprehension test using either 2D images or 3D cadaveric specimens. The effect of image quality on learning varied according to anatomical content, with high‐quality images having a greater effect on improving learning of hand anatomy than eye anatomy (high‐quality vs. low‐quality for hand anatomy P = 0.018; high‐quality vs. low‐quality for eye anatomy P = 0.247). Also, the benefit of high‐quality images on hand anatomy learning was restricted to performance on short‐answer (SA) questions immediately after learning (high‐quality vs. low‐quality on SA questions P = 0.018), but did not apply to performance on multiple‐choice (MC) questions (high‐quality vs. low‐quality on MC questions P = 0.109) or after participants had an additional learning opportunity (24 hours later) with anatomy content (high vs. low on SA questions P = 0.643). This study underscores the limited impact of image quality on anatomy learning, and questions whether investment in enhancing image quality of learning aids significantly promotes knowledge development. Anat Sci Educ 10: 249–261. © 2016 American Association of Anatomists.     

The Effects of a Functional Three-dimensional (3D) Printed Knee Joint Simulator in Improving Anatomical Spatial Knowledge

In recent decades, three-dimensional (3D) printing as an emerging technology, has been utilized for imparting human anatomy knowledge. However, most 3D printed models are rigid anatomical replicas that are unable to represent dynamic spatial relationships between different anatomical structures. In this study, the data obtained from a computed tomography (CT) scan of a normal knee joint were used to design and fabricate a functional knee joint simulator for anatomical education. Utility of the 3D printed simulator was evaluated in comparison with traditional didactic learning in first-year medical students (n = 35), so as to understand how the functional 3D simulator could assist in their learning of human anatomy. The outcome measure was a quiz comprising 11 multiple choice questions based on locking and unlocking of the knee joint. Students in the simulation group (mean score = 85.03%, ±SD 10.13%) performed significantly better than those in the didactic learning group, P < 0.05 (mean score = 70.71%, ±SD 15.13%), which was substantiated by large effect size, as shown by a Cohen’s d value of 1.14. In terms of learning outcome, female students who used 3D printed simulators as learning aids achieved greater improvement in their quiz scores as compared to male students in the same group. However, after correcting for the modality of instruction, the sex of the students did not have a significant influence on the learning outcome. This randomized study has demonstrated that the 3D printed simulator is beneficial for anatomical education and can help in enriching students’ learning experience.     

Virtual cerebral ventricular system: an MR-based three-dimensional computer model

The inherent spatial complexity of the human cerebral ventricular system, coupled with its deep position within the brain, poses a problem for conceptualizing its anatomy. Cadaveric dissection, while considered the gold standard of anatomical learning, may be inadequate for learning the anatomy of the cerebral ventricular system; even with intricate dissection, ventricular structures remain difficult to observe. Three-dimensional (3D) computer reconstruction of the ventricular system offers a solution to this problem. This study aims to create an accurate 3D computer reconstruction of the ventricular system with surrounding structures, including the brain and cerebellum, using commercially available 3D rendering software. Magnetic resonance imaging (MRI) scans of a male cadaver were segmented using both semiautomatic and manual tools. Segmentation involves separating voxels of different grayscale values to highlight specific neural structures. User controls enable adding or removing of structures, altering their opacity, and making cross-sectional slices through the model to highlight inner structures. Complex physiologic concepts, such as the flow of cerebrospinal fluid, are also shown using the 3D model of the ventricular system through a video animation. The model can be projected stereoscopically, to increase depth perception and to emphasize spatial relationships between anatomical structures. This model is suited for both self-directed learning and classroom teaching of the 3D anatomical structure and spatial orientation of the ventricles, their connections, and their relation to adjacent neural and skeletal structures.     

A novel patchwork model used in lecture and laboratory to teach the three‐dimensional organization of mesenteries

Anatomy teaching is seeing a decline in both lecture and laboratory hours across many medical schools in North America. New strategies are therefore needed to not only make anatomy teaching more clinically integrated, but also to implement new interactive teaching techniques to help students more efficiently grasp the complex organization of the human body. Among the difficult anatomical concepts that students struggle to understand, the anatomy of the peritoneal cavity with its complex projections of peritoneum could benefit strongly from new learning aids. In this report, an innovative teaching tool is presented to engage students during both lecture and laboratory, and help them build three‐dimensional (3D) mental maps of peritoneal cavity. The model consists of a patchwork of mesenteries and gut made from colored cloth stitched together onto a T‐shirt to denote the origin and outflow of each peritoneum projection. As the lecturer wears the life‐size model, the students can appreciate the 3D organization of the peritoneal cavity on a living body. In addition, the T‐shirt model can be used in parallel with dissection to ensure a strong reinforcement of the spatial understanding of the peritoneal cavity. Anat Sci Educ. © 2012 American Association of Anatomists.