An Alternative Method for Anatomy Training: Immersive Virtual Reality

The aim of this study was to investigate the effect of immersive three-dimensional (3D) interactive virtual reality (VR) on anatomy training in undergraduate physical therapy students. A total of 72 students were included in the study. The students were randomized into control (n = 36) and VR (n = 36) group according to the Kolb Learning Style Inventory, sex, and Purdue Spatial Visualization Test Rotations (PSVT-R). Each student completed a pre-intervention and post-intervention test, consisting of 15 multiple-choice questions. There was no significant difference between the two groups in terms of age, sex, Kolb Learning Style Inventory distribution, and the PSVT-R (P > 0.05). The post-test scores were significantly higher compared to pre-test scores in both the VR group (P < 0.001) and the control group (P < 0.001). The difference between the pre-test and post-test results was found to be significantly higher in favor of the VR group (P < 0.001). In this study, anatomy training with a 3D immersive VR system was found to be beneficial. These results suggest that VR systems can be used as an alternative method to the conventional anatomy training approach for health students.     

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.     

Dissection versus Prosection: A Comparative Assessment of the Course Experiences,Approaches to Learning,and Academic Performance of Non-medical Undergraduate Students in Human Anatomy

Many institutions rely upon prosection-based laboratories as more resource-efficient and time-effective alternatives to traditional cadaver dissection for human anatomy education. To facilitate growing enrollment numbers despite resource limitations, the University of Guelph (a non-medical institution) introduced a modified “stepwise” prosection-based laboratory cohort to supplement a dissection-based course. In this design, all students attended the same lectures, but those in the dissection-based cohort learned by performing regional dissections and students in the prosection-based cohort studied from those dissections. Prosection students thereby witnessed a “slow reveal” of structures throughout the course. This study compared the perceived course experiences, student approaches to learning, and academic performance between the two groups. Multiple linear regression analyses were used to isolate the effect of the laboratory environment on student approaches to learning and academic performance from demographic and situational covariates. Both groups reported positive course experience ratings and high average final grades that were not statistically dissimilar (P > 0.05), increased reliance on deep approaches to learning (P = 0.002), and decreased reliance on surface approaches to learning (P = 0.023). When controlling for covariates, participation in dissection had small but statistically significant positive associations with deep approaches to learning (P = 0.043), performance on laboratory oral assessments (P < 0.001), and average final grades (P = 0.039). Ultimately, both designs promoted meaningful learning and desirable performance outcomes, indicating that both dissection and stepwise prosection have the potential to facilitate high quality human anatomy instruction.     

Cadaveric Dissection in Relation to Problem-Based Learning Case Sequencing: A Report of Medical Student Musculoskeletal Examination Performances and Self-Confidence

Mercer University School of Medicine utilizes a problem-based learning (PBL) curriculum for educating medical students in the basic clinical sciences. In 2014, an adjustment was piloted that enabled PBL cases to align with their corresponding cadaver dissection that reviewed the content of anatomy contained in the PBL cases. Faculty had the option of giving PBL cases in sequence with the cadaveric dissection schedule (sequential group) or maintaining PBL cases out of sequence with dissections (traditional group). During this adjustment, students’ academic performances were compared. Students’ perception of their own preparedness for cadaveric dissection, their perceived utility of the cadaver dissections, and free-response comments were solicited via an online survey. There were no statistically significant differences when comparing student mean examination score values between the sequential and traditional groups on both multidisciplinary examinations (79.39 ± 7.63 vs. 79.88 ± 7.31, P = 0.738) and gross anatomy questions alone (78.15 ± 10.31 vs. 79.98 ± 9.31, P = 0.314). A statistically significant difference was found between the sequential group's and traditional group's (63% vs. 29%; P = 0.005) self-perceived preparedness for cadaveric dissections in the 2017 class. Analysis of free-response comments found that students in the traditional group believed their performance in PBL group, participation in PBL group and examination performance was adversely affected when compared to students with the sequential schedule. This study provides evidence that cadaveric dissections scheduled in sequence with PBL cases can lead to increased student self-confidence with learning anatomy but may not lead to improved examination scores.     

An Analysis of Anatomy Education Before and During Covid-19: May–August 2020

Coronavirus disease 2019 (Covid-19) created unparalleled challenges to anatomy education. Gross anatomy education has been particularly impacted given the traditional in-person format of didactic instruction and/or laboratory component(s). To assess the changes in gross anatomy lecture and laboratory instruction, assessment, and teaching resources utilized as a result of Covid-19, a survey was distributed to gross anatomy educators through professional associations and listservs. Of the 67 survey responses received for the May–August 2020 academic period, 84% were from United States (US) institutions, while 16% were internationally based. Respondents indicated that in-person lecture decreased during Covid-19 (before: 76%, during: 8%, P < 0.001) and use of cadaver materials declined (before: 76 ± 33%, during: 34 ± 43%, P < 0.001). The use of cadaver materials in laboratories decreased during Covid-19 across academic programs, stand-alone and integrated anatomy courses, and private and public institutions (P ≤ 0.004). Before Covid-19, cadaveric materials used in laboratories were greater among professional health programs relative to medical and undergraduate programs (P ≤ 0.03) and among stand-alone relative to integrated anatomy courses (P ≤ 0.03). Furthermore, computer-based assessment increased (P < 0.001) and assessment materials changed from cadaveric material to images (P < 0.03) during Covid-19, even though assessment structure was not different (P > 0.05). The use of digital teaching resources increased during Covid-19 (P < 0.001), with reports of increased use of in-house created content, BlueLink, and Complete Anatomy software (P < 0.05). While primarily representing US institutions, this study provided evidence of how anatomy educators adapted their courses, largely through virtual mediums, and modified laboratory protocols during the initial emergence of the Covid-19 pandemic.     

The Use of Anatomical Dissection Videos in Medical Education

Dissection videos are commonly utilized in gross anatomy courses; however, the actual usage of such videos, as well as the academic impact of student use of these videos, is largely unknown. Understanding how dissection videos impact learning is important in making curricular decisions. In this study, 22 dissection videos were created to review structures identified in laboratory sessions throughout the Organ Systems 1 (OS1), 2 (OS2), and 3 (OS3) courses. Dissection videos were provided to 201 first-year medical students, and viewing data were recorded. Demographic data for age and gender identity were also collected from students. Overall, there was a significant decrease in total views (P = 0.001), the number of students who pressed play (P < 0.001), and the number of students who viewed ≥ 90% of the total length of videos (P < 0.001) from OS1 to OS3. The total adjusted time spent viewing videos was not significantly different between individual OS courses. There were some instances where significant differences existed in examination performance between those who did and did not view videos, and by time spent viewing videos. There were no significant differences in time spent viewing videos by gender. Together these data suggest that students may utilize dissection videos more at the beginning of a dissection course, although they remain an important resource throughout the year for a subset of students.     

Examining the Motivation of Health Profession Students to Study Human Anatomy

Students' motivation is a vital determinant of academic performance that is influenced by the learning environment. This study aimed to assess and analyze the motivation subscales between different cohorts (chiropractic, dental, medical) of anatomy students (n = 251) and to investigate if these subscales had an effect on the students' anatomy performance. A 31-item survey, the Motivated Strategies for Learning Questionnaire was utilized, covering items on intrinsic and extrinsic goal orientation, task value, control of learning belief, self-efficiency for learning and performance, and test anxiety. First-year dental students were significantly more anxious than chiropractic students. Second-year chiropractic students attached more value to anatomy education than second-year medical students. The outcome of this research demonstrated a significant relationship between first- and second-year chiropractic students between anatomy performance and motivation subscales controlling for gender such as self-efficacy for learning and performance was (β = 8, CI: 5.18–10.8, P < 0.001) and (β = 6.25, CI: 3.40–9.10, P < 0.001) for first year and second year, respectively. With regards to intrinsic goal orientation, it was (β = 4.02, CI: 1.19–6.86, P = 0.006) and (β = 5.38, CI: 2.32–8.44, P = 0.001) for first year and second year, respectively. For the control of learning beliefs, it was (β = 3.71, 95% CI: 0.18–7.25, P = 0.04) and (β = 3.07, CI: 0.03–6.12, P = 0.048) for first year and second year, respectively. Interventions aimed at improving these motivation subscales in students could boost their anatomy performance.     

The Effectiveness of an Augmented Reality Head-Mounted Display in Learning Skull Anatomy at a Community College

Despite an increase in the use of technology in undergraduate anatomy education, and the rising popularity of online anatomy courses at community colleges in the United States, there have been no reports on the efficacy of augmented reality on anatomy education in this population. The purpose of this study was to test the hypothesis that augmented reality is an effective and engaging tool for learning anatomy in community college students. Participants recruited from Cuyahoga Community College (Cleveland, OH) studied skull anatomy using either traditional tools (i.e., textbook and plastic skull model) or an augmented reality head-mounted display with an interactive virtual skull application. Comparison of knowledge before and following the study period revealed that augmented reality was an effective tool for learning skull anatomy: pre-quiz = 32.7% (± 25.2); mean (± SD), post-quiz = 61.8% (± 19.5); n = 15; t₍₂₈₎ = 3.53; P = 0.001. The traditional tools were equally effective: pre-quiz = 44.9 % (± 18.6), post-quiz = 67.9 % (± 17.3); n = 17; t₍₃₂₎ = 3.73; P = 0.0007. Students rated the augmented reality device as 9.6 (± 1.0); mean (± SD) when asked if it fit the statement “fun to use” on a semantic differential scale from 1 (poor) to 10 (excellent). In conclusion, this study found that augmented reality is an effective and engaging tool for the instruction of skull anatomy at a community college.     

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.     

Does an Audiovisual Dissection Manual Improve Medical Students' Learning in the Gross Anatomy Dissection Course?

The gross anatomy dissection course is considered to be one of the most important subjects in medical school. Advancing technology facilitates the production of e-learning material that can improve the learning of topographic anatomy during the course. The purpose of this study was to examine a locally produced audiovisual dissection manual's effects on performance in dissection, formal knowledge gained, motivation, emotions, learning behavior, and learning efficiency of the medical students. The results, combined with the total effort put into the production of the manual, should support decisions on further implementation of this kind of audiovisual e-learning resource into the university's curriculum. First-year medical students (n = 279) were randomly divided into three groups for two weeks within the regular dissection course hours during the dissection of the anterior and posterior triangles of the neck. Two groups received an audiovisual dissection manual (n = 96) or an improved written manual (n = 94) as an intervention, the control group (n = 89) received the standard dissection manual. After dissection, each student filled out tests and surveys and their dissections were evaluated. The audiovisual dissection manual did not have any significant positive effects on the examined parameters. The effects of the audiovisual dissection manual on the medical students' learning experience, as observed in this study, did not support further curriculum implementation of this kind of e-learning resource. This study can serve as an orientation for further evaluation and design of e-learning resources for the gross anatomy dissection course.     

Enhancement of Anatomical Education Using Augmented Reality: An Empirical Study of Body Painting

Students in undergraduate premedical anatomy courses may experience suboptimal and superficial learning experiences due to large class sizes, passive lecture styles, and difficult-to-master concepts. This study introduces an innovative, hands-on activity for human musculoskeletal system education with the aim of improving students’ level of engagement and knowledge retention. In this study, a collaborative learning intervention using the REFLECT (augmented reality for learning clinical anatomy) system is presented. The system uses the augmented reality magic mirror paradigm to superimpose anatomical visualizations over the user’s body in a large display, creating the impression that she sees the relevant anatomic illustrations inside her own body. The efficacy of this proposed system was evaluated in a large-scale controlled study, using a team-based muscle painting activity among undergraduate premedical students (n = 288) at the Johns Hopkins University. The baseline knowledge and post-intervention knowledge of the students were measured before and after the painting activity according to their assigned groups in the study. The results from knowledge tests and additional collected data demonstrate that the proposed interactive system enhanced learning of the musculoskeletal system with improved knowledge retention (F_(10,133) = 3.14, P < 0.001), increased time on task (F_(1,275) = 5.70, P < 0.01), and a high level of engagement (F_(9,273) = 8.28, P < 0.0001). The proposed REFLECT system will be of benefit as a complementary anatomy learning tool for students.     

Does spatial awareness training affect anatomy learning in medical students?

Spatial ability (SA) is the cognitive capacity to understand and mentally manipulate concepts of objects, remembering relationships among their parts and those of their surroundings. Spatial ability provides a learning advantage in science and may be useful in anatomy and technical skills in health care. This study aimed to assess the relationship between SA and anatomy scores in first- and second-year medical students. The training sessions focused on the analysis of the spatial component of objects' structure and their interaction as applied to medicine; SA was tested using the Visualization of Rotation (ROT) test. The intervention group (n = 29) received training and their pre- and post-training scores for the SA tests were compared to a control group (n = 75). Both groups improved their mean scores in the follow-up SA test (P < 0.010). There was no significant difference in SA scores between the groups for either SA test (P = 0.31, P = 0.90). The SA scores for female students were significantly lower than for male students, both at baseline and follow-up (P < 0.010). Anatomy training and assessment were administered by the anatomy department of the medical school, and examination scores were not significantly different between the two groups post-intervention (P = 0.33). However, participants with scores in the bottom quartile for SA performed worse in the anatomy questions (P < 0.001). Spatial awareness training did not improve SA or anatomy scores; however, SA may identify students who may benefit from additional academic support.     

Sharps Injuries during Dissection: A Five-Year Retrospective Study in the Context of Safety

The supplementation of lecture-based anatomy teaching with laboratory sessions, involving dissection or anatomical specimens, is commonly used. Hands-on dissection allows students to handle instruments correctly while actively exploring three-dimensional anatomy. However, dissection carries a potential risk of sharps and splash injuries. The aim of this study was to quantify the frequency rate of such cases per 1,000 student-hours of dissection and identify potential factors than might influence safety in anatomy laboratories. Data were retrospectively collected from September 2013 to June 2018 at the University of St Andrews, Scotland, UK. Overall, 35 sharps injuries were recorded in undergraduate medical students, with a frequency rate of 0.384 and no splash cases. A statistically significant, moderate negative association between year of study and frequency rate (rho₍₂₅₎ = −0.663; P < 0.001) was noted. A statistically significant difference in the frequency rate between different semester modules (χ²₍₄₎ = 13.577, P = 0.009) was observed with the difference being between Year 1 Semester 2 and Year 3 Semester 1 (P = 0.004). The decreasing trend with advancing year of study might be linked to increasing dissecting experience or the surface area of the region dissected. The following factors might have contributed to increased safety influencing frequency rates: single-handed blade removal systems; mandatory personal protective equipment; and having only one student dissecting at a given time. The authors propose that safety familiarization alongside standardized training and safety measures, as part of an evidence-based culture shift, will instill safety conscious behaviors and reduce injuries in anatomy laboratories.     

Effects of Alternating Dissection with Peer Teaching and Faculty Prosected Cadaver Demonstrations in a Physical Therapy and Occupational Therapy Gross Anatomy Course

The most effective method to teach gross anatomy is largely unknown. This study examined two teaching methods utilized in a physical therapy and occupational therapy gross anatomy course, (1) alternating dissection with peer teaching every other laboratory session and (2) faculty demonstrations during laboratory sessions. Student (n = 57) subgroup (A or B) academic performance was determined using written, laboratory practical, and palpation practical examinations. Subgroup A performed significantly better on laboratory practical examination questions pertaining to dissected, in comparison to peer-taught structures (67.1% vs. 60.2%, P = 0.008). Subgroup B performed significantly better on laboratory practical examination questions pertaining to peer-taught, in comparison to dissected structures (64.1% vs. 57.9%, P = 0.001). When Subgroup A was compared to Subgroup B, there were no statistically significant differences on laboratory practical examination question types, whether the subgroup learned the structure through dissection or peer teaching. Based on within and between subgroup comparisons, faculty demonstrations had no effect on written, laboratory practical, or palpation practical examination scores. Although limited, data suggest that the student roles when alternating dissection with peer teaching every other laboratory session appear to be equally effective for learning gross anatomy. The benefits of this method include decreased student/faculty ratio in laboratory sessions and increased time for independent study. Faculty demonstrations during laboratory sessions do not seem to improve student academic performance.     

Narrated Dissection Videos and Peer-Mentoring to Enhance Anatomy Performance of Underrepresented Minority Students in Physical Therapy Education

Three-dimensional virtual technology (3DVT) educational tools and peer-tutoring have proven to be effective teaching strategies in improving student learning outcomes. The purpose of this study was threefold: (1) compare the anatomy academic performance between underrepresented minority (URM) and non-minority (non-URM) students, (2) compare the voluntary use of 3DVT dissection videos and peer-mentoring between these two cohorts, and (3) estimate the association between the use of these teaching strategies on anatomy examinations and course grades at a school of physical therapy. Three-dimensional virtual technology narrated dissection videos and peer-mentoring were made available to all students. Time accessing the video and attending peer-mentoring sessions was measured throughout the course for all students. Three practical and four written examinations and the final course grade were calculated. Numerous one-way ANOVAs were used to compare examination/course grades between student cohorts (URM and non-URM) and usage of the two educational strategies (3DVT and peer-mentoring). Multiple linear regressions were performed with teaching strategies as predictors and grades as outcomes. Underrepresented minority students demonstrated significantly lower practical examination scores (P = 0.04), lower final course grades (P = 0.01), and a greater use of mentorship hours (P = 0.001) compared to non-URM. The regression models with both predictors (3DVT and peer-mentoring) combined demonstrated the greatest association with grades for both URM and non-URM. For both groups of students, the association between predictors and practical examination scores, although fair, was not statistically significant. Peer-mentoring seems to be the most effective teaching strategy in helping URM students succeed in anatomy.     

Exploring the Utility and Student Perceptions of Synthetic Cadavers in an Undergraduate Human Anatomy Course

The synthetic cadaver is a high-fidelity model intended to replace or supplement other anatomy learning modalities. Academic attainment and student perceptions were examined in an undergraduate human anatomy course using a combination of plastic models and synthetic cadavers to learn lower body anatomy (“Experimental group”), compared to a Historical group who used only plastic models. Grades on an upper body test, for which both groups used only plastic models, were compared to ensure that no academic differences existed between groups (P = 0.7653). Students in the Experimental group performed better on the lower body test for which they used both plastic models and synthetic cadavers (median = 73.8% (95% CI: 72.0%-75.0%) compared to the Historical group (70.1% (95% CI: 68.3%-70.7%), P < 0.0001); however, less than half of students (49%) attributed this to the synthetic cadavers. Students' perception of laboratory resources (P < 0.0001) and learning experience (P < 0.0001) both improved with the addition of synthetic cadavers compared to using only plastic models, and 60% of students in the Experimental group agreed that the synthetic cadavers would be a key reason that they would choose that institution for undergraduate studies. This investigation showed improved student grades when plastic models and synthetic cadavers were combined, in addition to improved student perceptions of the learning experience. Results of the student questionnaires also suggested that although synthetic cadavers carry a notable up-front cost, they may be a useful recruitment tool for institutions.     

A Hands-On Organ-Slicing Activity to Teach the Cross-Sectional Anatomy

The presentation of pre-sliced specimens is a frequently used method in the laboratory teaching of cross-sectional anatomy. In the present study, a new teaching method based on a hands-on slicing activity was introduced into the teaching of brain, heart, and liver cross-sectional anatomy. A randomized, controlled trial was performed. A total of 182 third-year medical students were randomized into a control group taught with the prosection mode (pre-sliced organ viewing) and an experimental group taught with the dissection mode (hands-on organ slicing). These teaching methods were assessed by testing the students' knowledge of cross-sectional specimens and cross-sectional radiological images, and analyzing students' feedback. Using a specimen test on three organs (brain, heart, and liver), significant differences were observed in the mean scores of the control and experimental groups: for brain 59.6% (±14.2) vs. 70.1% (±15.5), (P < 0.001, Cohen's d = 0.17); for heart: 57.6% (±12.5) vs. 75.6% (±15.3), (P < 0.001, d = 0.30); and for liver: 60.4% (±14.5) vs. 81.7% (±14.2), (P < 0.001, d = 0.46). In a cross-sectional radiological image test, better performance was also found in the experimental group (P < 0.001). The mean scores of the control vs. experimental groups were as follows: for brain imaging 63.9% (±15.1) vs. 71.1% (±16.1); for heart imaging 64.7% (±14.5) vs. 75.2% (±15.5); and for liver imaging 61.1% (±15.5) vs. 81.2% (±14.6), respectively. The effect sizes (Cohen's d) were 0.05, 0.23, and 0.52, respectively. Students in the lower tertile benefited the most from the slicing experiences. Students' feedback was generally positive. Hands-on slicing activity can increase the effectiveness of anatomy teaching and increase students' ability to interpret radiological images.     

Cinematic Rendering in Anatomy: A Crossover Study Comparing a Novel 3D Reconstruction Technique to Conventional Computed Tomography

Integration of medical imaging into preclinical anatomy courses is already underway in many medical schools. However, interpretation of two-dimensional grayscale images is difficult and conventional volume rendering techniques provide only images of limited quality. In this regard, a more photorealistic visualization provided by Cinematic Rendering (CR) may be more suitable for anatomical education. A randomized, two-period crossover study was conducted from July to December 2018, at the University Hospital of Erlangen, Germany to compare CR and conventional computed tomography (CT) imaging for speed and comprehension of anatomy. Sixteen students were randomized into two assessment sequences. During each assessment period, participants had to answer 15 anatomy-related questions that were divided into three categories: parenchymal, musculoskeletal, and vascular anatomy. After a washout period of 14 days, assessments were crossed over to the respective second reconstruction technique. The mean interperiod differences for the time to answer differed significantly between the CR–CT sequence (−204.21 ± 156.0 seconds) and the CT–CR sequence (243.33 ± 113.83 seconds; P < 0.001). Overall time reduction by CR was 65.56%. Cinematic Rendering visualization of musculoskeletal and vascular anatomy was higher rated compared to CT visualization (P < 0.001 and P = 0.003), whereas CT visualization of parenchymal anatomy received a higher scoring than CR visualization (P < 0.001). No carryover effects were observed. A questionnaire revealed that students consider CR to be beneficial for medical education. These results suggest that CR has a potential to enhance knowledge acquisition and transfer from medical imaging data in medical education.     

Online Assessment of Applied Anatomy Knowledge: The Effect of Images on Medical Students' Performance

Anatomical examinations have been designed to assess topographical and/or applied knowledge of anatomy with or without the inclusion of visual resources such as cadaveric specimens or images, radiological images, and/or clinical photographs. Multimedia learning theories have advanced the understanding of how words and images are processed during learning. However, the evidence of the impact of including anatomical and radiological images within written assessments is sparse. This study investigates the impact of including images within clinically oriented single-best-answer questions on students' scores in a tailored online tool. Second-year medical students (n = 174) from six schools in the United Kingdom participated voluntarily in the examination, and 55 students provided free-text comments which were thematically analyzed. All questions were categorized as to whether their stimulus format was purely textual or included an associated image. The type (anatomical and radiological image) and deep structure of images (question referring to a bone or soft tissue on the image) were taken into consideration. Students scored significantly better on questions with images compared to questions without images (P < 0.001), and on questions referring to bones than to soft tissue (P < 0.001), but no difference was found in their performance on anatomical and radiological image questions. The coding highlighted areas of “test applicability” and “challenges faced by the students.” In conclusion, images are critical in medical practice for investigating a patient's anatomy, and this study sets out a way to understand the effects of images on students' performance and their views in commonly employed written assessments.