The effectiveness of virtual and augmented reality in health sciences and medical anatomy

Although cadavers constitute the gold standard for teaching anatomy to medical and health science students, there are substantial financial, ethical, and supervisory constraints on their use. In addition, although anatomy remains one of the fundamental areas of medical education, universities have decreased the hours allocated to teaching gross anatomy in favor of applied clinical work. The release of virtual (VR) and augmented reality (AR) devices allows learning to occur through hands‐on immersive experiences. The aim of this research was to assess whether learning structural anatomy utilizing VR or AR is as effective as tablet‐based (TB) applications, and whether these modes allowed enhanced student learning, engagement and performance. Participants (n = 59) were randomly allocated to one of the three learning modes: VR, AR, or TB and completed a lesson on skull anatomy, after which they completed an anatomical knowledge assessment. Student perceptions of each learning mode and any adverse effects experienced were recorded. No significant differences were found between mean assessment scores in VR, AR, or TB. During the lessons however, VR participants were more likely to exhibit adverse effects such as headaches (25% in VR P < 0.05), dizziness (40% in VR, P < 0.001), or blurred vision (35% in VR, P < 0.01). Both VR and AR are as valuable for teaching anatomy as tablet devices, but also promote intrinsic benefits such as increased learner immersion and engagement. These outcomes show great promise for the effective use of virtual and augmented reality as means to supplement lesson content in anatomical education. Anat Sci Educ 10: 549–559. © 2017 American Association of Anatomists.     

Virtual and Augmented Reality Enhancements to Medical and Science Student Physiology and Anatomy Test Performance: A Systematic Review and Meta-Analysis

Virtual and augmented reality have seen increasing employment for teaching within medical and health sciences programs. For disciplines such as physiology and anatomy, these technologies may disrupt the traditional modes of teaching and content delivery. The objective of this systematic review and meta-analysis is to evaluate the impact of virtual reality or augmented reality on knowledge acquisition for students studying preclinical physiology and anatomy. The protocol was submitted to Prospero and literature search undertaken in PubMed, Embase, ERIC, and other databases. Citations were reviewed and articles published in full assessing learning or knowledge acquisition in preclinical physiology and anatomy from virtual or augmented reality were included. Of the 919 records found, 58 eligible articles were reviewed in full-text, with 8 studies meeting full eligibility requirements. There was no significant difference in knowledge scores from combining the eight studies (626 participants), with the pooled difference being a non-significant increase of 2.9 percentage points (95% CI [−2.9; 8.6]). For the four studies comparing virtual reality to traditional teaching, the pooled treatment effect difference was 5.8 percentage points (95% CI [−4.1; 15.7]). For the five studies comparing augmented reality to traditional teaching, the pooled treatment effect difference was 0.07 (95% CI [−7.0; 7.2]). Upon review of the literature, it is apparent that educators could benefit from adopting assessment processes that evaluate three-dimensional spatial understanding as a priority in physiology and anatomy. The overall evidence suggests that although test performance is not significantly enhanced with either mode, both virtual and augmented reality are viable alternatives to traditional methods of education in health sciences and medical courses.     

Advantages and challenges associated with augmented reality for education: A systematic review of the literature

This study presents a systematic review of the literature on augmented reality (AR) used in educational settings. We consider factors such as publication year, learner type (e.g., K-12, higher education, and adult), technologies in AR, and the advantages and challenges of using AR in educational settings. The full range of SSCI journals was surveyed and a total of 68 research articles were selected for analysis. The findings reveal an increase in the number of AR studies during the last four years. The most reported advantage of AR is that it promotes enhanced learning achievement. Some noted challenges imposed by AR are usability issues and frequent technical problems. We found several other challenges and numerous advantages of AR usage, which are discussed in detail. In addition, current gaps in AR research and needs in the field are identified, and suggestions are offered for future research.     

A systematic review of immersive technology applications for medical practice and education - Trends,application areas,recipients, teaching contents,evaluation methods,and performance

Virtual reality (VR), augmented reality (AR), mixed reality (MR), and extended reality (XR) are examples of immersive technologies that have the potential to improve medical practice and education. As a result, they have recently sparked much research interest. However, there are few reviews related to the use of immersive technologies (including VR, AR, MR, and XR) in medical practice and education. Remarkably, six research questions related to the trends, application areas, recipients, teaching contents, evaluation methods, and performance remain unanswered. To this end, this study conducts a systematic review to analyse 128 articles from 2012 source papers, all of which are indexed in the Web of Science. The review results indicate that immersive technology is currently used primarily on surgery and anatomy-related subjects for doctors, medical students and interns. Furthermore, group experiments are the most commonly used data collection method. The results provide insights into the current research trends related to immersive technology applications for medical practice and education. They also serve as an essential reference for scholars in the medical practice and education contexts.     

Promoting more future-ready anatomy education after the Covid-19 pandemic: A scoping review

The coronavirus disease 2019 (Covid-19) pandemic caused an abrupt transition from face-to-face to online anatomy teaching, learning, and assessment. Although online education has ensured the continuity of anatomy education during the pandemic, its implementation has been challenging, and its effectiveness has been questioned. Therefore, literature pertinent to online anatomy education during the pandemic is crucial to explain Covid-19's disruptions to this field. Accordingly, this scoping review explored changes, disruptions, and gaps in anatomy teaching and assessment during Covid-19 using an enhanced version of Arksey and O′Malley's six-stage protocol. Five online databases were searched for articles that described changes and disruptions in anatomy education. Three independent researchers were involved in titles, abstracts, and full texts screening, while another four researchers were independently involved in data extraction, charting, and synthesis. This review revealed six themes: immediate strategic plans and actions, teaching and learning changes, online assessment practice, students' and educators' receptivity and adaptability, online learning and assessment effects, and future directions. It also revealed four gaps: non-future-ready curricula, learning obstacles, administrative and teaching challenges, and online education ethical issues. The results were reported in tabular and narrative forms, following the PRISMA Extension for Scoping Reviews (PRISMA-ScR guidelines). Understanding the evolution and gaps in anatomy education during the Covid-19 pandemic will help anatomists design future-ready, adaptable curricula.     

Evolving strategies in whirlwind mode: The changing face of anatomy education during Covid-19 pandemic

The Covid-19 pandemic stipulated adoption of unfamiliar strategies for delivering anatomy education in online mode. The factors which determine education strategies are variable across geographical regions. It was perceived that an overview of education strategies around the globe would be useful for anatomists. Hence this narrative review was undertaken to collate observations from different geographical regions pertaining to education strategies adopted during the pandemic. Data relevant to the topic of study were extracted from 12 articles that were selected from an initial pool of 317 articles based on search criteria set for the review. Subtle differences in core education strategies implied that baseline response from anatomists was similar across regions. It was evident that online digital tools were key elements of education strategies adopted by educators for delivering online anatomy classes across the globe. Interestingly, a considerable gap in terms of number and variety of online tools used for anatomy education (those requiring commercial purchase) was noted between economically developed and developing regions. This may have an impact on learning outcome for students and may even lead to variations in anatomical knowledge by regions. It was observed that offline human dissection sessions were incorporated into online practical classes in one region as positive cases showed a declining trend. This positive development is worth emulating elsewhere based on cautious assessment of prevailing situation. From a broad perspective timely introduction of education strategies ensured delivery of anatomy education during the pandemic and gave an evolved outlook to the fabric of anatomy education.     

Universal design for learning in anatomy education of healthcare students: A scoping review

There are concerns among healthcare practitioners about poor anatomical knowledge among recent healthcare graduates. Universal Design for Learning (UDL) is a framework developed to enhance students' experience of learning and help students to become motivated learners. This scoping review identified whether UDL has been utilized in third level healthcare education and if so, whether it had been used to enhance student motivation to study anatomy. Seven online databases were searched for studies reporting the use of UDL in the curricula of medical, dental, occupational therapy (OT) or speech and language therapy (SLT) programs. Studies were screened for eligibility with set inclusion criteria. Data were extracted and analyzed. Analysis revealed that UDL was not specifically mentioned in any of the studies thus there are no published studies on UDL being formally applied in healthcare education. However, the authors identified 33 publications that described teaching methods which aligned with UDL in anatomy curricula and a thematic analysis yielded four main themes relating to teaching strategies being employed. Universal design for learning was not mentioned specifically, indicating that educators may not be aware of the educational framework, although they appeared to be utilizing aspects of it in their teaching. The review revealed that there is a lack of research concerning the anatomy education of OT and SLT students. The role of UDL in enhancing motivation to learn anatomy in medical, dental, OT and SLT programs has yet to be explored.     

Neuroanatomy Learning: Augmented Reality vs. Cross-Sections

Neuroanatomy education is a challenging field which could benefit from modern innovations, such as augmented reality (AR) applications. This study investigates the differences on test scores, cognitive load, and motivation after neuroanatomy learning using AR applications or using cross-sections of the brain. Prior to two practical assignments, a pretest (extended matching questions, double-choice questions and a test on cross-sectional anatomy) and a mental rotation test (MRT) were completed. Sex and MRT scores were used to stratify students over the two groups. The two practical assignments were designed to study (1) general brain anatomy and (2) subcortical structures. Subsequently, participants completed a posttest similar to the pretest and a motivational questionnaire. Finally, a focus group interview was conducted to appraise participants’ perceptions. Medical and biomedical students (n = 31); 19 males (61.3%) and 12 females (38.7%), mean age 19.2 ± 1.7 years participated in this experiment. Students who worked with cross-sections (n = 16) showed significantly more improvement on test scores than students who worked with GreyMapp-AR (P = 0.035) (n = 15). Further analysis showed that this difference was primarily caused by significant improvement on the cross-sectional questions. Students in the cross-section group, moreover, experienced a significantly higher germane (P = 0.009) and extraneous cognitive load (P = 0.016) than students in the GreyMapp-AR group. No significant differences were found in motivational scores. To conclude, this study suggests that AR applications can play a role in future anatomy education as an add-on educational tool, especially in learning three-dimensional relations of anatomical structures.     

Evaluating the integration of body donor imaging into anatomical dissection using augmented reality

Augmented reality (AR) has recently been utilized as an integrative teaching tool in medical curricula given its ability to view virtual objects while interacting with the physical environment. The evidence for AR in medical training, however, is limited. For this reason, the purpose of this mixed method study was to evaluate the implementation of overlaying donor-specific diagnostic imaging (DSDI) onto corresponding body donors in a fourth-year, dissection-based, medical elective course entitled anatomy for surgeons (AFS). Students registered in AFS course were separated into groups, receiving either DSDI displayed on Microsoft HoloLens AR head-mounted display (n = 12) or DSDI displayed on iPad (n = 15). To test for the change in spatial ability, students completed an anatomical mental rotation test (AMRT) prior to and following the AFS course. Students also participated in a focus group discussion and completed a survey at the end of AFS, analyzed through thematic triangulation and an unpaired, Mann Whitney U test respectively, both addressing dissection experience, DSDI relevancy to dissection, and use of AR in anatomical education. Although statistically significant differences were not found when comparing student group AMRT scores, survey and discussion data suggest that the HoloLens had improved the students' understanding of, and their spatial orientation of, anatomical relationships. Trunk dissection quality grades were significantly higher with students using the HoloLens. Although students mentioned difficulties with HoloLens software, with faculty assistance, training, and enhanced software development, there is potential for this AR tool to contribute to improved dissection quality and an immersive learning experience.     

Development of a Virtual Three-Dimensional Assessment Scenario for Anatomical Education

In anatomical education three-dimensional (3D) visualization technology allows for active and stereoscopic exploration of anatomy and can easily be adopted into medical curricula along with traditional 3D teaching methods. However, most often knowledge is still assessed with two-dimensional (2D) paper-and-pencil tests. To address the growing misalignment between learning and assessment, this viewpoint commentary highlights the development of a virtual 3D assessment scenario and perspectives from students and teachers on the use of this assessment tool: a 10-minute session of anatomical knowledge assessment with real-time interaction between assessor and examinee, both wearing a HoloLens and sharing the same stereoscopic 3D augmented reality model. Additionally, recommendations for future directions, including implementation, validation, logistic challenges, and cost-effectiveness, are provided. Continued collaboration between developers, researchers, teachers, and students is critical to advancing these processes.     

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.     

Evaluation of an Augmented Reality Application for Learning Neuroanatomy in Psychology

Neuroanatomy is difficult for psychology students because of spatial visualization and the relationship among brain structures. Some technologies have been implemented to facilitate the learning of anatomy using three-dimensional (3D) visualization of anatomy contents. Augmented reality (AR) is a promising technology in this field. A mobile AR application to provide the visualization of morphological and functional information of the brain was developed. A sample of 67 students of neuropsychology completed tests for visuospatial ability, anatomical knowledge, learning goals, and experience with technologies. Subsequently, they performed a learning activity using one of the visualization methods considered: a 3D method using the AR application and a two-dimensional (2D) method using a textbook to color, followed by questions concerning their satisfaction and knowledge. After using the alternative method, the students expressed their preference. The two methods improved knowledge equally, but the 3D method obtained higher satisfaction scores and was more preferred by students. The 3D method was also more preferred by the students who used this method during the activity. After controlling for the method used in the activity, associations were found between the preference of the 3D method because of its usability and experience with technologies. These results found that the AR application was highly valued by students to learn and was as effective as the textbook for this purpose.     

The Effectiveness of Collaborative Augmented Reality in Gross Anatomy Teaching: A Quantitative and Qualitative Pilot Study

In the context of gross anatomy education, novel augmented reality (AR) systems have the potential to serve as complementary pedagogical tools and facilitate interactive, student-centered learning. However, there is a lack of AR systems that enable multiple students to engage in collaborative, team-based learning environments. This article presents the results of a pilot study in which first-year medical students (n = 16) had the opportunity to work with such a collaborative AR system during a full-day gross anatomy seminar. Student performance in an anatomy knowledge test, conducted after an extensive group learning session, increased significantly compared to a pre-test in both the experimental group working with the collaborative AR system (P < 0.01) and in the control group working with traditional anatomy atlases and three-dimensional (3D) models (P < 0.01). However, no significant differences were found between the test results of both groups. While the experienced mental effort during the collaborative learning session was considered rather high (5.13 ± 2.45 on a seven-point Likert scale), both qualitative and quantitative feedback during a survey as well as the results of a System Usability Scale (SUS) questionnaire (80.00 ± 13.90) outlined the potential of the collaborative AR system for increasing students' 3D understanding of topographic anatomy and its advantages over comparable AR systems for single-user experiences. Overall, these outcomes show that collaborative AR systems such as the one evaluated within this work stimulate interactive, student-centered learning in teams and have the potential to become an integral part of a modern, multi-modal anatomy curriculum.     

Spatial Abilities Training in Anatomy Education: A Systematic Review

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

The Benefits of an Augmented Reality Magic Mirror System for Integrated Radiology Teaching in Gross Anatomy

Early exposure to radiological cross-section images during introductory anatomy and dissection courses increases students’ understanding of both anatomy and radiology. Novel technologies such as augmented reality (AR) offer unique advantages for an interactive and hands-on integration with the student at the center of the learning experience. In this article, the benefits of a previously proposed AR Magic Mirror system are compared to the Anatomage, a virtual dissection table as a system for combined anatomy and radiology teaching during a two-semester gross anatomy course with 749 first-year medical students, as well as a follow-up elective course with 72 students. During the former, students worked with both systems in dedicated tutorial sessions which accompanied the anatomy lectures and provided survey-based feedback. In the elective course, participants were assigned to three groups and underwent a self-directed learning session using either Anatomage, Magic Mirror, or traditional radiology atlases. A pre- and posttest design with multiple choice questions revealed significant improvements in test scores between the two tests for both the Magic Mirror and the group using radiology atlases, while no significant differences in test scores were recorded for the Anatomage group. Furthermore, especially students with low mental rotation test (MRT) scores benefited from the Magic Mirror and Anatomage and achieved significantly higher posttest scores compared to students with a low MRT score in the theory group. Overall, the results provide supporting evidence that the Magic Mirror system achieves comparable results in terms of learning outcome to established anatomy learning tools such as Anatomage and radiology atlases.     

Spatial abilities and anatomy knowledge assessment: A systematic review

Anatomy knowledge has been found to include both spatial and non‐spatial components. However, no systematic evaluation of studies relating spatial abilities and anatomy knowledge has been undertaken. The objective of this study was to conduct a systematic review of the relationship between spatial abilities test and anatomy knowledge assessment. A literature search was done up to March 20, 2014 in Scopus and in several databases on the OvidSP and EBSCOhost platforms. Of the 556 citations obtained, 38 articles were identified and fully reviewed yielding 21 eligible articles and their quality were formally assessed. Non‐significant relationships were found between spatial abilities test and anatomy knowledge assessment using essays and non‐spatial multiple‐choice questions. Significant relationships were observed between spatial abilities test and anatomy knowledge assessment using practical examination, three‐dimensional synthesis from two‐dimensional views, drawing of views, and cross‐sections. Relationships between spatial abilities test and anatomy knowledge assessment using spatial multiple‐choice questions were unclear. The results of this systematic review provide evidence for spatial and non‐spatial methods of anatomy knowledge assessment. Anat Sci Educ 10: 235–241. © 2016 American Association of Anatomists.     

One year of anatomy teaching and learning in the outbreak: Has the Covid-19 pandemic marked the end of a century-old practice? A systematic review

At the end of 2019, the Covid-19 pandemic spread caused restrictions in business and social spheres. Higher education was also severely affected: universities and medical schools moved online to distance learning and laboratory facilities closed. Questions arise about the long-term effects of this pandemic on anatomical education. In this systematic review, the authors investigated whether or not anatomical educators were able to deliver anatomical knowledge during this pandemic. They also discuss the challenges that anatomical education has faced over the last year. The search strategy was conducted between July 2020 and July 2021. Two hundred and one records were identified, and a total of 79 studies were finally included. How best to deliver anatomy to students remains a moot point. In the last years, the advent of new technologies has raised the question of the possible overcoming of dissection as the main instrument in anatomical education. The Covid-19 pandemic further sharpened the debate. Remote learning enhanced the use of technologies other than cadaveric dissection to teach anatomy. Moreover, from the analyzed records it appears that both from students' perspective as well as teachers' there is a clear tear between those who endorse dissection and those who believe it could be easily overcome or at least integrated by virtual reality and online learning. The authors strongly believe that the best anatomy teaching practice requires the careful adaptation of resources and methods. Nevertheless, they support cadaveric dissection and hope that it will not be replaced entirely as a result of this pandemic.     

The Effect of Stereoscopic Augmented Reality Visualization on Learning Anatomy and the Modifying Effect of Visual-Spatial Abilities: A Double-Center Randomized Controlled Trial

Monoscopically projected three-dimensional (3D) visualization technology may have significant disadvantages for students with lower visual-spatial abilities despite its overall effectiveness in teaching anatomy. Previous research suggests that stereopsis may facilitate a better comprehension of anatomical knowledge. This study evaluated the educational effectiveness of stereoscopic augmented reality (AR) visualization and the modifying effect of visual-spatial abilities on learning. In a double-center randomized controlled trial, first- and second-year (bio)medical undergraduates studied lower limb anatomy with stereoscopic 3D AR model (n = 20), monoscopic 3D desktop model (n = 20), or two-dimensional (2D) anatomical atlas (n = 18). Visual-spatial abilities were tested with Mental Rotation Test (MRT), Paper Folding Test (PFT), and Mechanical Reasoning (MR) Test. Anatomical knowledge was assessed by the validated 30-item paper posttest. The overall posttest scores in the stereoscopic 3D AR group (47.8%) were similar to those in the monoscopic 3D desktop group (38.5%; P = 0.240) and the 2D anatomical atlas group (50.9%; P = 1.00). When stratified by visual-spatial abilities test scores, students with lower MRT scores achieved higher posttest scores in the stereoscopic 3D AR group (49.2%) as compared to the monoscopic 3D desktop group (33.4%; P = 0.015) and similar to the scores in the 2D group (46.4%; P = 0.99). Participants with higher MRT scores performed equally well in all conditions. It is instrumental to consider an aptitude–treatment interaction caused by visual-spatial abilities when designing research into 3D learning. Further research is needed to identify contributing features and the most effective way of introducing this technology into current educational programs.     

The Use of Augmented Reality Technology in Medical Specimen Museum Tours

Human anatomical specimen museums are commonly used by medical, nursing, and paramedical students. Through dissection and prosection, the specimens housed in these museums allow students to appreciate the complex relationships of organs and structures in more detail than textbooks could provide. However, it may be difficult for students, particularly novices, to identify the various parts of these anatomical structures without additional explanations from a docent or supplemental illustrations. Recently, augmented reality (AR) has been used in many museum exhibits to display virtual objects in videos captured from the real world. This technology can significantly enhance the learning experience. In this study, three AR-based support systems for tours in medical specimen museums were developed, and their usability and effectiveness for learning were examined. The first system was constructed using an AR marker. This system could display virtual label information for specimens by capturing AR markers using a tablet camera. Individual AR markers were required for all specimens, but their presence in and on the prosected specimens could also be obtrusive. The second system was developed to set the specimen image itself as an image marker, as most specimens were displayed in cross section. Visitors could then obtain the label information presented by AR without any markers intruding on the display or anatomical specimens. The third system was comprised of a head-mounted display combined with a natural click interface. The system could provide visitors with an environment for the natural manipulation of virtual objects with future scalability.