Abstract
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.
Highlights
Anatomical knowledge among undergraduate medical students and recently graduated doctors has repeatedly been reported to be insufficient (McKeown et al, 2003; Prince et al, 2005; Spielmann and Oliver, 2005; Waterston and Stewart, 2005; Bergman et al, 2008)
One of the main reasons is the decrease in anatomy teaching time in undergraduate education, related to increasing costs and limited availability of cadavers, and time pressure on the curriculum, have led to a decreased exposure to traditional cadaveric dissections (Pryde and Black, 2005; Waterston and Stewart, 2005; Azer and Eizenberg, 2007; Drake et al, 2009; Bergman et al, 2013)
A considerable number of studies have evaluated the effectiveness of digital 3D anatomical models which can be explored on a two-dimensional (2D) screen of a regular computer, smartphone or tablet
Summary
Anatomical knowledge among undergraduate medical students and recently graduated doctors has repeatedly been reported to be insufficient (McKeown et al, 2003; Prince et al, 2005; Spielmann and Oliver, 2005; Waterston and Stewart, 2005; Bergman et al, 2008). The educational value is being debated (Azer and Eizenberg, 2007), cadaveric dissections provide a complete visual and tactile learning experience of anatomy which is three-dimensional (3D) by nature Features such as stereopsis (visual sense of depth), dynamic exploration (the possibility to view the object of study from different angles), and haptic feedback (sense of touch) are crucial for the engagement in 3D anatomy (Klatzky and Lederman, 2011; Reid et al, 2018). For the purpose of this study an augmented reality application DynamicAnatomy was Anatomical Sciences Education September/October 2020559 developed at the department of Anatomy and Embryology at Leiden University Medical Center and the Centre for Innovation of Leiden University This application provides a dynamic stereoscopic 3D view on the lower limb including the musculoskeletal anatomy. Further specification of the application is provided in the Methods section
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