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Teaching anatomy to medical and health science students has traditionally depended on the standard methods of cadaver dissection and the use of textbooks. However, there are substantial costs and ethical constraints associated to the use of cadavers(1) . Furthermore, cadaver dissection is
time-consuming and requires close supervision from teachers, imposing further limitations on their continued applicability, particularly since universities have been reducing the number of hours allocated to anatomy courses to favour clinical practice(2) . And while dissection represents an effective resource for accurate understanding of the 3D anatomical structures and allows to “learn-
by-doing”, various areas of the human body such as skeletal and nervous systems are not trivial to teach on cadavers, and textbooks must be used alongside in order to be able to properly identify the anatomical structures. On the other hand, taught classes and textbooks are not as engaging, are densely packed with information, and are not ideally suited to display spatial information.
For these reasons, there is an increased need for alternative teaching methods and new tools that could combine the teaching content of textbooks with the spatial information of a real body, allowing the student to actively learn while exploring the human body. The opportunity to bring real experience to anatomy classes, while promoting active learning and student engagement, could be
achieved through extended realities such as augmented reality (AR) and virtual reality (VR). Efforts have been made in the last years to develop 3D anatomy models for VR and AR, while also assessing the effectiveness of these new methods. Looking at scientific databases, the search of the words “virtual reality” associated to “anatomy education” does not yield results 30 years before today,
while more than 600 results are shown from the early 90s, with more than half being published only in the last few years. A similar trend is observed for augmented reality in anatomy learning, overall showing that the interest in extended reality related to medical learning has indeed exceptionally increased in the last decade and it is still increasing. Indeed, the features of these new technologies may present some advantages over traditional methods.
Spatial information
3D computer graphics models and AR/VR allow students to visualize 3D structures that cannot be appreciated with the use of the 2D image textbooks or are even difficult to view during dissection, improving overall students’ spatial awareness and reducing the performance gap that exists between those who struggle to visualize spatial structures and those confident in their spatial ability.
VR/AR technologies may also assist overall comprehension by reducing the cognitive effort required when learning new anatomical contexts(3). Indeed, descriptions may be conveniently added to each anatomical structure as drop-down button menus, facilitating the learning without the hassle of juggling between books and 3D atlas/cadavers. Students that used VR simulators or 3D computer graphics models, for instance, achieved a higher test score compared to students who studied on textbooks(4,5) or performed as good as students who learnt during dissection(6), indicating that VR/AR technologies may be a good alternative to the traditional methods.
Improved student engagement and motivation
Independently from the score of the tests, students confirmed they felt more engaged and motivated when studying with VR/AR and thought that the learning experience was more enjoyable and useful (3,6,7). This may be in part due to the novelty of these technologies that creates inherent interest but that could however taper off once students get familiarized. At the same time, the
engaging nature of the VR/AR may speed up the learning process and achieve more permanent knowledge (8, 9), boosting students’ motivation and satisfaction.
Active learning
The engaging and interactive nature of the new technologies favor indeed the so-called active learning, which opposes to the traditional passive learning such as that of lecturing methods. This concept may be simplified by thinking that for many people it is easier to remember a route while actively driving, rather than as passenger. As such, active learning has been proved to increase students’ performance(10), enhancing memory, knowledge retention and critical thinking skill.
Accessibility and Students Empowering
Another advantage of extended reality and 3D-modelling software is the possibility of using them anytime, so that the learning is not limited to the time spent in the dissection room. Furthermore, VR/AR offer the opportunity for repetitive practice and students can receive instantaneous feedbacks. In this way, students are more empowered to learn at their own pace and focus on the
anatomical areas they need.
Translational skills
In addition, the use of these new technologies brings to the students the possibility to develop a new set of translational competencies not achieved with the traditional methods. These include digital transformation skill. Moreover, VR/AR promote collaboration between students and supports
development of inter-professional competencies that are critical for healthcare professionals. In this way, although commonly VR/AR medical training has been viewed as mainly a way to increase knowledge and practical skills, it also provides valuable scenarios to support work-related social skills.(11–13)
Limitations
Of note, there are potential limitations to the application of these technologies which include the initial costs of hardware and devices. Nevertheless, it could still represent a financial and ethical advantage with respect to cadavers.
Furthermore, it has been reported that some students experienced dizziness and nausea with prolonged use of VR 3, which could limit the use of this technology. However, improvements have constantly being made to reduce the cybersickness and it is very likely this will be overcome in the
near future.
Overall, research have documented that VR/AR devices work well with all students’ levels and could help students to learn anatomical relations in a more effective way, while enabling personalized, and self-directed learning. AR/VR technologies may be a viable addition to traditional anatomy education in this increasingly technological world, complementing the resources already available to students.
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3. Moro, C., Štromberga, Z., Raikos, A. & Stirling, A. The effectiveness of virtual and augmented reality in health sciences and medical anatomy. Anat Sci Educ 10, 549–559 (2017).
4. Maresky, H. S. et al. Virtual reality and cardiac anatomy: Exploring immersive three-dimensional cardiac imaging, a pilot study in undergraduate medical anatomy education. Clinical Anatomy 32, 238–243 (2019).
5. Mitrousias, V. et al. Anatomy learning from prosected cadaveric specimens versus three-dimensional software: A comparative study of upper limb anatomy. Annals of Anatomy 218, 156–164 (2018).
6. Chen, S. et al. Can virtual reality improve traditional anatomy education programmes? A mixed- methods study on the use of a 3D skull model. BMC Med Educ 20, (2020).
7. Stepan, K. et al. Immersive virtual reality as a teaching tool for neuroanatomy. Int Forum Allergy Rhinol 7, 1006–1013 (2017).
8. Küçük, S., Kapakin, S. & Göktaş, Y. Learning anatomy via mobile augmented reality: Effects on achievement and cognitive load. Anat Sci Educ 9, 411–421 (2016).
9. Bölek, K. A., de Jong, G. & Henssen, D. The effectiveness of the use of augmented reality in anatomy education: a systematic review and meta-analysis. Sci Rep 11, (2021).
10. Freeman, S. et al. Active learning increases student performance in science, engineering, and mathematics. Proc Natl Acad Sci U S A 111, 8410–8415 (2014).
11. Dhar, P., Rocks, T., Samarasinghe, R. M., Stephenson, G. & Smith, C. Augmented reality in medical education: students’ experiences and learning outcomes. Medical Education Online vol. 26 Preprint at https://doi.org/10.1080/10872981.2021.1953953 (2021).
12. Izard, S. G. et al. Virtual Reality as an Educational and Training Tool for Medicine. J Med Syst 42, (2018).
13. Cardoso, A., Alves, G. R., Restivo, T., IEEE Education Society & Institute of Electrical and Electronics Engineers. Proceedings of the 2020 IEEE Global Engineering Education Conference (EDUCON): 27-30 April 2020, Porto, Portugal.
