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On the Added Benefit of Virtual Anatomy for Dissection-Based Skills

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Title: On the Added Benefit of Virtual Anatomy for Dissection-Based Skills
Language: English
Authors: Niedermair, Julian F. (ORCID 0000-0002-2321-7996), Antipova, Veronica, Manhal, Simone, Siwetz, Martin, Wimmer-Röll, Monika, Hammer, Niels, Fellner, Franz A. (ORCID 0000-0003-3009-4944)
Source: Anatomical Sciences Education. May-Jun 2023 16(3):439-451.
Availability: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
Peer Reviewed: Y
Page Count: 13
Publication Date: 2023
Document Type: Journal Articles
Reports - Research
Education Level: Higher Education
Postsecondary Education
Descriptors: Anatomy, Laboratory Procedures, Science Instruction, Visual Aids, Computer Simulation, Medical Students, Medical Education, Universities, Radiology, Diagnostic Tests, Pathology, Educational Benefits, Likert Scales, Student Attitudes, Student Improvement, Instructional Effectiveness, Scores, Preferences, Course Descriptions, Foreign Countries
Geographic Terms: Germany
DOI: 10.1002/ase.2234
ISSN: 1935-9772
1935-9780
Abstract: Technological approaches deploying three-dimensional visualization to integrate virtual anatomy are increasingly used to provide medical students with state-of-the-art teaching. It is unclear to date to which extent virtual anatomy may help replace the dissection course. Medical students of Johannes Kepler University attend both a dissection and a virtual anatomy course. This virtual anatomy course is based on Cinematic Rendering and radiological imaging and teaches anatomy and pathology. This study aims to substantiate student benefits achieved from this merged teaching approach. Following their dissection course, 120 second-year students took part in objective structured practical examinations (OSPE) conducted on human specimens prior to and following a course on Cinematic Rendering virtual anatomy. Likert-based and open-ended surveys were conducted to evaluate student perceptions of both courses and their utility. Virtual anatomy teaching was found to be unrelated to improvements in student's ability to identify anatomical structures in anatomical prosections, yielding only a 1.5% increase in the OSPE score. While the students rated the dissection course as being more important and impactful, the virtual anatomy course helped them display the learning content in a more comprehensible and clinically applicable way. It is likely that Cinematic Rendering-based virtual anatomy affects knowledge gain in domains other than the recognition of anatomical structures in anatomical prosections. These findings underline students' preference for the pedagogic strategy of the dissection course and for blending this classical approach with novel developments like Cinematic Rendering, thus preparing future doctors for their clinical work.
Abstractor: As Provided
Entry Date: 2023
Accession Number: EJ1376702
Database: ERIC
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  Value: <anid>AN0163604836;[8z8k]01may.23;2023May11.02:49;v2.2.500</anid> <title id="AN0163604836-1">On the added benefit of virtual anatomy for dissection‐based skills </title> <p>Technological approaches deploying three‐dimensional visualization to integrate virtual anatomy are increasingly used to provide medical students with state‐of‐the‐art teaching. It is unclear to date to which extent virtual anatomy may help replace the dissection course. Medical students of Johannes Kepler University attend both a dissection and a virtual anatomy course. This virtual anatomy course is based on Cinematic Rendering and radiological imaging and teaches anatomy and pathology. This study aims to substantiate student benefits achieved from this merged teaching approach. Following their dissection course, 120 second‐year students took part in objective structured practical examinations (OSPE) conducted on human specimens prior to and following a course on Cinematic Rendering virtual anatomy. Likert‐based and open‐ended surveys were conducted to evaluate student perceptions of both courses and their utility. Virtual anatomy teaching was found to be unrelated to improvements in student's ability to identify anatomical structures in anatomical prosections, yielding only a 1.5% increase in the OSPE score. While the students rated the dissection course as being more important and impactful, the virtual anatomy course helped them display the learning content in a more comprehensible and clinically applicable way. It is likely that Cinematic Rendering‐based virtual anatomy affects knowledge gain in domains other than the recognition of anatomical structures in anatomical prosections. These findings underline students' preference for the pedagogic strategy of the dissection course and for blending this classical approach with novel developments like Cinematic Rendering, thus preparing future doctors for their clinical work.</p> <p>Keywords: anatomy curriculum; anatomy teaching; Cinematic Rendering; dissection course; gross anatomy education; novel teaching modalities; radiology education; undergraduate education; virtual anatomy</p> <hd id="AN0163604836-2">INTRODUCTION</hd> <p>Anatomical dissection is a well‐established and highly effective tool to teach human anatomy.[[<reflink idref="bib1" id="ref1">1</reflink>]] Despite various new and emerging methods becoming available to teach anatomy, dissection has remained the most appreciated teaching tool among anatomists, especially for three‐dimensional (3D) understanding.[<reflink idref="bib3" id="ref2">3</reflink>] Recent studies confirm the importance of the dissection course as a mainstay in anatomical teaching.[[<reflink idref="bib4" id="ref3">4</reflink>]] A great benefit of dissection is that it integrates multiple senses to understand anatomical facts.[<reflink idref="bib6" id="ref4">6</reflink>] Further benefits students receive from anatomical dissection, include, but are not restricted to skill development, coping with stress, time management, learning strategies, and the ability to work in teams during the course.[<reflink idref="bib7" id="ref5">7</reflink>] In addition, it is a strategy that can assist learners in relating structure, function, and pathology.[<reflink idref="bib8" id="ref6">8</reflink>] During the global pandemic of Covid‐19 in 2020, in‐person teaching was largely restricted[<reflink idref="bib9" id="ref7">9</reflink>]; digital learning resources like voice‐over videos and web‐based training approaches, which were previously only used as additional learning material, became increasingly important as an attempt to replace anatomical dissection.[[<reflink idref="bib10" id="ref8">10</reflink>], [<reflink idref="bib12" id="ref9">12</reflink>]] Also, virtual 3D models became popular among many universities.[<reflink idref="bib13" id="ref10">13</reflink>] Although brought to the forefront by the pandemic, these techniques that enable distance learning, particularly for anatomy were already in existence; virtual anatomy is an umbrella term for teaching methods of gross (macroscopic) anatomy that are not based on anatomical specimens, atlases, or printed media such as books. This includes 3D visualization technologies and imaging methods such as plain radiography, ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and angiography.[<reflink idref="bib14" id="ref11">14</reflink>]</p> <p>According to previous studies, an effective method for teaching gross anatomy combines both radiology and classical anatomy teaching such as anatomical dissection of human post‐mortem tissues.[[<reflink idref="bib15" id="ref12">15</reflink>], [<reflink idref="bib17" id="ref13">17</reflink>]] Integrating radiology education early into the curriculum stimulates students' interest in anatomy, helps them engage with medical imaging, and creates a clear connection between basic and clinical sciences.[[<reflink idref="bib16" id="ref14">16</reflink>], [<reflink idref="bib18" id="ref15">18</reflink>], [<reflink idref="bib20" id="ref16">20</reflink>]] Orsbon et al.[<reflink idref="bib22" id="ref17">22</reflink>] showed that trained doctors are in favor of vertical integration of anatomy teaching.</p> <p>Another important aspect of integrating radiology into anatomy teaching is that the human body and pathologies can be shown in situ or even in vivo, while anatomical specimens are limited to a post‐mortem state, which is potentially accompanied by spatial distortion due to the embalming and dissection processes.[<reflink idref="bib15" id="ref18">15</reflink>] Small‐group radiology teaching was also shown to increase students' scores in multiple‐choice questions on anatomy.[<reflink idref="bib23" id="ref19">23</reflink>] In contrast, however, imaging methods have been unable to replace the tactile experience while working with human specimens.[<reflink idref="bib15" id="ref20">15</reflink>]</p> <hd id="AN0163604836-3">Three‐dimensional visualization technologies</hd> <p>Advancements in computer technologies have led to the development of virtual tools to facilitate visualization in various medical disciplines.[[<reflink idref="bib24" id="ref21">24</reflink>]] For example, the photo‐realistic 3D visualization technology Cinematic Rendering (Siemens Healthineers, Erlangen, Germany) has already been found to be useful for preoperative planning and diagnosis of visceral pathology.[[<reflink idref="bib26" id="ref22">26</reflink>]]</p> <p>Furthermore, students are becoming increasingly interested in using 3D visualization technology for their anatomy learning, which is reflected by the growing market offering 3D technologies for anatomy users.[[<reflink idref="bib28" id="ref23">28</reflink>]] In a meta‐analysis, including 3D visualization technology in anatomy teaching was found to be more effective than including two‐dimensional (2D) representations, thus resulting in higher user satisfaction. According to the findings, the gain in spatial comprehension was consistently superior. Regarding factual knowledge, the 3D visualization methods tended to be superior.[<reflink idref="bib30" id="ref24">30</reflink>]</p> <hd id="AN0163604836-4">Creation of renderings</hd> <p>The following three steps form the basis of volume rendering methods for CT‐ or MRI‐data sets:</p> <p></p> <ulist> <item> Volume formation: First, the 3D volume is created from 2D data.</item> <p></p> <item> Classification: The visual characteristics are calculated for each voxel based on the properties of the tissue it represents.</item> <p></p> <item> Image projection: Finally, the voxels are projected on the volume in a user‐selected orientation, this is how the pixels of the 3D image are created. [<reflink idref="bib31" id="ref25">31</reflink>]</item> </ulist> <hd id="AN0163604836-5">Visualizing imaging data sets using the Cinematic Rendering technology</hd> <p>Cinematic Rendering is a new and emerging technology.[<reflink idref="bib32" id="ref26">32</reflink>] It comprises a 3D post‐processing software provided by Siemens Healthineers (Siemens Healthcare GmbH, Erlangen, Germany), and is characterized by photorealistic 3D visualization of CT and MRI data sets.[[<reflink idref="bib33" id="ref27">33</reflink>]] To animate the data sets and present them in a more realistic fashion, complex interactions between light and anatomical structures are taken into account.[<reflink idref="bib35" id="ref28">35</reflink>] Compared to conventional 3D visualization techniques, this leads to better spatial differentiation of neighboring anatomical structures.[<reflink idref="bib36" id="ref29">36</reflink>] The physical simulation of light diffusion is achieved by Monte Carlo integration,[<reflink idref="bib37" id="ref30">37</reflink>] which is also used in the film industry. In addition, the lighting conditions of a spherical panorama are applied to the data set. In contrast, in conventional volume rendering—each pixel receives only one ray of light, thus no details such as reflections and shadows can be displayed.[<reflink idref="bib33" id="ref31">33</reflink>]</p> <hd id="AN0163604836-6">The benefits of Cinematic Rendering as a tool in gross anatomy education</hd> <p>In recent studies, students rated Cinematic Rendering to be useful in anatomy education.[[<reflink idref="bib38" id="ref32">38</reflink>]] Visualization, along with memorization and comprehension, is seen as one of the key components to gain anatomical knowledge.[<reflink idref="bib40" id="ref33">40</reflink>] Consequently, 3D visualization technology seems to be a beneficial tool as it was shown to be more effective for spatial comprehension than 2D images.[<reflink idref="bib30" id="ref34">30</reflink>] Furthermore, Cinematic Rendering was found to be superior to other 3D visualization technologies regarding differentiation of adjacent structures, and spatial distinction.[<reflink idref="bib36" id="ref35">36</reflink>] Therefore, Cinematic Rendering appears to provide certain benefits in the realm of virtual anatomy teaching.</p> <hd id="AN0163604836-7">Aims and hypotheses</hd> <p>The aim of this given study was to (<reflink idref="bib1" id="ref36">1</reflink>) determine whether virtual anatomy teaching can help improve student performance in identifying anatomical structures, (<reflink idref="bib2" id="ref37">2</reflink>) evaluate student opinions on the added value of virtual anatomy using Cinematic Rendering merged with classical anatomy teaching, and (<reflink idref="bib3" id="ref38">3</reflink>) correlate potential relationships between student performance and preferred teaching methods.</p> <p>It has been hypothesized that Cinematic Rendering allows students to improve their ability to identify anatomical structures in human prosections.</p> <hd id="AN0163604836-8">MATERIALS AND METHODS</hd> <p></p> <hd id="AN0163604836-9">Course details</hd> <p>Anatomy is a subject taught in the first and second year at the Medical Faculty of the Johannes Kepler University (JKU) in Linz (Austria). Anatomy teaching comprises courses on histology, embryology, neuroanatomy, and gross anatomy. For the latter, the following courses are held (Figure 1).</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/8Z8K/01may23/ase2234-fig-0001.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="ase2234-fig-0001.jpg" title="1 This schematic diagram shows the gross anatomy curriculum at the Medical Faculty of the Johannes Kepler University Linz. The objective structured practical examinations (OSPE) and surveys were held at the beginning of the third semester and at the end of the third and fourth semesters. Contact hours (h) are given as units of 60 minutes." /> </p> <p></p> <p>In the first semester, 18 hours of lectures are spent on gross anatomy. Students are taught the anatomy of the musculoskeletal system, the cardiovascular system, head and neck, trunk, upper and lower limbs, and the peripheral nervous system. This course is held in face‐to‐face classes based on lectures, discussions, and e‐learning. At the end of the course, students are assessed by a written electronic examination. Parallel to this course, 9 hours of lectures and 39 hours of seminars on the topics of the dissection course are held.</p> <p>In the second semester, a four‐week dissection course is held at the Medical University of Graz (Austria) for JKU students. The provision of knowledge, technology, and dissection‐based classes is regulated in a memorandum of understanding between both universities. In 94 contact hours of lectures, the basics for the upcoming dissection sessions are taught. A total of 64 hours is spent on cadaver‐based dissection and another 16 hours on self‐directed learning. Students are split into two groups of 60 to 70 and dissect 10 to 12 Thiel[<reflink idref="bib41" id="ref39">41</reflink>] or ethanol‐glycerin[<reflink idref="bib42" id="ref40">42</reflink>] embalmed bodies within the four‐week time frame. Alongside the active participation of the students in the dissection course, a final examination forms the basis for assessing the successful completion of the course. A 100‐page dissection manual is provided by the Medical University of Graz, alongside book recommendations. In the remainder of the second semester, 12 hours of lectures on the blood and lymphatic system are held.</p> <p>In the third and fourth semesters, a course on virtual anatomy and pathology is conducted. It consists of 22.5 hours of lectures on gross anatomy per semester. This course presents both human morphology and common pathologies predominantly based on plain radiography, CT and MRI, and virtual reconstructions using the Cinematic Rendering software Cinematic Anatomy CA VA70A (Siemens Healthineers GmbH, Erlangen, Germany). The lessons are held at a custom‐built training facility at the JKU, the so‐called "medSPACE," created in a collaboration with JKU, Siemens Healthineers, and Ars Electronica Futurelab (Ars Electronica Linz GmbH & Co KG, Linz, Austria). This facility consists of a 30‐foot‐high black box where Cinematic Rendering is presented on a wall‐filling 8K‐screen. Students are provided with 3D active shutter glasses to follow the interactive presentations given by an experienced anatomist and radiologist, who navigates through the 3D Cinematic Rendering images using a controller (Figures 2 and 3).</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/8Z8K/01may23/ase2234-fig-0002.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="ase2234-fig-0002.jpg" title="2 The "medSPACE" of the Johannes Kepler University, in which human anatomy is taught using Cinematic Rendering presentations. The image shows an audience being presented the anatomy of the vessels of the abdominal region alongside with the topography of the kidneys." /> </p> <p></p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/8Z8K/01may23/ase2234-fig-0003.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="ase2234-fig-0003.jpg" title="3 Three‐dimensional Cinematic Rendering reconstructions used for the virtual anatomy course. (A) Frontal view; and (B) lateral view of head and neck region of a clinical routine patient; (C, D) Frontal cutaway views of the abdomen of a routine patient in the coronal plane. Scale bar = 100 mm." /> </p> <p></p> <p>This course also includes lectures from surgeons, who present their clinical cases, and video broadcasts from the operation theater. Furthermore, using live streaming directly from the dissection room, students have the possibility to see specific structures on prosected human specimens. Although this course is instructor‐centered, special emphasis is placed on student involvement, therefore, interactive presentation software Mentimeter Pro 3.2.5 (Mentimeter AB, Stockholm, Sweden) is used to allow students to interact with the lecturer. Grading in this course is based on active participation in the lectures.</p> <p>In addition to the virtual anatomy course, 27 hours of lectures and 18 hours of seminars on internal organs are held in the third semester. In the fourth semester, 30 hours of lectures and 22.5 hours of seminars on musculoskeletal anatomy and neuroanatomy are held by anatomists, neurologists, and orthopedists. In these courses, sonography, plastinates, and models are used for teaching.</p> <hd id="AN0163604836-13">Objective structured practical examination (OSPE), student evaluation, and qualitative data a...</hd> <p>Second‐year medical students of JKU who had already finished the dissection course were invited to participate in this study.</p> <p>The objective structured practical examination on human prosections was conducted at the beginning and upon completion of virtual anatomy teaching in the third semester, assessing topographical knowledge of the neck, thorax, and abdomen anatomy. The OSPE is an established tool for the objective assessment of learning achievements and practical examinations. It is recommended over written examinations to assess anatomy knowledge[<reflink idref="bib43" id="ref41">43</reflink>] and has been frequently used at various universities including the University of Otago (Dunedin, New Zealand) for the assessment of student learning. Only questions on topics that have been taught in the dissection course were included. The examination design and choice of questions for the OSPE were conducted by experienced anatomists and psychologists. The OSPE consisted of 23 multiple‐choice questions designed to address comprehension, the second level of cognitive objectives in Bloom's taxonomy.[<reflink idref="bib44" id="ref42">44</reflink>] Students had to identify these given structures and their function or spatial relationship.</p> <p>For the neck and abdomen, eight structures were marked by tags in prosections, and for the thorax, seven anatomical structures were marked. Each question had to be answered within 1 minute before the students moved onto the next question. The results of the first OSPE were used to calculate the difficulty index with a median of 0.40 (range = 0.18–0.84; Q1 = 0.30, Q2 = 0.59) and a KR‐20 value of 0.33. Cronbach's alpha of pre‐ and post‐virtual anatomy results was 0.54, indicating weak consistency. Kendall Tau‐b is presented in the appendix (Figure 4).</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/8Z8K/01may23/ase2234-fig-0004.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="ase2234-fig-0004.jpg" title="4 Ethanol‐glycerin embalmed human specimen as used in the objective structured practical examination. Front view of the right‐rotated neck, tags indicate: 01, sternocleidomastoid; 02, sympathetic trunk; 03, ansa cervicalis; 04, vagus nerve [x]; 05, external carotid artery; 06, common carotid artery; 07, internal jugular vein; 08, phrenic nerve. Scale bar = 20 mm." /> </p> <p></p> <p>Furthermore, students were assessed on their perceptions regarding the utility of dissection‐based and virtual anatomy for their learning gain, and their preference for one over the other. Also, student perceptions of the utility of Cinematic Rendering was assessed. Five‐point Likert scales were used for this purpose (1 = strongly agree to 5 = strongly disagree). This survey was designed by experienced anatomists and psychologists. Pilot testing and assessment took place prior to its use for the given study. This assessment was conducted following the completion of the last OSPE.</p> <p>The Likert‐Survey questions assessing either the dissection course or virtual anatomy were separated for validation analyses. These groups did not include the questions assessing whether the course could be removed from the curriculum and whether the subject matter was overwhelming, as these questions assessed negative aspects, unlike the other Likert elements. Cronbach's alpha for the dissection course group was 0.67 and 0.78 for the virtual anatomy group, indicating acceptable to a good consistency. Kendall Tau‐b is presented in the appendix.</p> <p>In addition, student perceptions of the virtual anatomy and dissection courses were assessed using open‐ended questions to gather qualitative data. These questions used were evaluated by the same team as above and an experienced radiologist:</p> <p></p> <ulist> <item> How was your experience with virtual anatomy teaching using Cinematic Rendering?</item> <p></p> <item> Where do you see the benefit for your clinical work and the clinical part of your medical education in virtual anatomy teaching using Cinematic Rendering?</item> <p></p> <item> How was your experience with the dissection course?</item> <p></p> <item> Where do you see the benefit of your clinical work and the clinical part of your medical education in the dissection course?</item> </ulist> <hd id="AN0163604836-15">Statistical evaluation</hd> <p>Microsoft Excel, spreadsheet program version 16.58 (Microsoft Corp., Redmond, WA), IBM SPSS Statistics, version 28.0.1.1 (<reflink idref="bib14" id="ref43">14</reflink>), (IBM Corp., Armonk, NY), and Prism 9, statistical softwareversion 9.4.1, (Graphstats Technologies, San Diego, CA) software were used for statistical analysis. Descriptive and inferential statistics were performed. D'Agostino and Pearson's test for normality were used. Normally distributed data and results of the five‐point Likert questionnaire are presented as mean values and standard deviation (mean ± SD). To compare the OSPE scores of pre‐ and post‐virtual anatomy teaching results (results of all regions and subregions "neck," "thorax," and "abdomen"), paired t‐tests were conducted, as the data collected were normally distributed. To compare the data from the paired objects of the Likert survey (questions asking the same thing about dissection course and virtual anatomy), a Mann–Whitney <emph>U</emph> test was conducted, as the data failed standardized tests of normal distribution. To detect correlations between the progress in examination results (the difference between post‐ and pre‐virtual anatomy results) and the answers to the Likert questionnaire, a two‐tailed Spearman correlation test was carried out. Levels of significance were determined a priori as 0.05 or lower.</p> <p>As this is an exploratory study, no post hoc correction is made for the multiple testing of the main target variables. However, both the overall score and scores in the sub‐regions are tested. For this multiple uses of the same data, the significance level for subregions is corrected by dividing the significance level of the overall score by the number of subregions (0.05/3 = 0.01667, Bonferroni correction).</p> <hd id="AN0163604836-16">RESULTS</hd> <p></p> <hd id="AN0163604836-17">Demographic information</hd> <p>A total of 120 medical students (<emph>n</emph> = 1 20; 72 females, 48 males) at the JKU who were in the third semester of their studies and had already finished their dissection course, participated in this study. All participating students completed the Likert questionnaire. In the OSPE, 108 students participated (62 females, 46 males). Data from 81 students could be paired for the correlation analyses (<emph>n</emph> = 81; 49 female, 32 male). Students who completed both examinations and filled in the questionnaire with the correct credentials were included in this part of the study. In the survey utilizing open‐ended questions, 24 students participated (15 females, 9 males).</p> <p>The participants were on average 22.2 (±3.6) years old, 36 of them had completed professional training, and 12 of them were in a medical job.</p> <hd id="AN0163604836-18">Results for objective structured practical examinations yielded no difference between pre‐ an...</hd> <p>No significant difference was observed when comparing the pre‐ and post‐virtual anatomy teaching examinations of all participants. Furthermore, this applied to all subregions assessed with neck, abdomen, and thorax for the pre‐ and post‐virtual anatomy course assessments. Similarly, the comparison of sex difference of the above‐mentioned results similarly yielded no significant difference (<emph>p</emph> > 0.431). Differences in results based on the embalming technique used were not observed in either the pre‐ or the post‐virtual anatomy examination (<emph>p</emph> > 0.244; Table 1).</p> <p>1 TABLE Pre‐ and post‐virtual anatomy teaching results in objective structured practical examinations.</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left">Region (number of questions)</th><th align="left">Objective structured practical examination results</th><th align="left"><italic>p</italic>‐Value Cohen's <italic>d</italic></th></tr><tr><th align="left">Pre‐virtual anatomy Mean % (±SD)</th><th align="left">Post‐virtual anatomy Mean % (±SD)</th></tr></thead><tbody valign="top"><tr><td>All (23)</td><td>44.8 (±11.6)</td><td>46.3 (±13.8)</td><td>p = 0.311d = 0.098</td></tr><tr><td>Neck (8)</td><td>34.5 (±18.2)</td><td>36.5 (±18.7)</td><td>p = 0.417d = 0.078</td></tr><tr><td>Thorax (7)</td><td>47.1 (±21.3)</td><td>48.9 (±22.2)</td><td>p = 0.493d = 0.066</td></tr><tr><td>Abdomen (8)</td><td>53.1 (±16.1)</td><td>53.9 (±17.6)</td><td>p = 0.680d = 0.040</td></tr></tbody></table> </ephtml> </p> <p>1 <emph>Note</emph>: Student scores at pre‐ and post‐virtual anatomy (VA) teaching examinations are presented in percentages as mean ± standard deviation (±SD). In none of the groups, a significant change in examination results was observed. The number of participants (<emph>n</emph> = 108).</p> <hd id="AN0163604836-19">The dissection course was perceived as being the more important but overwhelming part of anat...</hd> <p>The Likert survey indicated that the importance of the dissection course was rated significantly higher than that of virtual anatomy. Moreover, the dissection course was significantly more likely to be rated as the best way to learn human anatomy. The increase in knowledge was rated as high in both courses with no significant difference. Moreover, students felt significantly less likely to be overwhelmed by the scope of the subject matter in virtual anatomy when compared to the dissection course. Students strongly declined the possibility to remove either of the courses from the curriculum (Table 2).</p> <p>2 TABLE Survey results from medical students comparing virtual anatomy and dissection course.</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left">Likert‐question</th><th align="left">Likert‐survey results mean (±SD)</th></tr><tr><th align="left">Virtual anatomy Mean (±SD)</th><th align="left">Dissection course Mean (±SD)</th></tr></thead><tbody valign="top"><tr><td>... is the most important course in anatomical teaching for learning and understanding</td><td>2.7 (±1.0)</td><td>1.9 (±0.9)</td></tr><tr><td>The best teaching tool for anatomy is ...</td><td>2.8 (±0.8)</td><td>1.9 (±0.9)</td></tr><tr><td>I rate my knowledge gain through ... as high</td><td>1.8 (±0.8)</td><td>2.0 (±1.0)</td></tr><tr><td>In ..., I feel overwhelmed by the scope of the subject matter</td><td>4.6 (±0.7)</td><td>1.7 (±0.9)</td></tr><tr><td>... can be removed from the curriculum without replacement</td><td>4.8 (±0.6)</td><td>4.8 (±0.7)</td></tr></tbody></table> </ephtml> </p> <p>2 <emph>Note</emph>: Student perceptions of dissection and virtual anatomy course. 120 students responded on the five‐point Likert‐type scale with 1 being "strongly agree" and 5 being "strongly disagree". Results are shown as mean ± standard deviation (SD).</p> <hd id="AN0163604836-20">Dissection motivates students to active learning; virtual anatomy is rated as easier to under...</hd> <p>According to the Likert survey, the students were significantly more likely to prepare and review the learning content parallel to the dissection course than in virtual anatomy. Moreover, virtual anatomy was rated to be significantly more likely to stimulate interest in anatomy, while both courses achieved good results in this question. Presentation of the subject matter was ranked significantly more understandable in virtual anatomy than in the dissection course. Additionally, students felt significantly better prepared for the clinical part of their study in virtual anatomy than in the dissection course (Figure 5 and Table 3).</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/8Z8K/01may23/ase2234-fig-0005.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="ase2234-fig-0005.jpg" title="5 Student perceptions of dissection and virtual anatomy course. A total of 120 students responded on a 5‐point Likert‐type scale with 1 being "strongly agree" and 5 being "strongly disagree". Boxes indicate the mean values. Whiskers indicate standard deviation. Blue boxes indicate the dissection course, red boxes indicate the virtual anatomy course. Significant differences are presented with the level of significance of ap < 0.001." /> </p> <p></p> <p>3 TABLE Survey results from medical students comparing virtual anatomy and dissection course.</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left">Likert‐question</th><th align="left">Likert‐survey results mean (±SD)</th></tr><tr><th align="left">Virtual anatomy Mean (±SD)</th><th align="left">Dissection course Mean (±SD)</th></tr></thead><tbody valign="top"><tr><td>In ..., I regularly prepared and repeated the learning content</td><td>3.3 (±1.1)</td><td>2.1 (±1.1)</td></tr><tr><td>... stimulates my interest in anatomy</td><td>1.4 (±0.7)</td><td>1.7 (±0.9)</td></tr><tr><td>In ..., the subject matter is presented in a comprehensible way</td><td>1.2 (±0.5)</td><td>2.7 (±1.0)</td></tr><tr><td>... makes me feel well‐prepared for the clinical part of my studies</td><td>2.0 (±0.9)</td><td>2.9 (±1.0)</td></tr></tbody></table> </ephtml> </p> <p>3 <emph>Note</emph>: Student perceptions of dissection and virtual anatomy course. 120 students responded on a five‐point Likert‐type scale with 1 being "strongly agree" and 5 being "strongly disagree". Results are shown as mean ± standard deviation (SD).</p> <hd id="AN0163604836-22">To undergraduate medical students Cinematic Rendering is interesting but offers no replacemen...</hd> <p>According to the Likert survey, students rate Cinematic Rendering as an interesting tool, that is easy to follow and helps to supplement anatomical knowledge. It was also rated as incapable of fully replacing the dissection course (Figure 6 and Table 4).</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/8Z8K/01may23/ase2234-fig-0006.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="ase2234-fig-0006.jpg" title="6 Student perceptions of Cinematic Rendering‐based anatomy. 120 students responded on a five‐point Likert‐type scale with 1 being "strongly agree" and 5 being "strongly disagree". Boxes indicate the mean values. Whiskers indicate standard deviation." /> </p> <p></p> <p>4 TABLE Survey results from medical students rating Cinematic Rendering.</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left">Statement</th><th align="left">Survey results Mean (±SD)</th></tr></thead><tbody valign="top"><tr><td>Cinematic Rendering‐based anatomy is interesting to me</td><td>1.2 (±0.4)</td></tr><tr><td>Cinematic Rendering presentations are difficult to follow</td><td>3.6 (±1.0)</td></tr><tr><td>The use of Cinematic Rendering complements my anatomical knowledge</td><td>1.2 (±0.5)</td></tr><tr><td>Cinematic Rendering can replace dealing with real human specimens</td><td>4.1 (±1.0)</td></tr></tbody></table> </ephtml> </p> <p>4 <emph>Note</emph>: Student perceptions of Cinematic Rendering. 120 students responded on a five‐point Likert‐type scale with 1 being "strongly agree" and 5 being "strongly disagree". Results are shown as mean ± standard deviation (SD).</p> <hd id="AN0163604836-24">Examination outcomes positively correlated with student attitudes that dissection is indispen...</hd> <p>Correlation analyses of the data from 81 students revealed that those students perceiving virtual anatomy as helpful to engage with the learning contents scored higher in the post‐examination than in the pre‐examination. A weak, positive correlation was found (<emph>r</emph><subs><emph>s</emph></subs> = 0.22, <emph>p</emph> = 0.049). Likewise, students stating that the dissection course forms an integral part of their curriculum performed better in the post‐examination than in the pre‐examination. A weak, positive correlation was found (<emph>r</emph><subs><emph>s</emph></subs> = 0.26, <emph>p</emph> = 0.021).</p> <hd id="AN0163604836-25">Students value the visualization provided in virtual anatomy and the haptic experience provid...</hd> <p>Most of the students participating in the qualitative assessment (75%) mentioned that the virtual anatomy course is beneficial for anatomy visualization purposes. Some students described that the proportions and spatial relationships can be shown particularly well, and that viewing anatomy from all perspectives offers benefits over dissection‐based anatomy. The students found that the virtual anatomy course and the clinical lectures prepared them well for the clinical part of their studies and that a connection was established between anatomy and radiology and thus between preclinical and clinical teaching. The fact that the recognition of common pathologies in imaging is taught early in the curriculum was also noted as positive. One student mentioned that he is sure he will be able to implement the gained knowledge in the operation theater. For the dissection course, the haptic experience was mentioned as beneficial by 33% of the participants. For 21% of participants, the course was perceived as being too short. Students also appreciated learning to apply theoretical knowledge in practice, learning how to use basic surgical instruments, and to see the proportions of structures on real specimens. Fear of the first contact with post‐mortem human specimens was mentioned once. One student viewed the dissection course as an outdated form of anatomical education and raised ethical concerns. Some students mentioned a boost of confidence after finishing the dissection course. A table showing all results of the open‐ended questions is provided in the appendix.</p> <hd id="AN0163604836-26">DISCUSSION</hd> <p>A broad range of contemporary anatomy teaching methods has become available in recent years.[[<reflink idref="bib45" id="ref44">45</reflink>]] Some are only used at a few universities,[[<reflink idref="bib47" id="ref45">47</reflink>]] and others worldwide.[<reflink idref="bib49" id="ref46">49</reflink>] There is a strong consensus that contemporary teaching technologies present powerful options to add to the standard anatomy curriculum.[[<reflink idref="bib4" id="ref47">4</reflink>], [<reflink idref="bib50" id="ref48">50</reflink>]] Students appear to prefer learning with 3D tools over traditional methods to some extent.[<reflink idref="bib51" id="ref49">51</reflink>] The given study aimed to substantiate the added benefit of Cinematic Rendering‐based virtual anatomy teaching on students' dissection‐based anatomy knowledge and to evaluate students' opinion on the courses. The virtual anatomy course at the JKU deployed a blended learning approach, utilizing radiological imaging, digital volume rendering technology Cinematic Rendering, lectures held by clinicians, and live streams delivered by anatomists from the dissection room.</p> <p>This novel approach to teaching anatomy makes it possible to learn under a more integrated and encompassing approach. Students participated in a full‐scale dissection course in their second semester, followed by courses in system‐based integrated anatomy teaching in their third and fourth semesters. This philosophy aims at repeating, supplementing, and consolidating what has been taught in the dissection course and to create a connection to the clinical sciences.</p> <p>This study aimed at assessing student knowledge and their ability to identify structures in OSPEs conducted on human prosections prior to and following one semester of virtual anatomy teaching. Further objectives were to compare and capture student perceptions of the virtual anatomy course, the dissection course, and of Cinematic Rendering. Potential relationships between student performance and their preferred teaching methods were determined in correlation analyses.</p> <hd id="AN0163604836-27">Virtual anatomy teaching appeared to be unrelated to improved knowledge in prosection‐based a...</hd> <p>In the OSPEs assessing anatomy knowledge in prosections, students were not found to have improved their results on a significant level. In consequence, additional teaching based on Cinematic Rendering used in the given setup combined with anatomical dissection, may not help enhance the students' ability to identify anatomical structures in prosections when compared to dissection‐based learning alone. Vice versa, virtual anatomy undoubtedly helped preserve and consolidate the knowledge obtained in dissection and other anatomy courses. This may help explain the similar OSPE scores in spite of the time lapsed between the dissection course and (repeated) learning assessments. Further benefits of the course included early exposure to 3D visualization techniques in anatomy and radiology. Students further reported that virtual anatomy teaching helped them prepare for their learning in the clinical phase of their study: <emph>"I really liked the course virtual anatomy using Cinematic Rendering. The learned content could be visualized and thus better understood."</emph></p> <p>This given study is the first one to assess knowledge gained through virtual anatomy teaching when compared to dissection alone. One other comparative study presented the virtual anatomy technique VesARlius (a joint project of the Ludwig Maximilian University Munich (Germany) and the Technical University Munich), an augmented reality software that uses a mixed reality headset to project human anatomy into space. VesARlius was demonstrated to be superior to 3D models and anatomy atlases available at the time.[<reflink idref="bib47" id="ref50">47</reflink>] The Magic Mirror tool used by the same team comprised a screen and the Kinect One camera (Microsoft Corp., Redmond, WA), allowing the user to visualize anatomical structures and crossectional images projected on their own body. Medical students working with the Magic Mirror improved their test scores in the multiple‐choice text and image questions.[<reflink idref="bib48" id="ref51">48</reflink>] Students receiving additional teaching on radiology imaging using CT scans of the specimens on the Anatomage Table (Anatomage Inc., Silicon Valley, CA) parallel to their dissection, performed better in multiple‐choice questions on basic anatomy than those with dissection alone.[<reflink idref="bib49" id="ref52">49</reflink>] The Anatomage Table visualizes models obtained from human tissues or clinical imaging stereoscopically, a feature claimed by the manufacturer to equal "virtual dissection." Students who combined lectures and the 3D software BioDigital Human, version 1.0.4, (BioDigital Inc., New York, NY) for learning performed better in tag‐based examinations, identifying anatomical structures in projected images than those who learned with lectures and dissection alone.[<reflink idref="bib52" id="ref53">52</reflink>] These previous studies helped substantiate the nature of learning gained with emerging techniques in virtual anatomy and jointly found that the application of additional visualization techniques was related to knowledge gain. However, these previous studies used other techniques and addressed other learning domains compared to this given study. Also, the OSPE used in this study assessed anatomy using high discriminatory power. This study could not find a significant knowledge gain in prosection‐based anatomy using Cinematic Rendering‐based virtual anatomy teaching, therefore, future studies may be needed to assess knowledge gain in other learning domains.</p> <hd id="AN0163604836-28">Dissection‐based anatomy remains an indispensable teaching and learning tool in gross anatomy...</hd> <p>In the given assessment, the importance of the dissection course was rated higher than the importance of virtual anatomy teaching. This finding helps substantiate the results from previous studies showing that students consider contemporary (virtual) techniques an adjunct but not a replacement for dissection‐based anatomy.[<reflink idref="bib53" id="ref54">53</reflink>] Students and anatomists likewise stated that the dissection course should keep its position as the key teaching tool in anatomy.[[<reflink idref="bib3" id="ref55">3</reflink>], [<reflink idref="bib5" id="ref56">5</reflink>]] This finding is confirmed both quantitatively in the given study, and further underlined by student comments: <emph>"The dissection course is essential to really understand anatomy."</emph></p> <p>It must however be kept in mind that no single teaching tool combines all curriculum requirements for future doctors[<reflink idref="bib8" id="ref57">8</reflink>] and many anatomists support the integration of diverse and system‐based teaching.[<reflink idref="bib54" id="ref58">54</reflink>] Using virtual anatomy, the participants of this study stated that the subject matter was presented in a comprehensible fashion, whereas they felt overwhelmed in the dissection course. Moro et al.[<reflink idref="bib55" id="ref59">55</reflink>] confirmed that students view virtual anatomy as a tool that helps them understand anatomy. A recent study also shows that students feel more stress and fear before dissection than before virtual anatomy[<reflink idref="bib52" id="ref60">52</reflink>]; exposure to stress is inevitable for future physicians; hence, it might be beneficial to learn to deal with it early on. The appreciation for this becomes apparent in this student's comment: <emph>"In the dissection course I learned how to deal with stress."</emph></p> <hd id="AN0163604836-29">A combination of dissection‐based and virtual anatomy may help form an undergraduate curricul...</hd> <p>The Likert elements assessing whether the dissection course or virtual anatomy should be removed from the curriculum indicated that both courses were highly valued by the students to achieve their learning objectives, and thus should not be removed from the present curriculum. A small number of American institutions, which had removed the dissection course from their curriculum almost completely resumed or re‐established aspects of the dissection experience.[<reflink idref="bib56" id="ref61">56</reflink>] Only a few universities have discontinued using dissection as a principal method of anatomy teaching.[[<reflink idref="bib57" id="ref62">57</reflink>], [<reflink idref="bib59" id="ref63">59</reflink>]]</p> <p>A recently published study warns that anatomy lectures will perish unless the most effective pedagogical methods and interactive learning are integrated.[<reflink idref="bib60" id="ref64">60</reflink>] Therefore, a curriculum combining radiology and classical anatomy teaching methods[<reflink idref="bib15" id="ref65">15</reflink>] with modern 3D visualization techniques may be a complementary approach.</p> <hd id="AN0163604836-30">Students spend less time preparing for virtual anatomy and rated it to be more stimulating re...</hd> <p>Students prepared and reviewed the learning content more regularly in the dissection course than in the virtual anatomy course as seen by the five‐point Likert questionnaire (Figure 5). This may be partly ascribed to the fact that the dissection course is one of the JKU students' first exposure to anatomy. Throughout the four‐week dissection course, students spent more time dealing with the subject matter outside the dissection room which likely helped them to consolidate gained knowledge and go deeper into the subject. Both the dissection course and virtual anatomy were found to stimulate interest in anatomy, with virtual anatomy reaching a better result than dissection. Triepels et al.[<reflink idref="bib29" id="ref66">29</reflink>] assessed medical students' perceptions of anatomy and reported that 55.6% did not find anatomy to be an attractive subject in the sense of arousing their interest. It must be critically noted that the assessment of the quality of teaching is significantly influenced by the curriculum, curricular framework conditions, and the lecturers themselves.</p> <hd id="AN0163604836-31">Students perceive virtual anatomy to be an excellent preparation for their clinical phase</hd> <p>The combination of anatomy with pathology offered in this course on virtual anatomy allowed students to understand the importance of anatomy by pointing out clinical relevance, which was sparsely the case in old teaching curricula.[<reflink idref="bib61" id="ref67">61</reflink>]</p> <p>Students commented: "I find it helpful and beneficial that medical students can relate to the clinical implications early in their training through this curriculum. The complicated field of radiology is brought closer to the students with exciting case studies and interactive work" and "Virtual anatomy helped us gain better orientation for surgery and profound basic knowledge in the evaluation of CT, MRI and plain radiography."</p> <p>Another benefit of virtual anatomy indicated by the survey is that students feel well‐prepared for their clinical phase of medical education. Previous studies demonstrated that students consider the "clinical utility" of both dissection and virtual anatomy as high.[<reflink idref="bib52" id="ref68">52</reflink>] The dissection course on the one hand is the first contact with basic surgical instruments for most medical students, and they develop professional competence in dealing with stress, time management skills, learning strategies, and working in teams. On the other hand, virtual anatomy allows students to consolidate anatomy knowledge in a 3D environment, without being bound to the dissection room.[<reflink idref="bib7" id="ref69">7</reflink>]</p> <hd id="AN0163604836-32">Students rate Cinematic Rendering as a highly beneficial method for anatomy teaching</hd> <p>The digital volume rendering technology "Cinematic Rendering" is a popular aspect of the virtual anatomy course at the JKU. Although Cinematic Rendering is deemed by the students as an interesting tool, easy to follow, and helps supplement anatomical knowledge, it is still found to be incapable of fully replacing the dissection course. The positive results concerning Cinematic Rendering confirm the results of previous studies in which students rated this technology as highly helpful for learning anatomy.[<reflink idref="bib38" id="ref70">38</reflink>] While the effect on student knowledge still must be confirmed, student perception indicates that it is a beneficial tool in anatomy teaching.</p> <hd id="AN0163604836-33">Preparing and repeating subject matter in virtual anatomy led to higher improvement in the ob...</hd> <p>Correlation analyses demonstrated that there were different learning types among the participants. This might help contextualize to some extent why no improvement in OSPEs could be seen. Students who stated that the dissection course was indispensable to their curriculum could improve their performance in the OSPEs. Those who did not prepare or repeat the learning materials, in consequence, did not benefit from the course, respectively, achieved negative results, which offset the positive effect of the other group of learners.</p> <hd id="AN0163604836-34">Limitations of the study</hd> <p>Considering the results of the OSPEs, it must be kept in mind that the here assessed students have not had direct exposure to anatomy dissections for more than 6 months prior to the OSPEs, that the exposure to video streams was timely limited, and that there was a difference in the teaching style used in the dissection course and virtual anatomy. In addition, the OSPE questionnaire was designed to assess primarily the learning outcomes of the dissection course, whereas the learning outcomes in virtual anatomy were partly deviant, especially regarding pathological findings. Future research should try and determine the effects of virtual anatomy teaching using other examination modalities, e.g., recognizing structures in CT and MR images.</p> <hd id="AN0163604836-35">CONCLUSIONS</hd> <p>Cinematic Rendering seems to be a beneficial tool in virtual anatomy to supplement conventional dissection‐based anatomy training. This study shows that students are in favor of additional anatomy teaching using Cinematic Rendering and that they feel well prepared for their clinical training through radiologic imaging‐ and Cinematic Rendering‐based virtual anatomy education. Additionally, this type of virtual anatomy helped present the subject matter in a comprehensible way and helped students visualize anatomy. A significant knowledge gain in OSPEs on human specimens was not found in this study. Future studies should assess student knowledge gain in other modalities, aligned with other specific goals of virtual anatomy teaching. Further advantages of Cinematic Rendering warrant further exploration.</p> <hd id="AN0163604836-36">ACKNOWLEDGMENTS</hd> <p>The authors express their gratitude to the body donors donating their bodies for research after passing. Also, the authors would like to thank Prof. Maren Engelhardt, Chair of the Institute of Anatomy at the Johannes Kepler University, who kindly supported us by providing facilities and helped organize the OSPE examinations. Dr. Philipp Hermann and Prof. Helga Wagner of the Center for Clinical Studies supported this project with statistical advice. The authors would like to express their gratitude to Dr. Katharina Steininger‐Kaar and Mag. Sarah Fuchs for data collection and organization. The image in Figure 2 was captured by Dr. Tomislav Mesic. The image in Figure 4 was captured by Christine Hammer. Dr. Aqeeda Singh proofread the paper as a native speaker. 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Anat Sci Educ. 2022 ; 15 : 1145 – 51.</bibtext> </blist> <blist> <bibtext> Turney BW. Anatomy in a modern medical curriculum. Ann R Coll Surg Engl. 2007 ; 89 : 104 – 7.</bibtext> </blist> </ref> <aug> <p>By Julian F. Niedermair; Veronica Antipova; Simone Manhal; Martin Siwetz; Monika Wimmer‐Röll; Niels Hammer and Franz A. Fellner</p> <p>Reported by Author; Author; Author; Author; Author; Author; Author</p> <p></p> <p>Julian F. Niedermair, is a sixth‐year medical student at the Medical University of Graz, Austria. He is interested in pursuing a residency in radiology at the Kepler University Hospital, Linz.</p> <p>Veronica Antipova, M.D., P.D., a senior lecturer in the Department of Clinical and Macroscopic Anatomy at the Medical University of Graz, Graz, Austria. She teaches anatomy to medical, dentistry, and graduate students, and her research focused on neuroanatomy, neurodegenerative disease, clinical anatomy, cranio‐facial system, dentistry, and teaching in clinical anatomy.</p> <p>Simone Manhal, Mgr., is a certified psychologist and works as an assistant to the Vice‐Rector for studies and teaching at the Medical University of Graz, Graz, Austria. Her research interest is in medical education, learning outcome, student‐centered learning, and student selection.</p> <p>Martin Siwetz is a sixth‐year medical student at the Medical University of Graz, Graz, Austria, and a student assistant at the Department of Macroscopic an.d Clinical Anatomy. His research interest is in the macroscopic anatomy of the human body combined with clinical questioning. He is interested in pursuing a residency in Orthopedic Surgery.</p> <p>Monika Wimmer‐Röll, D.Sc., is a professor in the Institute of Anatomy and Cell Biology at the Johannes Kepler University (JKU), Linz, Austria. She teaches macroscopic and microscopic anatomy and embryology to medical students. Her research interest is in molecular biology and signal transduction.</p> <p>Niels Hammer, M.D., Dr. habil., is a professor and Chair of the Anatomy Division at the Medical University of Graz, Graz, Austria. He teaches gross and clinical anatomy and histology to undergraduate students, and to graduate students and surgeons. His research focuses on surgical anatomy, biomechanics, and teaching in clinical anatomy.</p> <p>Franz A. Fellner, M.D., Dr. habil., is a professor of virtual morphology at the Johannes Kepler University and Chair of the Central Radiology Institute of Johannes Kepler University, Linz, Austria. He teaches anatomy and radiology to students. His research focuses on magnetic resonance imaging (especially in neuroradiology), virtual anatomy education, and Cinematic Rendering.</p> </aug> <nolink nlid="nl1" bibid="bib10" firstref="ref8"></nolink> <nolink nlid="nl2" bibid="bib12" firstref="ref9"></nolink> <nolink nlid="nl3" bibid="bib13" firstref="ref10"></nolink> <nolink nlid="nl4" bibid="bib14" firstref="ref11"></nolink> <nolink nlid="nl5" bibid="bib15" firstref="ref12"></nolink> <nolink nlid="nl6" bibid="bib17" firstref="ref13"></nolink> <nolink nlid="nl7" bibid="bib16" firstref="ref14"></nolink> <nolink nlid="nl8" bibid="bib18" firstref="ref15"></nolink> <nolink nlid="nl9" bibid="bib20" firstref="ref16"></nolink> <nolink nlid="nl10" bibid="bib22" firstref="ref17"></nolink> <nolink nlid="nl11" bibid="bib23" firstref="ref19"></nolink> <nolink nlid="nl12" bibid="bib24" firstref="ref21"></nolink> <nolink nlid="nl13" bibid="bib26" firstref="ref22"></nolink> <nolink nlid="nl14" bibid="bib28" firstref="ref23"></nolink> <nolink nlid="nl15" bibid="bib30" firstref="ref24"></nolink> <nolink nlid="nl16" bibid="bib31" firstref="ref25"></nolink> <nolink nlid="nl17" bibid="bib32" firstref="ref26"></nolink> <nolink nlid="nl18" bibid="bib33" firstref="ref27"></nolink> <nolink nlid="nl19" bibid="bib35" firstref="ref28"></nolink> <nolink nlid="nl20" bibid="bib36" firstref="ref29"></nolink> <nolink nlid="nl21" bibid="bib37" firstref="ref30"></nolink> <nolink nlid="nl22" bibid="bib38" firstref="ref32"></nolink> <nolink nlid="nl23" bibid="bib40" firstref="ref33"></nolink> <nolink nlid="nl24" bibid="bib41" firstref="ref39"></nolink> <nolink nlid="nl25" bibid="bib42" firstref="ref40"></nolink> <nolink nlid="nl26" bibid="bib43" firstref="ref41"></nolink> <nolink nlid="nl27" bibid="bib44" firstref="ref42"></nolink> <nolink nlid="nl28" bibid="bib45" firstref="ref44"></nolink> <nolink nlid="nl29" bibid="bib47" firstref="ref45"></nolink> <nolink nlid="nl30" bibid="bib49" firstref="ref46"></nolink> <nolink nlid="nl31" bibid="bib50" firstref="ref48"></nolink> <nolink nlid="nl32" bibid="bib51" firstref="ref49"></nolink> <nolink nlid="nl33" bibid="bib48" firstref="ref51"></nolink> <nolink nlid="nl34" bibid="bib52" firstref="ref53"></nolink> <nolink nlid="nl35" bibid="bib53" firstref="ref54"></nolink> <nolink nlid="nl36" bibid="bib54" firstref="ref58"></nolink> <nolink nlid="nl37" bibid="bib55" firstref="ref59"></nolink> <nolink nlid="nl38" bibid="bib56" firstref="ref61"></nolink> <nolink nlid="nl39" bibid="bib57" firstref="ref62"></nolink> <nolink nlid="nl40" bibid="bib59" firstref="ref63"></nolink> <nolink nlid="nl41" bibid="bib60" firstref="ref64"></nolink> <nolink nlid="nl42" bibid="bib29" firstref="ref66"></nolink> <nolink nlid="nl43" bibid="bib61" firstref="ref67"></nolink>
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  Data: On the Added Benefit of Virtual Anatomy for Dissection-Based Skills
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  Data: English
– Name: Author
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  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Niedermair%2C+Julian+F%2E%22">Niedermair, Julian F.</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-2321-7996">0000-0002-2321-7996</externalLink>)<br /><searchLink fieldCode="AR" term="%22Antipova%2C+Veronica%22">Antipova, Veronica</searchLink><br /><searchLink fieldCode="AR" term="%22Manhal%2C+Simone%22">Manhal, Simone</searchLink><br /><searchLink fieldCode="AR" term="%22Siwetz%2C+Martin%22">Siwetz, Martin</searchLink><br /><searchLink fieldCode="AR" term="%22Wimmer-Röll%2C+Monika%22">Wimmer-Röll, Monika</searchLink><br /><searchLink fieldCode="AR" term="%22Hammer%2C+Niels%22">Hammer, Niels</searchLink><br /><searchLink fieldCode="AR" term="%22Fellner%2C+Franz+A%2E%22">Fellner, Franz A.</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-3009-4944">0000-0003-3009-4944</externalLink>)
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  Data: <searchLink fieldCode="SO" term="%22Anatomical+Sciences+Education%22"><i>Anatomical Sciences Education</i></searchLink>. May-Jun 2023 16(3):439-451.
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  Data: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
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  Label: Peer Reviewed
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  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 13
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2023
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
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  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Anatomy%22">Anatomy</searchLink><br /><searchLink fieldCode="DE" term="%22Laboratory+Procedures%22">Laboratory Procedures</searchLink><br /><searchLink fieldCode="DE" term="%22Science+Instruction%22">Science Instruction</searchLink><br /><searchLink fieldCode="DE" term="%22Visual+Aids%22">Visual Aids</searchLink><br /><searchLink fieldCode="DE" term="%22Computer+Simulation%22">Computer Simulation</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+Students%22">Medical Students</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+Education%22">Medical Education</searchLink><br /><searchLink fieldCode="DE" term="%22Universities%22">Universities</searchLink><br /><searchLink fieldCode="DE" term="%22Radiology%22">Radiology</searchLink><br /><searchLink fieldCode="DE" term="%22Diagnostic+Tests%22">Diagnostic Tests</searchLink><br /><searchLink fieldCode="DE" term="%22Pathology%22">Pathology</searchLink><br /><searchLink fieldCode="DE" term="%22Educational+Benefits%22">Educational Benefits</searchLink><br /><searchLink fieldCode="DE" term="%22Likert+Scales%22">Likert Scales</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Attitudes%22">Student Attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Improvement%22">Student Improvement</searchLink><br /><searchLink fieldCode="DE" term="%22Instructional+Effectiveness%22">Instructional Effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Scores%22">Scores</searchLink><br /><searchLink fieldCode="DE" term="%22Preferences%22">Preferences</searchLink><br /><searchLink fieldCode="DE" term="%22Course+Descriptions%22">Course Descriptions</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink>
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  Label: Geographic Terms
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  Data: <searchLink fieldCode="DE" term="%22Germany%22">Germany</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1002/ase.2234
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  Label: ISSN
  Group: ISSN
  Data: 1935-9772<br />1935-9780
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Technological approaches deploying three-dimensional visualization to integrate virtual anatomy are increasingly used to provide medical students with state-of-the-art teaching. It is unclear to date to which extent virtual anatomy may help replace the dissection course. Medical students of Johannes Kepler University attend both a dissection and a virtual anatomy course. This virtual anatomy course is based on Cinematic Rendering and radiological imaging and teaches anatomy and pathology. This study aims to substantiate student benefits achieved from this merged teaching approach. Following their dissection course, 120 second-year students took part in objective structured practical examinations (OSPE) conducted on human specimens prior to and following a course on Cinematic Rendering virtual anatomy. Likert-based and open-ended surveys were conducted to evaluate student perceptions of both courses and their utility. Virtual anatomy teaching was found to be unrelated to improvements in student's ability to identify anatomical structures in anatomical prosections, yielding only a 1.5% increase in the OSPE score. While the students rated the dissection course as being more important and impactful, the virtual anatomy course helped them display the learning content in a more comprehensible and clinically applicable way. It is likely that Cinematic Rendering-based virtual anatomy affects knowledge gain in domains other than the recognition of anatomical structures in anatomical prosections. These findings underline students' preference for the pedagogic strategy of the dissection course and for blending this classical approach with novel developments like Cinematic Rendering, thus preparing future doctors for their clinical work.
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  Data: 2023
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  Data: EJ1376702
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