Learning Functional Human Anatomy with a New Interactive Three-Dimensional Digital Tool
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| Title: | Learning Functional Human Anatomy with a New Interactive Three-Dimensional Digital Tool |
|---|---|
| Language: | English |
| Authors: | Mélanie Gallot (ORCID |
| Source: | Anatomical Sciences Education. 2024 17(3):660-673. |
| 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: | 14 |
| Publication Date: | 2024 |
| Document Type: | Journal Articles Reports - Research |
| Education Level: | Higher Education Postsecondary Education |
| Descriptors: | Anatomy, Technology Uses in Education, Interaction, Kinesiology, College Freshmen, Spatial Ability, Educational Technology |
| DOI: | 10.1002/ase.2377 |
| ISSN: | 1935-9772 1935-9780 |
| Abstract: | Human anatomy requires understanding spatial relationships among anatomical structures and is often perceived as difficult to learn by students. To overcome this concern, several digital tools exist with some strengths and limitations among which the lack of interactivity especially for complex functional anatomy learning. In this way, a new interactive three-dimensional tool called Antepulsio was designed. Antepulsio was assessed by comparing three groups of first year kinesiology students to test whether it is likely to favor functional anatomy learning during three training sessions spread over a week. The experiment was conducted during a real academic course. Laterality judgment, 3D spatial abilities and working memory abilities from all participants were previously collected to create three homogeneous groups: the active group (n = 17, 17.76 ± 0.56 years) interacted with Antepulsio, the passive group (n = 18, 17.89 ± 0.83 years) watched videos of Antepulsio while the control group (n = 15, 18.07 ± 0.80 years) performed a neutral activity unrelated to anatomy. Anatomy knowledge was also assessed during pretest, posttest, and retention test (8 weeks after the posttest). The most significant outcome of this study revealed that in case of better working visual memory, the active group outperformed the passive group between pretest and retention test (p < 0.01). In other words, Antepulsio tool is efficient only for students with high visuospatial working memory. These selective benefits of Antepulsio are discussed in terms of cognitive load, training duration and the necessary period of familiarization with the tool. |
| Abstractor: | As Provided |
| Entry Date: | 2024 |
| Accession Number: | EJ1419161 |
| Database: | ERIC |
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| FullText | Links: – Type: pdflink Url: https://content.ebscohost.com/cds/retrieve?content=AQICAHj0k_4E0hTGH8RJwT4gCJyBsGNe_WN95AvKlDbXJGqwxwHTJOMh0OcmH7z4ubWxmUdmAAAA4jCB3wYJKoZIhvcNAQcGoIHRMIHOAgEAMIHIBgkqhkiG9w0BBwEwHgYJYIZIAWUDBAEuMBEEDLT-MVBEV93OCooWmgIBEICBmgDltmp0OEbdDwQbgl7FQjmmRGUHjNMdJuM5rVPM6uD-iSZqUoXO63oveOMm0GZ8jCn2Kx_wqEqAUD4SPCQ89briPZm1Sg_cFQnW11CfHJNRhmYmwlQZrjsY7epROHbTvteLTrl_1xIHUofkNllzKc9eSOk-miMLStxMrBUoNAyj7b-sX_L93s8bD7q1LTP2cwmm3CNuHR6cOl0= Text: Availability: 1 Value: <anid>AN0176409634;[8z8k]01apr.24;2024Apr05.05:40;v2.2.500</anid> <title id="AN0176409634-1">Learning functional human anatomy with a new interactive three‐dimensional digital tool </title> <p>Human anatomy requires understanding spatial relationships among anatomical structures and is often perceived as difficult to learn by students. To overcome this concern, several digital tools exist with some strengths and limitations among which the lack of interactivity especially for complex functional anatomy learning. In this way, a new interactive three‐dimensional tool called Antepulsio was designed. Antepulsio was assessed by comparing three groups of first year kinesiology students to test whether it is likely to favor functional anatomy learning during three training sessions spread over a week. The experiment was conducted during a real academic course. Laterality judgment, 3D spatial abilities and working memory abilities from all participants were previously collected to create three homogeneous groups: the active group (n = 17, 17.76 ± 0.56 years) interacted with Antepulsio, the passive group (n = 18, 17.89 ± 0.83 years) watched videos of Antepulsio while the control group (n = 15, 18.07 ± 0.80 years) performed a neutral activity unrelated to anatomy. Anatomy knowledge was also assessed during pretest, posttest, and retention test (8 weeks after the posttest). The most significant outcome of this study revealed that in case of better working visual memory, the active group outperformed the passive group between pretest and retention test (p &lt; 0.01). In other words, Antepulsio tool is efficient only for students with high visuospatial working memory. These selective benefits of Antepulsio are discussed in terms of cognitive load, training duration and the necessary period of familiarization with the tool.</p> <p>Keywords: 3D digital tool; embodiment; human anatomy learning; interactivity; spatial ability</p> <hd id="AN0176409634-2">INTRODUCTION</hd> <p>Teaching human anatomy is part of several curricula of both clinical (e.g., medicine, physiotherapy, or osteopathy) and sport sciences courses (e.g., kinesiology). Knowledge about human body structures and functions is fundamental for professional skills. The way in which the educational content is built is one of the main concerns to provide scientific knowledge for health professionals. Dissection was the primary teaching method for over 400 years[<reflink idref="bib1" id="ref1">1</reflink>] and has then been drastically reduced due to cost and time constraints.[[<reflink idref="bib2" id="ref2">2</reflink>]] Estai and Bunt[<reflink idref="bib4" id="ref3">4</reflink>] described six other different teaching methods for medical, dental, and associated health sciences, for example, prosection, plastination, computer‐based teaching, medical imaging, living anatomy, and lecture‐based teaching. Nevertheless, due to specific aims and recent societal problems, some teaching methods and tools are more useful than others. Recently, the computer‐based teaching and learning is more developed in relation to students increasing number and lately to COVID‐19 crisis which has imposed the emergency move to a distance learning, to ensure a pedagogical continuity.[<reflink idref="bib5" id="ref4">5</reflink>]</p> <p>Computer‐based teaching and learning was extensively used to facilitate the pedagogical continuity during COVID‐19 crisis by giving free access to anatomical knowledge to every student.[<reflink idref="bib6" id="ref5">6</reflink>] However, it is noteworthy to mention that calling upon computer‐based tools for teaching and learning anatomy started long before COVID‐19 crisis. In fact, computer‐based teaching and learning can be used to address, or in some cases, to emphasize the difficulties encountered by students during anatomy learning.[<reflink idref="bib7" id="ref6">7</reflink>] Students often report experiencing learning difficulties due to the amount of information and time required for memorization.[<reflink idref="bib8" id="ref7">8</reflink>] Moreover, establishing spatial relationships among different anatomical structures is a major difficulty in understanding anatomical organizations,[<reflink idref="bib9" id="ref8">9</reflink>] especially for complex spatial relationships.[<reflink idref="bib10" id="ref9">10</reflink>] Furthermore, this requires spatial orientation and judging scale.[<reflink idref="bib8" id="ref10">8</reflink>] Therefore, better understanding the teaching tools and the student's expectations and needs, is one of the main aims to facilitate their learning and apply anatomical knowledge in health professionals.[<reflink idref="bib8" id="ref11">8</reflink>] Keehner et al.[<reflink idref="bib11" id="ref12">11</reflink>] reported positive correlations between spatial abilities and 3D visualizations on computer screens. Furthermore, several previous researches provided evidence that spatial ability is one of the main key‐components of being skilled in anatomy.[[<reflink idref="bib11" id="ref13">11</reflink>], [<reflink idref="bib13" id="ref14">13</reflink>], [<reflink idref="bib15" id="ref15">15</reflink>], [<reflink idref="bib17" id="ref16">17</reflink>]] Moreover, mental rotation training enhances anatomy learning.[<reflink idref="bib18" id="ref17">18</reflink>]</p> <p>The use of images, including three‐dimensional (3D) representations, improves anatomy learning outcomes[[<reflink idref="bib19" id="ref18">19</reflink>], [<reflink idref="bib21" id="ref19">21</reflink>]] by helping learners in mentally representing the anatomical structures which is essential for developing long‐term knowledge consolidation.[[<reflink idref="bib22" id="ref20">22</reflink>], [<reflink idref="bib24" id="ref21">24</reflink>]] Computer‐based learning with 3D visualization has the potential to improve whole human body exploration[<reflink idref="bib26" id="ref22">26</reflink>] by providing observations from multiple angles.[<reflink idref="bib27" id="ref23">27</reflink>]</p> <p>Previous studies comparing 3D devices (from interactive computer‐based teaching to 3D videography) to more traditional methods[<reflink idref="bib4" id="ref24">4</reflink>] brought new insights for learning. Khalil et al.[<reflink idref="bib28" id="ref25">28</reflink>], Moorman[<reflink idref="bib29" id="ref26">29</reflink>], and Di Lullo et al.[<reflink idref="bib30" id="ref27">30</reflink>] reported that students preferred computer‐based teaching and digital video clips presenting dissection guidance than paper‐based material. Nicholson et al.[<reflink idref="bib31" id="ref28">31</reflink>] mentioned that 3D‐computer‐based teaching enhanced students' learning. Abid et al.[<reflink idref="bib32" id="ref29">32</reflink>] provided evidence of better performance in examination when learning with interactive 3D anatomy graphics than with chalkboard drawings. Finally, Hoyek et al.[<reflink idref="bib7" id="ref30">7</reflink>] evidenced the effectiveness of 3D digital animation compared with 2D drawings.</p> <p>Simultaneously and paradoxically, 3D may also impair learning in students with low spatial abilities compared with two‐dimensional (2D) representations.[<reflink idref="bib33" id="ref31">33</reflink>] Learning with multimedia tools generally requires spatial cognitive processing associated with visuospatial working memory abilities.[<reflink idref="bib34" id="ref32">34</reflink>] Weak skills may thus decrease the effectiveness of mental model construction[<reflink idref="bib35" id="ref33">35</reflink>] or mental imagery.[<reflink idref="bib36" id="ref34">36</reflink>] According to the ability‐as‐compensator theory[[<reflink idref="bib37" id="ref35">37</reflink>]] low spatial abilities learners may benefit from 3D‐tools. On the other hand, the ability‐as‐enhancer theory[<reflink idref="bib39" id="ref36">39</reflink>] explains how high spatial abilities learners could allocate cognitive resources in building referential connections among the views provided by the 3D‐tool. The relationship between users (i.e., students) spatial abilities and 3D tools interface and content is in the core of the present study. In fact, learning human anatomy is positively related to the interaction between the learner's spatial ability and the interactivity with the instructional tool.[<reflink idref="bib40" id="ref37">40</reflink>] Content and interface of digital tools are thus crucial in the learning process. Three‐dimensional tools can be used either passively when students listen to the instructor's guidance and explanation[<reflink idref="bib41" id="ref38">41</reflink>] or actively when students learn by directly interacting with the tools.[<reflink idref="bib42" id="ref39">42</reflink>] Both interactive and non‐interactive tools may enhance learning outcomes however the internal cognitive processes they trigger are not the same. Passive observation of 3D tools better helps understanding the spatial relationships among anatomical structures.[[<reflink idref="bib7" id="ref40">7</reflink>], [<reflink idref="bib43" id="ref41">43</reflink>]] On the other hand active learning relates to the cognitive theory of embodiment, thus suggesting that performing actual actions linked with anatomy knowledge is more efficient than passive learning.[[<reflink idref="bib44" id="ref42">44</reflink>], [<reflink idref="bib46" id="ref43">46</reflink>]] Direct manipulation of anatomical structures in a 3D environment is believed to improve mental representation.[<reflink idref="bib47" id="ref44">47</reflink>] This active learning is particularly useful when learning is about the musculoskeletal system because it improves kinesthetic perceptions associated with motor functions.[<reflink idref="bib48" id="ref45">48</reflink>]</p> <p>Most of the well‐known anatomy 3D applications (i.e., Visible Body, an@tomedia, Anatomy.app, 3D4 Complete anatomy) present strengths and limitations.[<reflink idref="bib49" id="ref46">49</reflink>] They provide a lot of information on human body structures and the links between them. Moreover, some of these tools include functional anatomy content showing a movement with its responsible muscles (Visible Body, 3D4 Complete anatomy). However, the weakness of existing tools is their lack of interactivity with the users, especially when it is about understanding functional anatomy. In fact, in those tools, the users can just click on a movement and passively observe it. Moreover, Lewis et al.[<reflink idref="bib49" id="ref47">49</reflink>] pointed the lack of pedagogical support for anatomy contents (more details not conducive to teaching and learning, certain structures are mislabeled or absents) and the lack of test on the potential impact on anatomy education. In addition to the above‐mentioned applications, 3D animations were created in public universities and are freely available on YouTube (i.e., "Anatomie 3D Lyon" YouTube channel). Even though their positive impact on learning outcome has been demonstrated[<reflink idref="bib7" id="ref48">7</reflink>] those animations do not allow interaction with the users.</p> <p>The aim of this paper is to present the development in Lyon 1 University of a new interactive 3D tool for teaching and learning functional anatomy called Antepulsio. This application is divided into several sections and offers specific functionalities that have not been previously explored, for example, motion reproduction within an interactive framework. In fact, users do not just observe a movement to understand the functional anatomy. They interact with the application by testing individually several muscles to reproduce a desired movement, by selecting the appropriate muscular synergy. Antepulsio was designed according to the user‐centered method. Users' experiences were collected to improve the tool interface, scenario, and contents.[<reflink idref="bib50" id="ref49">50</reflink>] In their study, Chaker et al.[<reflink idref="bib50" id="ref50">50</reflink>] collected users' experience and verbal feedbacks of two Antepulsio version. The first version was the prototype designed by the researchers and the second has been enhanced according to students' feedbacks. The first version's indicates both positive (e.g., the interaction with the model enables a better 3D visualization of movement; the software is a good tool for study and assessments; the interaction makes the students more active in their learning process) and negative results (e.g., students needed too much guidance to pass from an exercise to another; some guidelines were not clear; some explanations were missing). After the first version's enhancement, the results indicated a significant improvement of the Attrakdiff scores,[<reflink idref="bib51" id="ref51">51</reflink>] especially for the hedonic quality (e.g., the product allows the user to identify with it) and the pragmatic quality dimensions (e.g., the usability and the usefulness of the product). To complete this previous study about Antepulsio's users feedback and according to Lewis et al.[<reflink idref="bib49" id="ref52">49</reflink>], the experimental design conducted here, aimed to test Antepulsio software and its effects on anatomy learning outcomes. It is noteworthy to mention that this study aimed to test a design (i.e., the use of Antepulsio software) that was embedded within a larger course.</p> <p>Because the time spent on learning outside formal face‐to‐face courses has a positive impact on learning outcomes,[<reflink idref="bib13" id="ref53">13</reflink>] the "Study time" was added as an independent variable. In fact, the self‐study is an important part of learning, allowing students to acquire discipline‐specific competencies and generic competencies.[<reflink idref="bib52" id="ref54">52</reflink>]</p> <p>Based on the previous theoretical background, our main hypothesis is that only the students with good spatial abilities can profit from interacting with the 3D tool in order to have better anatomy results.</p> <hd id="AN0176409634-3">MATERIALS AND METHODS</hd> <p></p> <hd id="AN0176409634-4">Participants</hd> <p>Seventy‐one students, attending the same human anatomy course, initially volunteered to participate in this study. All were registered in the first‐year of kinesiology at Lyon 1 University, France. There are no pre‐requisites to attend this study. During the recruitment process, each participant completed a sociodemographic questionnaire about previous academic studies. None of them had previously learned anatomy. Thus, students who were repeating the first year were excluded from the data collection as well as those with language or/and visual impairments. Students who did not complete all learning and assessment sessions were excluded. This was a behavioral study based on observation, the experiment was not interventional (e.g., no intrusive intervention in the participants' organism, no ingestion of active molecule) as defined and described by the French Jardé law. In line with the Helsinki declaration and with the French ethical law, a written informed consent was obtained from all participants who received a compensation for their participation (a $ 21.06 gift voucher). Furthermore, the local committee for human research of Lyon 1 University approved this study.</p> <hd id="AN0176409634-5">Educational context</hd> <p>All participants attended the same human musculoskeletal system course consisting of six lecture‐sessions (12 h) and six laboratory practical skill‐training sessions (12 h), given by the same lecturer. The lecturer gave relevant information in a one‐way method of communication during each lecture, for example, without verbal exchange with the students. However, a 2 min‐session for questions every 15 min were planned to improve learners' active participation and self‐motivation. The laboratory practical sessions consisted of problem‐based‐learning and team‐based learning exercises during which the students were encouraged to execute movement before solving functional anatomy problems. There was no dissection or prosection during these courses. All participants had the same written reference materials (lecture notes) as study guidelines and free access to the 3D animations on the university website.[<reflink idref="bib7" id="ref55">7</reflink>] Students' knowledge were assessed during three examination sessions: one in the beginning of the course (40 questions covering the first third of the program), one at the middle of the course (40 questions covering the second third of the program) and one at the end (100 questions covering the overall program). Across years the average success rates varied between 7 and 9 out of 20 with standard deviations varying between 3 and 4.</p> <hd id="AN0176409634-6">Study groups and design</hd> <p>Among the 71 students who initially volunteered to participate in the study, 50 students fulfilled all the inclusion criteria (e.g., first time to learn anatomy and no language or/and visual impairments). They were distributed into the three homogeneous groups: active group (<emph>n</emph> = 17, 6 females; age = 17.76 ± 0.56 years), passive group (<emph>n</emph> = 18, 7 females; age = 17.89 ± 0.83 years) and control group (<emph>n</emph> = 15, 4 female; age = 18.07 ± 0.80 years) (see Table 1). The three groups were homogenous according to the results of several tests described below (MRT, left–right hand recognition test, Corsi block task and anatomy pretest) (see Table 1). In addition to the 12 learning sessions (see educational context above), participants took part in different activities according to their respective groups.</p> <p>1 TABLE Study population demographics and performance at the pretest.</p> <p> <ephtml> &lt;table&gt;&lt;thead valign="bottom"&gt;&lt;tr&gt;&lt;th align="left" /&gt;&lt;th align="left" /&gt;&lt;th align="left"&gt;Active group&lt;/th&gt;&lt;th align="left"&gt;Passive group&lt;/th&gt;&lt;th align="left"&gt;Control group&lt;/th&gt;&lt;th align="left" /&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody valign="top"&gt;&lt;tr&gt;&lt;td align="left"&gt;Demographics&lt;/td&gt;&lt;td align="left"&gt;n&lt;/td&gt;&lt;td align="left"&gt;17 (6 females)&lt;/td&gt;&lt;td align="left"&gt;18 (7 females)&lt;/td&gt;&lt;td align="left"&gt;15 (4 females)&lt;/td&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;Age (years)&lt;/td&gt;&lt;td align="left"&gt;17.76&amp;#8201;&amp;#177;&amp;#8201;0.56&lt;/td&gt;&lt;td align="left"&gt;17.89&amp;#8201;&amp;#177;&amp;#8201;0.83&lt;/td&gt;&lt;td align="left"&gt;18.07&amp;#8201;&amp;#177;&amp;#8201;0.80&lt;/td&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;F (p)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;Pretest performance&lt;/td&gt;&lt;td align="left"&gt;VMRT test&lt;/td&gt;&lt;td align="left"&gt;5.47&amp;#8201;&amp;#177;&amp;#8201;2.67&lt;/td&gt;&lt;td align="left"&gt;6.17&amp;#8201;&amp;#177;&amp;#8201;2.95&lt;/td&gt;&lt;td align="left"&gt;3.64&amp;#8201;&amp;#177;&amp;#8201;3.64&lt;/td&gt;&lt;td align="left"&gt;0.815 (p&amp;#8201;=&amp;#8201;0.449)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;Laterality recognition&lt;/td&gt;&lt;td align="left"&gt;61.47&amp;#8201;&amp;#177;&amp;#8201;3.68&lt;/td&gt;&lt;td align="left"&gt;61.39&amp;#8201;&amp;#177;&amp;#8201;2.87&lt;/td&gt;&lt;td align="left"&gt;60.13&amp;#8201;&amp;#177;&amp;#8201;4.69&lt;/td&gt;&lt;td align="left"&gt;0.625 (p&amp;#8201;=&amp;#8201;0.54)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;Corsi&lt;/td&gt;&lt;td align="left"&gt;5.82&amp;#8201;&amp;#177;&amp;#8201;1.18&lt;/td&gt;&lt;td align="left"&gt;6.17&amp;#8201;&amp;#177;&amp;#8201;0.71&lt;/td&gt;&lt;td align="left"&gt;6.27&amp;#8201;&amp;#177;&amp;#8201;1.33&lt;/td&gt;&lt;td align="left"&gt;0.747 (p&amp;#8201;=&amp;#8201;0.48)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;Anatomy pretest&lt;/td&gt;&lt;td align="left"&gt;12.94&amp;#8201;&amp;#177;&amp;#8201;2.82&lt;/td&gt;&lt;td align="left"&gt;13.00&amp;#8201;&amp;#177;&amp;#8201;2.30&lt;/td&gt;&lt;td align="left"&gt;13.40&amp;#8201;&amp;#177;&amp;#8201;2.75&lt;/td&gt;&lt;td align="left"&gt;0.143 (p&amp;#8201;=&amp;#8201;0.867)&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <p>1 <emph>Note</emph>: The pretest results used for setting up the three homogenous group: VMRT corresponds to the Vanderberg and Kuse mental rotation test (score on 24 points); Laterality recognition corresponds to the Left and right recognition test (score on 64 points); Corsi corresponds to the Corsi block task (score on 9 points); Anatomy pretest corresponds to the paper and pencil test with a 20‐item questionnaire (score on 20 points). An ANOVA test was used to compare the result of our three groups.</p> <p>The active group (ACT group) attended three training sessions with the Antepulsio software. The passive group (PAS group) attended three training sessions during which they watched Antepulsio screencasts. The control group (CTRL group) took part in a neutral activity consisting of free discussions, without anatomy topics, with the experimenter during equivalent time as that of the active and passive groups.</p> <p>The experiment included a pre‐ and post‐training session test and was implemented during a real academic course. One training week separated pre and posttest. Participants have, at least, one night's rest between each training session. They did not have two training sessions during the same day allowing learning consolidation due to one‐night sleep.[<reflink idref="bib53" id="ref56">53</reflink>]</p> <p>The main dependent variable was the level of anatomy reached. The pretest was administered just before the study started to set up the three homogeneous groups. The posttest was administered at the end of the experimental week and the retention test was administered 8 weeks after the posttest at the end of the semester. Between posttest and retention test, participants did not have any access to the Antepulsio tool.</p> <p>Due to ethical considerations, Antepulsio was in free access at the end of this study, after the last anatomy test (retention test) for the control group and for all students who did not take part in the experiment.</p> <hd id="AN0176409634-7">Instructional multimedia tool in the active and passive groups</hd> <p>The Antepulsio application is an agile manufactured software. It is a user‐centered design aimed at improving the user interface design and gameplay. The advantages are to make the application continuously improved, based on users' feedback. A previous study was conducted to obtain the users' feedback on Antepulsio and to provide its continuous enhancement, as described in the Introduction part.[<reflink idref="bib50" id="ref57">50</reflink>] Antepulsio was developed for both PC and Apple® computers (Californie, USA) within Unity<sups>®</sups> (2019.4, Unity Technology, Danemark). The pedagogical content was created by anatomists. Antepulsio is made of four exercises: Muscle understanding, Motion analysis, Motion reproduction and Evaluation. "Muscle understanding" presents a series of exercises aiming to select a muscle presented on a model, to name it and to discover the different actions it can perform (see Figure 1). The "Motion analysis" requires to understand the kinematic organization of an action by requesting the students to select the involved muscles with the associated type of contraction (concentric, eccentric, and isometric) (see Figure 2). The "Motion reproduction" consisted of movement recognition while using the same procedure as to that of the motion analysis exercises. The students should make the avatar reproduce the movement by finding the involved muscles with the associated contraction type (see Figure 3). Finally, the "Evaluation exercise" tested the ability of understanding functional anatomy through a multiple‐choice questionnaire. These questions were formative assessments meant to provide feedback to students about their knowledge level (see Figure 4). In the first three exercises, participants had several attempts to answer and complete an exercise. In the "Evaluation exercise," the correct answers were given at the end of the assessment. Participants were not familiar with the Antepulsio contents but they were used to 3D contents during formal lectures and laboratory sessions. In a previous study on users' experience, Chaker et al.[<reflink idref="bib50" id="ref58">50</reflink>] did not report students' difficulties with image comprehension.</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/8Z8K/01apr24/ase2377-fig-0001.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="ase2377-fig-0001.jpg" title="1 Muscle understanding exercise. Participants had to select a muscle on the model, name it and observe its anatomical function." /> </p> <p></p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/8Z8K/01apr24/ase2377-fig-0002.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="ase2377-fig-0002.jpg" title="2 Motion analysis exercise. Participants had to select the correct movement then associate the involved muscles and their type of contraction." /> </p> <p></p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/8Z8K/01apr24/ase2377-fig-0003.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="ase2377-fig-0003.jpg" title="3 Motion reproduction exercise. Participants had first to select the appropriate movement name (A) and then to choose the appropriate involved muscles (B) to reproduce the correct movement presented by the model." /> </p> <p></p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/8Z8K/01apr24/ase2377-fig-0004.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="ase2377-fig-0004.jpg" title="4 Formative assessment exercise. Participants had to answer several questions related to a presented movement animation." /> </p> <p></p> <p>These above‐mentioned exercises were completed by the participants of the active group. They could directly interact with the application with a mouse. The students could rotate the anatomical model, zoom around its different axis, and then, test several propositions. The passive group passively observed screencasts of someone who performed all the above‐mentioned exercises. This was the only difference between the active and the passive groups who had, moreover, the same amount of practice during the same time.</p> <hd id="AN0176409634-12">Assessments</hd> <p></p> <hd id="AN0176409634-13">Anatomy tests</hd> <p>Three anatomy tests were administered: pretest (before training), posttest (immediately after the training week), retention test (8 weeks after posttest). The three tests contained different questions with no repeated items. Items were pulled from a pool of questions. The alignment between the assessments and the learning goals was verified according to the Bloom's Taxonomy of Learning Objectives.[<reflink idref="bib54" id="ref59">54</reflink>] The pretest was administered just before the study and was not part of the official assessments described above. Its aim was to assess students' baseline level of anatomy and its results were used to have three homogeneous groups. Unlike the pretest, the posttest and the retention test were part of the official assessments described above. Students had thus the incentive to perform well. The format of all three assessments was identical among the three groups. It consisted of a paper‐and‐pencil tests with 20‐item questionnaire on trunk functional anatomy each. The posttest consisted of 20 items on trunk functional anatomy. Those items were taken from the 40‐item official assessment covering the second third of the program. The retention test consisted of 20 items on trunk functional anatomy taken from the 100‐item official assessment (administered at the end of the course and covering the overall program). For all these questions students had to analyze trunk movements and then answer to questions regarding the anatomical structures (e.g., bones, ligaments, muscles) respective reactions (see Figure 5). Each item had three possible answers: true, false, or "I do not know." Only the correct answers were kept for each test. Three scores, ranging from 0 to 20, were collected for each student. The three tests contained different questions. However, they had the same difficulty level and contained questions corresponding to the first four categories of Bloom's Taxonomy (Knowledge, Comprehension, Application, and Analysis).</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/8Z8K/01apr24/ase2377-fig-0005.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="ase2377-fig-0005.jpg" title="5 Items examples of the different anatomy tests. This figure is taken from one of the same authors previous papers published in ASE.[48] The participants have three possibilities to answer: &quot;True,&quot; &quot;False,&quot; &quot;I don't know.&quot;" /> </p> <p></p> <p>All three tests lasted 15 min and their internal consistencies (Cronbach alpha) were 0.70, 0.73, 0.76 for pretest, posttest, and retention, respectively. The students had no feedback and no score after the three anatomy tests to avoid behavioral changes during the study.</p> <hd id="AN0176409634-15">Study time</hd> <p>All participants were also asked to estimate how much time they spent per week on learning anatomy outside formal face‐to‐face courses. The duration spent for learning anatomy was collected in hours and minutes.[<reflink idref="bib13" id="ref60">13</reflink>] This time does not include the time spent in face‐to‐face anatomical courses. The participants learned anatomy with the different available course materials provided by Lyon 1 University (e.g., lecture session materials and practical skill training session materials, etc.).</p> <hd id="AN0176409634-16">Vanderberg and Kuse mental rotation test</hd> <p>The Vanderberg and Kuse mental rotation test (MRT) is a paper‐and‐pencil test made of 24 items of 3D‐objects.[<reflink idref="bib55" id="ref61">55</reflink>] Each item is made of five figures, the first figure being the reference on the left panel, associated with four others on the right panel, each differently oriented from the reference. Among the four structures of the right panel, only the two similar to the model should be found. Each participant should mentally rotate each of the target figures, without head movement or changing the orientation of the test‐sheet, and find the two matching the reference. The 24 items must be completed within a 6 min‐period (or, at least, the greatest number among the 24 items). The individual score thus ranged from 0 to 24, one point being given only if the two correct figures were properly identified. The MRT scores were considered in setting up the three homogenous groups.</p> <hd id="AN0176409634-17">Corsi block task</hd> <p>The Corsi block task assesses the visuospatial component of the working memory.[[<reflink idref="bib56" id="ref62">56</reflink>]] It is made of nine blocks successively and irregularly arranged on a computer screen. The sequence starts with two blocks lighting up one after the other. The participant should recall the perceived sequence by tapping the order in which the blocks lighted. The number of blocks correctly recall in each sequence then increases by one new block until the participant is unable to successively recall the correct sequence. The score for each individual ranges from 2 to 9 and represents the working memory ability of each individual. The Corsi scores were considered in setting up the three homogenous groups.</p> <hd id="AN0176409634-18">Left–right hand recognition test</hd> <p>Left–right recognition of hand pictures was assessed on a computer screen.[<reflink idref="bib58" id="ref63">58</reflink>] The test was developed with e‐prime<sups>®</sups> (e‐prime 3.0 Build 3.0.3.80, 1996–2018 Psychology Software Tools, Sharpsburg, USA). The aim was to detect whether the participant distinguished his right from his left. Hand pictures representing a right or a left hand were displayed from the back or palm sides from various orientations with reference to the vertical axis on the screen (0°, 90°, 180°, 270°). To distinguish between a left and right hand, the participants should mentally rotate each item, without hand and head movements. A total of 64 items were presented and participants had to identify as fast and as accurate as possible the laterality of the hand picture by clicking on the right or left arrow. Both number of correct answers and response times were collected. The left–right hand recognition test scores were considered in setting up the three homogenous groups.</p> <hd id="AN0176409634-19">Statistical analysis</hd> <p>The anatomy grades were collected to observe how learning outcomes evolved in each group (ACT, PAS and CTRL) during the pretest, posttest and retention test. Other associated variables (MRT, Corsi block task, left–right hand recognition test and time spent on learning) were also collected. The anatomy grade was the dependent variable. The group (ACT, PAS, CTRL), test rank (pretest, posttest and retention test) and all the others variables (MRT, Corsi block task, left–right hand recognition test and time spent on learning) were the independent variables.</p> <p>The R‐software (version 3.5, R Core Team, New Zealand) was used to run a linear mixed effect analysis with a by‐subject random intercept of the anatomy test grades. As fixed effects, experimental condition (ACT, PAS and CTRL groups), test (pretest, posttest, retention) with interaction terms were entered. Some variables are included as numeric regressor: (<reflink idref="bib1" id="ref64">1</reflink>) spatial ability (MRT, left–right hand recognition test) and working memory capabilities (Corsi test), (<reflink idref="bib2" id="ref65">2</reflink>) experimental group and (<reflink idref="bib3" id="ref66">3</reflink>) time spent on learning. A backward stepwise procedure was applied to select the random‐coefficient regression formulae.[<reflink idref="bib59" id="ref67">59</reflink>] Inspection of the residual plots did not reveal any obvious deviation from the hypotheses of homoscedasticity or normality. The statistical significance threshold was set up for a type 1 error rate of <emph>α</emph> = 5%. As effect sizes, the amount of explained variance was calculated, that is, partial coefficients of determination (Rp<sups>2</sups>) using the ad hoc procedure for linear mixed effects models implemented in the r2glmm package (version O.1.2).[[<reflink idref="bib60" id="ref68">60</reflink>]] Main effects and interactions investigated post hoc using general linear hypotheses testing of planned contrasts form the multcomp package (version 1.4‐20).[[<reflink idref="bib62" id="ref69">62</reflink>]] Holm's corrections were applied to control the false discovery rate.[<reflink idref="bib64" id="ref70">64</reflink>]</p> <p>On the one hand, comparing active group anatomy performance to the passive group performance would allow isolating the effect of interacting with Antepulsio application. On the other hand, comparing both ACT and PAS groups' performances to the CTRL group performance would allow isolating the effect of the content delivered by Antepulsio application.</p> <p>The anatomy test performance of each group was observed by comparing the delta evolution between two anatomy tests, thus indicating the group progresses.</p> <hd id="AN0176409634-20">RESULTS</hd> <p>The ANOVA test revealed five effects of the independent variables on anatomy grades: a main effect of Test (<emph>p</emph> &lt; 0.01), a two‐way interaction of group*test (<emph>p</emph> &lt; 0.01), a two‐way interaction of test* study (p &lt; 0.05), a three‐way interaction of group*test* study (<emph>p</emph> &lt; 0.05) and a three‐way interaction of group*test*Corsi (<emph>p</emph> &lt; 0.05) (see Table 2).</p> <p>2 TABLE ANOVA test results.</p> <p> <ephtml> &lt;table&gt;&lt;thead valign="bottom"&gt;&lt;tr&gt;&lt;th align="left" /&gt;&lt;th align="left"&gt;&lt;italic&gt;df&lt;/italic&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;italic&gt;F&lt;/italic&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;italic&gt;p&lt;/italic&gt;&lt;/th&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody valign="top"&gt;&lt;tr&gt;&lt;td align="left"&gt;Test&lt;/td&gt;&lt;td align="left"&gt;2&lt;/td&gt;&lt;td align="char" char="."&gt;7.50&lt;/td&gt;&lt;td align="char" char="."&gt;&amp;#60;0.01&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;Group*test&lt;/td&gt;&lt;td align="left"&gt;4&lt;/td&gt;&lt;td align="char" char="."&gt;4.69&lt;/td&gt;&lt;td align="char" char="."&gt;&amp;#60;0.01&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;Test*study&lt;/td&gt;&lt;td align="left"&gt;2&lt;/td&gt;&lt;td align="char" char="."&gt;5.49&lt;/td&gt;&lt;td align="char" char="."&gt;&amp;#60;0.05&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;Group*test*study&lt;/td&gt;&lt;td align="left"&gt;4&lt;/td&gt;&lt;td align="char" char="."&gt;4.57&lt;/td&gt;&lt;td align="char" char="."&gt;&amp;#60;0.05&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;Group*test*Corsi&lt;/td&gt;&lt;td align="left"&gt;4&lt;/td&gt;&lt;td align="char" char="."&gt;3.69&lt;/td&gt;&lt;td align="char" char="."&gt;&amp;#60;0.05&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <p>2 <emph>Note</emph>: This test revealed five significant results. <emph>df</emph> corresponds to Degree of Freedom.</p> <p>No significant result was observed for the other variables (MRT, left–right recognition test).</p> <p>Post‐hoc tests were realized to show the ANOVA's difference, the results were presented as Mean and 95% Confidence Interval (<emph>M</emph>, 95% CI) for results with qualitative variables only (i.e., Test or group*test) and they were presented as Predictive impact and 95% Confidence Interval (PI, 95% CI) for results with quantitative variables (test*study; group*test* study, group*test*Corsi). Predictive impact corresponds to the anatomy grades evolution according the considered variables.</p> <p>The results were divided in to two parts: (i) general results without considering the groups, for example, test periods were compared between them (ii) specific results comparing the experimental groups according to the studied variables.</p> <hd id="AN0176409634-21">Results without considering the groups</hd> <p>Main effect: comparing the three anatomy tests results.</p> <p>The three groups improved their grades at the end of the semester.</p> <p>The retention anatomy test grades (16.18, 95% CI [15.18, 17.19]) were better than those of the pretest (14.24, 95% CI [13.25, 15.23]) (<emph>p</emph> = 0.01) and of the posttest (14.93, 95% CI [13.94, 15.93]) (<emph>p</emph> = 0.01), irrespective of the groups. Figure 6 shows a significant result between the retention test and the pretest: the anatomy scores were better at the end of the study (retention test) than at the beginning (pretest).</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/8Z8K/01apr24/ase2377-fig-0006.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="ase2377-fig-0006.jpg" title="6 Anatomy grades according to the test period (pretest, posttest and retention test). Retention anatomy test grades were significantly higher than those of the pretest and the posttest. *p = 0.01." /> </p> <p></p> <p>Two‐way interaction of test*study: comparing the three anatomy tests results according the time spent on learning anatomy.</p> <p>The three groups had better anatomy results at posttest and retention test compared with pretest when considering the time spent on learning anatomy. The predictive impact of the time spent on learning on anatomy grades was higher for the posttest (0.34, 95% CI [−0.39, 1.07]) and retention test (0.65, 95% CI [−0.09, 1.39]) than for pretest (−0.61, 95% CI [−1.34, 0.11]) (<emph>p</emph> &lt; 0.05 and <emph>p</emph> &lt; 0.01 respectively), regardless of the experimental group. Spending more time on learning anatomy leads to better results at posttest and retention test than at pretest, irrespective of the groups.</p> <hd id="AN0176409634-23">Results comparing the three groups</hd> <p>Two‐way interaction of group*test: comparing the three anatomy tests results between the three groups.</p> <p>The CTRL group exhibited larger increase of anatomy grades between posttest and retention test than the PAS group only. The anatomy grades delta evolution between the posttest and the retention test was higher in the CTRL group (posttest: 13.82, 95% CI [11.58, 16.07]; retention test: 18.14, 95% CI [15.89, 20.38]) compared with the PAS group (posttest: 14.91, 95% CI [13.58, 16.23]; retention test: 15.04, 95% CI [13.67, 16.40]) (<emph>p</emph> &lt; 0.05). In other words, the CTRL group demonstrated greater progress than only the PAS group between posttest and retention test. There is no significant result with the active group.</p> <p>Three‐way interaction of group*test*study: comparing the three anatomy tests results between the three groups while considering their respective study time.</p> <p>When comparing the impact of study time between the groups, results showed that spending more time on learning anatomy leads: (i) the PAS group to outperform the CTRL group between pretest and posttest and; (ii) the CTRL group to outperform the two others groups between posttest and retention test.</p> <p>The predictive impact gap of the time spent on learning on the anatomy grades between the pretest and the posttest was higher for the PAS group (pretest: −0.85, 95% CI [−1.91, 0.21]; posttest: 1.06, 95% CI [−0.06, 2.14]) than for the CTRL group (pretest: −0.22, 95% CI [−1.38, 1.43]; posttest: −1.58, 95% CI [−3.2, 0.06]) (<emph>p</emph> &lt; 0.05). The PAS group exhibited larger increase of anatomy grades between pretest and posttest than the CTRL group when they spent more time on learning anatomy. Moreover, the predictive impact gap of the time spent on learning on the anatomy grades between posttest and retention test was higher for CTRL group (posttest: −1.58, 95% CI [−3.2, 0.06]; retention test: 1.38, 95% CI [−0.25, 3.01]) than for the two other groups, ACT group (posttest: 0.56, 95% CI [−0.70, 1.84]; retention test: −0.30, 95% CI [1.82, 0.72]) (<emph>p</emph> &lt; 0.01) and PAS group (posttest: 1.06, 95% CI [−0.06, 2.14]; retention test: 1.06, 95% CI [0.002, 2.12]) (<emph>p</emph> &lt; 0.01 for both) (see Figure 7). The CTRL group exhibited larger increase of anatomy grades between the posttest and the retention test than the two others groups (ACT and PAS groups) when they spent more time on learning anatomy. Moreover, there was no significant difference between the ACT group and the PAS group.</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/8Z8K/01apr24/ase2377-fig-0007.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="ase2377-fig-0007.jpg" title="7 Predictive impact gap of time spent on learning anatomy (study time) on anatomy grades between posttest and retention test. The CTRL group progressed better than the two other groups between posttest and retention test when considering the time spent on learning anatomy (*p &lt; 0.05). ACT, active group; CTRL, control group; PAS, passive group." /> </p> <p></p> <p>Three‐way interaction of group*test*Corsi: comparing the three anatomy tests results between the three groups while considering their respective Corsi test scores.</p> <p>This result showed that in case of better working visual memory, the ACT group exhibited larger increase of anatomy grades between pretest and retention test than the PAS group. The predictive impact gap of the Corsi test score between the pretest and the retention test was higher for the ACT group (pretest: 0.76, 95% CI [0.19, 4.04]; retention test: 2.11, 95% CI [−1.38, 2.42]) than for the PAS group (pretest: −0.33, 95% CI [−5.9, −1.2]; retention test: −3.62, 95% CI [−3.98, 0.68]) (<emph>p</emph> &lt; 0.01). Having a better working visual memory leads to progress better by interacting with Antepulsio. However, there are no significant difference between the ACT group and the CTRL group (see Figure 8).</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/8Z8K/01apr24/ase2377-fig-0008.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="ase2377-fig-0008.jpg" title="8 Predictive impact gap of Corsi‐test score on anatomy grades between pretest and retention test. The ACT group progressed better than the PAS group between pretest and retention test when considering students' working visual memory (*p &lt; 0.05). ACT, active group; CTRL, control group; PAS, passive group." /> </p> <p></p> <hd id="AN0176409634-26">DISCUSSION</hd> <p>This experimental design aimed to test the use of Antepulsio software that was embedded within a real academic course. The main dependent variable evaluating students' learning outcomes consisted of 20 different questions on trunk functional anatomy (no repeated questions were administered). Data were collected from three learning groups. The ACT group participants actively learnt anatomy with the support of the interactive 3D tool Antepulsio. The PAS group learnt anatomy with a non‐interactive version of this tool while the CTRL group did not experiment the Antepulsio system. The anatomy grades were assessed three times during the study: at the beginning (pretest), at the end (posttest), and 8 weeks after the end (retention test).</p> <p>All students from the three groups better performed during retention test (at the end of the semester) than during pretest and posttest. This is linked to the skills and memory consolidation overtime, that is, during retention test.[<reflink idref="bib65" id="ref71">65</reflink>]</p> <p>The examination score was directly linked to the time allocated to working on the course in the three groups. Thus, students had better anatomy grades in both posttest and retention test due to increased study time. As the pretest was administered at the beginning of learning, students had less knowledge than at the end of the courses and after the official examination period, for example, during both posttest and retention test. The retention test, 8 weeks after the end of courses and training was the final official examination of the first‐year kinesiology program. Motivation and self‐involvement may probably explain the increase in study time and the improvement of anatomy scores during this test. Indeed, a high motivation level has early been correlated to examinations success.[<reflink idref="bib66" id="ref72">66</reflink>] Moreover, students' success is also determined by self‐involvement[<reflink idref="bib67" id="ref73">67</reflink>] and increase in time allocated to work and learn.[<reflink idref="bib68" id="ref74">68</reflink>] Harackiewicz et al.[<reflink idref="bib69" id="ref75">69</reflink>] also observed that final examination sessions had positive effect on students' performance and score.</p> <p>However, when the statistical analyses included the group variable, differences were observed among the three groups. The CTRL group exhibited larger increase of anatomy grades between posttest and retention test than the PAS group. First, this result could be explained by a potential cognitive overload experienced by the PAS group who watched Antepulsio screencast compared with the CTRL group who had a neutral activity unrelated to anatomy.[[<reflink idref="bib65" id="ref76">65</reflink>], [<reflink idref="bib70" id="ref77">70</reflink>]] Second, this result cannot be properly interpreted without considering the 3 groups respective study time. In fact, when the time spent on learning increased, the CTRL group outperformed both the PAS and ACT groups at retention test compared to posttest. There is no doubt that the time spent on learning outside formal face‐to‐face courses has a positive impact on learning outcomes, especially in the context of anatomy learning.[<reflink idref="bib13" id="ref78">13</reflink>] However, the PAS group exhibited larger increase of anatomy grades between pretest and posttest than the CTRL group. These two previous results pose a challenge in terms of their sensitivity and present complexity in their interpretation. Authors hypothesize that watching Antepulsio's screencasts was beneficial for the PAS group. However, this result was only observed at the beginning of the course, where the amount of information to be learnt was low. Hoyek et al.[<reflink idref="bib7" id="ref79">7</reflink>] previously evidenced that passive observation of a 3D digital tool was beneficial for learning. They observed that students who benefited from 3D animations better performed than those who learnt human anatomy from 2D drawings. It is therefore surprising to find that interacting with the 3D tool had no actual positive effects on the ACT group students irrespective from study time. Authors assume that the time needed to become familiar with the Antepulsio system has probably interfered with its short‐term benefits. Thus, this may have resulted in high mental load for the ACT group. Unlike the ACT group, the PAS group did not need supplementary time to get familiar with an external learning tool. Therefore, they could have improved more quickly. This result is in line with De Witte et al.[<reflink idref="bib70" id="ref80">70</reflink>] who observed that students experienced additional cognitive training when dealing with a new tool in a short‐term training period. This resulted in high scores in mental load, particularly in the frustration items of the NASA‐TLX questionnaire.[<reflink idref="bib71" id="ref81">71</reflink>] Thus, too complex or new learning conditions and tools do not favor learning, at least during the early stages. There is therefore a step to be taken by familiarizing students with the tool and automating its use. As a consequence, less information remains to be engaged in meaningful knowledge construction. A temporary excessive load during the familiarization period with Antepulsio (e.g., novelty effect or handling application) may have consumed cognitive resources that were not allocated to anatomy learning. Moreover, unnecessary (extraneous) information required learners to allocate cognitive resources to extract relevant from irrelevant information, irrelevant cues playing the role of distractors.[[<reflink idref="bib72" id="ref82">72</reflink>], [<reflink idref="bib74" id="ref83">74</reflink>]] This may explain why the ACT group did not perform better than the two others. In addition to the cognitive load induced by Antepulsio, the working sessions that were added to a real academic course for the purpose of the study increased the volume of information to be learnt by both ACT and PAS groups. It is well known that massed teaching could also induce a greater cognitive load which disables long‐term knowledge retention.[[<reflink idref="bib75" id="ref84">75</reflink>], [<reflink idref="bib77" id="ref85">77</reflink>]]</p> <p>The most notable result of this study in favor of using Antepulsio is related to students' spatial abilities, more particularly visuospatial working memory. This result is supported by Nguyen et al.[<reflink idref="bib78" id="ref86">78</reflink>] who observed that spatial visualization ability is the main source of variation in spatial anatomy task performance.</p> <p>When the Corsi test score increased, the ACT group outperformed the PAS group. This was specifically observed between the pretest and retention test.</p> <p>The visuospatial working memory was a key‐ability of success in the ACT group, as previously shown by Keehner et al.[<reflink idref="bib11" id="ref87">11</reflink>] in the perception of 3D computer pictures. Indeed, perceiving 2D or 3D digital tools required good spatial abilities[[<reflink idref="bib37" id="ref88">37</reflink>], [<reflink idref="bib39" id="ref89">39</reflink>], [<reflink idref="bib79" id="ref90">79</reflink>]] and specifically a good visuospatial working memory.[<reflink idref="bib34" id="ref91">34</reflink>] In line with Hegarty and Sims,[<reflink idref="bib38" id="ref92">38</reflink>] students with high spatial abilities outperformed those with low ones, particularly when questions required a mental animation and representation of the involved structures. Moreover, they observed that differences in spatial working memory abilities distinguished among students, those with the lowest spatial abilities being less accurate. Levinson et al.[<reflink idref="bib33" id="ref93">33</reflink>] confirmed that students with low spatial abilities exhibited learning difficulties when the digital tool showed 3D images in comparison with 2D images only highlighting key‐views. However, whether 3D outperformed 2D images remains unclear. Several studies[[<reflink idref="bib80" id="ref94">80</reflink>], [<reflink idref="bib82" id="ref95">82</reflink>]] evidenced that 3D images can be rotated in virtual space and provided similar gains in learning anatomy as compared to 2D images that only depicted key‐views. As 3D offers different observation perspectives, the resulting information may exceed working memory abilities if the learners are unable to connect the whole views with mental rotation processes. This may explain that participants with a high Corsi‐test score better interacted with the 3D digital tool. With this said, Antepulsio tool fits more into the ability‐as‐enhancer theory.[<reflink idref="bib39" id="ref96">39</reflink>] In other words, high spatial abilities learners could better allocate cognitive resources in building referential connections among the views provided by Antepulsio.</p> <hd id="AN0176409634-27">Limitations of the study and future directions</hd> <p>Cognitive load was not assessed in the present study. The NASA TLX questionnaire could have been used. The results of this study should serve a new version of Antepulsio. This new version could include new exercises with more movement functional analyses, allowing possibly a better knowledge retention. The new version should be developed while considering its induced cognitive load. Its design should be optimized by considering the limitations of the human mind to promote meaningful learning. It should also be improved with users' feedbacks on the easily‐to‐use, the design and the application assessment through the AttrakDiff questionnaire. Furthermore, this new version should be properly implemented into a new academic curriculum, for example, implemented in a distributed (not massed) training sessions. Concurrently with this implementation, future experiments should prioritize internal validity, aligning with Campbell and Stanley's model.[<reflink idref="bib83" id="ref97">83</reflink>] Finally, students' motivation and self‐involvement in anatomy courses should also be assessed.</p> <hd id="AN0176409634-28">CONCLUSION</hd> <p>In its present form, Antepulsio is not an inclusive tool because it is beneficial only for students with good spatial working memory. The advantages of Antepulsio are linked with students' visuospatial working memory capacity. Direct interaction (as the ACT group experienced) better involved working memory than passively watching videos (PAS group). In its present form, Antepulsio may have induced high cognitive load for both its features and instructions. Finally, implementing massed learning sessions for the use of Antepulsio into a real academic course may have overloaded the students.</p> <hd id="AN0176409634-29">ACKNOWLEDGMENTS</hd> <p>The authors thank Jean‐Michel Capdeboscq from Lyon Ingenierie Projet for his precious guidance on the administrative and legal level during all the Antepulsio® project steps. The authors thank Brûle company that coordinated the production process by interlinking the project's different work packages. The authors thank Anatoscope company that built a real‐time physical simulation model of the human body. The authors thank Ochelys company that ensured the agile manufacturing of the application thanks to the UX tests analysis. 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She teaches human anatomy to first‐year kinesiology students and her research interest lies in the impact of digital tools interaction on learning human anatomy.</p> <p>Franck di Rienzo, Ph.D., is an associate professor of cognitive neuroscience, in the Department of Kinesiology and a researcher in the Inter‐University Laboratory of Human Movement Science at the Université de Lyon, Université Claude Bernard, Lyon 1, Villeurbanne Cedex, France. He teaches anatomy, neuroscience and statistics. His research interest lies in neural correlates of mental and motor imagery.</p> <p>Marion Binay, M.Sc., is a research assistant in the Inter‐University Laboratory of Human Movement Science, at the Université de Lyon, Université Claude Bernard, Lyon 1, Villeurbanne Cedex, France. 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| Items | – Name: Title Label: Title Group: Ti Data: Learning Functional Human Anatomy with a New Interactive Three-Dimensional Digital Tool – Name: Language Label: Language Group: Lang Data: English – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Mélanie+Gallot%22">Mélanie Gallot</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-4353-2835">0000-0003-4353-2835</externalLink>)<br /><searchLink fieldCode="AR" term="%22Franck+di+Rienzo%22">Franck di Rienzo</searchLink><br /><searchLink fieldCode="AR" term="%22Marion+Binay%22">Marion Binay</searchLink><br /><searchLink fieldCode="AR" term="%22Christian+Collet%22">Christian Collet</searchLink><br /><searchLink fieldCode="AR" term="%22Nady+Hoyek%22">Nady Hoyek</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-1093-0263">0000-0003-1093-0263</externalLink>) – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="SO" term="%22Anatomical+Sciences+Education%22"><i>Anatomical Sciences Education</i></searchLink>. 2024 17(3):660-673. – Name: Avail Label: Availability Group: Avail 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 – Name: PeerReviewed Label: Peer Reviewed Group: SrcInfo Data: Y – Name: Pages Label: Page Count Group: Src Data: 14 – Name: DatePubCY Label: Publication Date Group: Date Data: 2024 – Name: TypeDocument Label: Document Type Group: TypDoc Data: Journal Articles<br />Reports - Research – Name: Audience 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="%22Technology+Uses+in+Education%22">Technology Uses in Education</searchLink><br /><searchLink fieldCode="DE" term="%22Interaction%22">Interaction</searchLink><br /><searchLink fieldCode="DE" term="%22Kinesiology%22">Kinesiology</searchLink><br /><searchLink fieldCode="DE" term="%22College+Freshmen%22">College Freshmen</searchLink><br /><searchLink fieldCode="DE" term="%22Spatial+Ability%22">Spatial Ability</searchLink><br /><searchLink fieldCode="DE" term="%22Educational+Technology%22">Educational Technology</searchLink> – Name: DOI Label: DOI Group: ID Data: 10.1002/ase.2377 – Name: ISSN Label: ISSN Group: ISSN Data: 1935-9772<br />1935-9780 – Name: Abstract Label: Abstract Group: Ab Data: Human anatomy requires understanding spatial relationships among anatomical structures and is often perceived as difficult to learn by students. To overcome this concern, several digital tools exist with some strengths and limitations among which the lack of interactivity especially for complex functional anatomy learning. In this way, a new interactive three-dimensional tool called Antepulsio was designed. Antepulsio was assessed by comparing three groups of first year kinesiology students to test whether it is likely to favor functional anatomy learning during three training sessions spread over a week. The experiment was conducted during a real academic course. Laterality judgment, 3D spatial abilities and working memory abilities from all participants were previously collected to create three homogeneous groups: the active group (n = 17, 17.76 ± 0.56 years) interacted with Antepulsio, the passive group (n = 18, 17.89 ± 0.83 years) watched videos of Antepulsio while the control group (n = 15, 18.07 ± 0.80 years) performed a neutral activity unrelated to anatomy. Anatomy knowledge was also assessed during pretest, posttest, and retention test (8 weeks after the posttest). The most significant outcome of this study revealed that in case of better working visual memory, the active group outperformed the passive group between pretest and retention test (p < 0.01). In other words, Antepulsio tool is efficient only for students with high visuospatial working memory. These selective benefits of Antepulsio are discussed in terms of cognitive load, training duration and the necessary period of familiarization with the tool. – Name: AbstractInfo Label: Abstractor Group: Ab Data: As Provided – Name: DateEntry Label: Entry Date Group: Date Data: 2024 – Name: AN Label: Accession Number Group: ID Data: EJ1419161 |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1002/ase.2377 Languages: – Text: English PhysicalDescription: Pagination: PageCount: 14 StartPage: 660 Subjects: – SubjectFull: Anatomy Type: general – SubjectFull: Technology Uses in Education Type: general – SubjectFull: Interaction Type: general – SubjectFull: Kinesiology Type: general – SubjectFull: College Freshmen Type: general – SubjectFull: Spatial Ability Type: general – SubjectFull: Educational Technology Type: general Titles: – TitleFull: Learning Functional Human Anatomy with a New Interactive Three-Dimensional Digital Tool Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Mélanie Gallot – PersonEntity: Name: NameFull: Franck di Rienzo – PersonEntity: Name: NameFull: Marion Binay – PersonEntity: Name: NameFull: Christian Collet – PersonEntity: Name: NameFull: Nady Hoyek IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 01 Type: published Y: 2024 Identifiers: – Type: issn-print Value: 1935-9772 – Type: issn-electronic Value: 1935-9780 Numbering: – Type: volume Value: 17 – Type: issue Value: 3 Titles: – TitleFull: Anatomical Sciences Education Type: main |
| ResultId | 1 |
