A meta‐analysis of the educational effectiveness of three‐dimensional visualization technologies in teaching anatomy

Many medical graduates are deficient in anatomy knowledge and perhaps below the standards for safe medical practice. Three‐dimensional visualization technology (3DVT) has been advanced as a promising tool to enhance anatomy knowledge. The purpose of this review is to conduct a meta‐analysis of the effectiveness of 3DVT in teaching and learning anatomy compared to all teaching methods. The primary outcomes were scores of anatomy knowledge tests expressed as factual or spatial knowledge percentage means. Secondary outcomes were perception scores of the learners. Thirty‐six studies met the inclusion criteria including 28 (78%) randomized studies. Based on 2,226 participants including 2,128 from studies with comparison groups, 3DVTs (1) resulted in higher (d = 0.30, 95%CI: 0.02–0.62) factual knowledge, (2) yielded significant better results (d = 0.50, 95%CI: 0.20–0.80) in spatial knowledge acquisition, and (3) produced significant increase in user satisfaction (d = 0.28, 95%CI = 0.12–0.44) and in learners' perception of the effectiveness of the learning tool (d = 0.28, 95%CI = 0.14–0.43). The total mean scores (out of five) and ±SDs for QUESTS's Quality and Strength dimensions were 4.38 (±SD 1.3) and 3.3 (±SD 1.7), respectively. The results have high internal validity, for the improved outcomes of 3DVTs compared to other methods of anatomy teaching. Given that anatomy teaching and learning in the modern medical school appears to be approaching a crisis, 3DVT can be a potential solution to the problem of inadequate anatomy pedagogy. Anat Sci Educ 8: 525–538. © 2014 American Association of Anatomists.

[1]  T. Boutefnouchet,et al.  A three‐year prospective longitudinal cohort study of medical students' attitudes toward anatomy teaching and their career aspirations , 2010, Anatomical sciences education.

[2]  Örjan Smedby,et al.  Web‐based interactive 3D visualization as a tool for improved anatomy learning , 2009, Anatomical sciences education.

[3]  W. Cottam,et al.  Adequacy of medical school gross anatomy education as perceived by certain postgraduate residency programs and anatomy course directors , 1999, Clinical anatomy.

[4]  Hans-Peter Meinzer,et al.  Teaching on Three-Dimensional Presentation Does Not Improve the Understanding of According CT Images: A Randomized Controlled Study , 2012, Teaching and learning in medicine.

[5]  S. Becker,et al.  Malpractice in Head and Neck Surgery , 2012, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[6]  Neil M. Hamilton,et al.  A novel 3D stereoscopic anatomy tutorial , 2012, The clinical teacher.

[7]  Stuart R. Lipsitz,et al.  Patterns of Technical Error Among Surgical Malpractice Claims: An Analysis of Strategies to Prevent Injury to Surgical Patients , 2007, Annals of surgery.

[8]  C P Friedman,et al.  The research we should be doing , 1994, Academic medicine : journal of the Association of American Medical Colleges.

[9]  The clinical anatomy of several invasive procedures , 2022 .

[10]  M. A. Tavares,et al.  A clinical anatomy curriculum for the medical student of the 21st century: gross anatomy. , 1997, Clinical anatomy.

[11]  S. Kavic,et al.  Coupled physical and digital cadaver dissection followed by a visual test protocol provides insights into the nature of anatomical knowledge and its evaluation , 2008, Anatomical sciences education.

[12]  A. Khurana,et al.  The anatomy of anatomy: A review for its modernization , 2010, Anatomical sciences education.

[13]  Timothy D. Wilson,et al.  Computer visualizations: Factors that influence spatial anatomy comprehension , 2012, Anatomical sciences education.

[14]  Zhuming Ai,et al.  Virtual Reality: New Method of Teaching Anorectal and Pelvic Floor Anatomy , 2003 .

[15]  Peter R Bergethon,et al.  A novel three‐dimensional tool for teaching human neuroanatomy , 2010, Anatomical sciences education.

[16]  M. Stringer,et al.  Iatrogenic nerve injury in a national no‐fault compensation scheme: an observational cohort study , 2012, International journal of clinical practice.

[17]  D. Heylings,et al.  Evaluation of a computer program (‘disect’) to consolidate anatomy knowledge: A randomised-controlled trial , 2010, Medical teacher.

[18]  Farah Naaz,et al.  Item difficulty in the evaluation of computer‐based instruction: An example from neuroanatomy , 2012, Anatomical sciences education.

[19]  A. Winkelmann,et al.  Anatomical dissection as a teaching method in medical school: a review of the evidence , 2007, Medical education.

[20]  Sandrine de Ribaupierre,et al.  Evaluation of Neuroanatomical Training Using a 3D Visual Reality Model , 2012, MMVR.

[21]  Ara Darzi,et al.  Face and Content Validation of a Virtual Reality Temporal Bone Simulator , 2012, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[22]  O Findl,et al.  Advantage of three dimensional animated teaching over traditional surgical videos for teaching ophthalmic surgery: a randomised study , 2005, British Journal of Ophthalmology.

[23]  C Schmidt,et al.  MyMiCROscope: intelligent virtual microscopy in a blended learning model at Ulm University. , 2011, Annals of anatomy = Anatomischer Anzeiger : official organ of the Anatomische Gesellschaft.

[24]  Frederic Venail,et al.  Enhancement of temporal bone anatomy learning with computer 3D rendered imaging softwares , 2010, Medical teacher.

[25]  Lindsey E. Dayer,et al.  Smartphone medication adherence apps: potential benefits to patients and providers. , 2013, Journal of the American Pharmacists Association : JAPhA.

[26]  Emil H Schemitsch,et al.  Virtual fracture carving improves understanding of a complex fracture: a randomized controlled study. , 2012, The Journal of bone and joint surgery. American volume.

[27]  D. Altman,et al.  Measuring inconsistency in meta-analyses , 2003, BMJ : British Medical Journal.

[28]  D. Moher,et al.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. , 2010, International journal of surgery.

[29]  Susana Norma Biasutto,et al.  Teaching anatomy: cadavers vs. computers? , 2006, Annals of anatomy = Anatomischer Anzeiger : official organ of the Anatomische Gesellschaft.

[30]  G R Norman,et al.  Do virtual computer models hinder anatomy learning? , 1999, Academic medicine : journal of the Association of American Medical Colleges.

[31]  Vincent Delmas,et al.  Traditional versus three-dimensional teaching of peritoneal embryogenesis: a comparative prospective study , 2010, Surgical and Radiologic Anatomy.

[32]  Kevin Fung,et al.  Long-term retention of a 3-dimensional educational computer model of the larynx: a follow-up study. , 2011, Archives of otolaryngology--head & neck surgery.

[33]  D. Cook.  The Research We Still Are Not Doing: An Agenda for the Study of Computer-Based Learning , 2005, Academic medicine : journal of the Association of American Medical Colleges.

[34]  K. Fung,et al.  Role of a computer-generated three-dimensional laryngeal model in anatomy teaching for advanced learners , 2011, The Journal of Laryngology & Otology.

[35]  Zhuming Ai,et al.  Virtual Reality , 2003, Diseases of the colon and rectum.

[36]  W. Pawlina,et al.  Medical education in the anatomical sciences: The winds of change continue to blow , 2009, Anatomical sciences education.

[37]  G. Norman,et al.  How medical students learn spatial anatomy , 2001, The Lancet.

[38]  D. Heylings,et al.  Anatomy 1999–2000: the curriculum, who teaches it and how? , 2002, Medical education.

[39]  Kevin W Eva,et al.  Is There Any Real Virtue of Virtual Reality?: The Minor Role of Multiple Orientations in Learning Anatomy from Computers , 2002, Academic medicine : journal of the Association of American Medical Colleges.

[40]  R. Leonard,et al.  A clinical anatomy curriculum for the medical student of the 21st century: Gross anatomy , 1996, Clinical anatomy.

[41]  S. Daniel,et al.  Can virtual reality improve anatomy education? A randomised controlled study of a computer‐generated three‐dimensional anatomical ear model , 2006, Medical education.

[42]  H. Ellis.  Medico-legal Litigation and its Links with Surgical Anatomy , 2002 .

[43]  Julian A. Smith.  Can anatomy teaching make a come back? , 2005, ANZ journal of surgery.

[44]  E. Winer,et al.  Evaluating mental workload of two-dimensional and three-dimensional visualization for anatomical structure localization. , 2013, Journal of laparoendoscopic & advanced surgical techniques. Part A.

[45]  Leo Donnelly,et al.  Virtual human dissector as a learning tool for studying cross-sectional anatomy , 2009, Medical teacher.

[46]  J. Higgins,et al.  Cochrane Handbook for Systematic Reviews of Interventions, Version 5.1.0. The Cochrane Collaboration , 2013 .

[47]  D. Dolmans,et al.  A systematic review of faculty development initiatives designed to improve teaching effectiveness in medical education: BEME Guide No. 8 , 2006, Medical teacher.

[48]  Patricia S O'Sullivan,et al.  Comparison of traditional methods with 3D computer models in the instruction of hepatobiliary anatomy , 2011, Anatomical sciences education.

[49]  S. Tibrewal.  The anatomy knowledge of surgical trainees: the trainer's view , 2006 .

[50]  Hans-Peter Meinzer,et al.  Three‐dimensional visualisation improves understanding of surgical liver anatomy , 2010, Medical education.

[51]  Julijana Vuchkova,et al.  Testing the educational potential of 3D visualization software in oral radiographic interpretation. , 2011, Journal of dental education.

[52]  B. S. Hampton,et al.  A Randomized Trial to Estimate the Effect of an Interactive Computer Trainer on Resident Knowledge of Female Pelvic Floor Dysfunction and Anatomy , 2010, Female pelvic medicine & reconstructive surgery.

[53]  J. Kooloos,et al.  Do images influence assessment in anatomy? Exploring the effect of images on item difficulty and item discrimination , 2013, Anatomical sciences education.

[54]  K Moss.  Learner retention of anatomical information presented in a digital two-dimensional format versus a digital three-dimensional format. , 2001, The Journal of biocommunication.

[55]  D. J. Lowrie,et al.  Survey of gross anatomy, microscopic anatomy, neuroscience, and embryology courses in medical school curricula in the United States , 2002, The Anatomical record.

[56]  Amy JoAnne Hilbelink,et al.  The effectiveness and user perception of 3-dimensional digital human anatomy in an online undergraduate anatomy laboratory , 2007 .

[57]  R. Trelease.  Diffusion of innovations: Smartphones and wireless anatomy learning resources , 2008, Anatomical sciences education.

[58]  Glenn Regehr,et al.  Exploring the Changing Learning Environment of the Gross Anatomy Lab , 2011, Academic medicine : journal of the Association of American Medical Colleges.

[59]  F. Naaz.  Learning from graphically integrated 2D and 3D representations improves retention of neuroanatomy. , 2012 .

[60]  G. Norman,et al.  Virtual reality and brain anatomy: a randomised trial of e‐learning instructional designs , 2007, Medical education.

[61]  A. Ladd,et al.  Evaluation of a surgical simulator for learning clinical anatomy , 2004, Medical education.

[62]  O. Plaisant,et al.  The future of clinical anatomy , 2011 .

[63]  Amit Garg,et al.  Modern moulage: evaluating the use of 3-dimensional prosthetic mimics in a dermatology teaching program for second-year medical students. , 2010, Archives of dermatology.

[64]  Janet Grant,et al.  Best Evidence Medical Education , 2000, Advances in health sciences education : theory and practice.

[65]  P. Pospiech,et al.  Introducing and evaluating MorphoDent, a Web-based learning program in dental morphology. , 2010, Journal of dental education.

[66]  J. Somville,et al.  Analysis of Surgical Errors in Malpractice Claims in Belgium , 2010, Acta chirurgica Belgica.

[67]  Takeshi Konishi,et al.  The Effectiveness of an Interactive 3-Dimensional Computer Graphics Model for Medical Education , 2012, Interactive journal of medical research.

[68]  Thenkurussi Kesavadas,et al.  Can image-based virtual reality help teach anatomy? , 2010, Journal of endourology.

[69]  D. Moher,et al.  Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement , 2009, BMJ : British Medical Journal.

[70]  Kevin Fung,et al.  Evaluation of a three-dimensional educational computer model of the larynx: voicing a new direction. , 2010, Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale.

[71]  M. Stuart,et al.  Survey of clinicians' attitudes to the anatomical teaching and knowledge of medical students , 2005, Clinical anatomy.

[72]  Hernando Cuellar,et al.  Endoscopic Sinus Surgery Simulator as a teaching tool for anatomy education. , 2008, American journal of surgery.

[73]  Sarah B. Williams,et al.  “Let's Get Physical”: Advantages of a physical model over 3D computer models and textbooks in learning imaging anatomy , 2013, Anatomical sciences education.

[74]  J. Fasel,et al.  Anatomy teaching for medical undergraduates: General practice as a guideline? The brain , 1999, Clinical anatomy.

[75]  B. Wainman,et al.  The relative effectiveness of computer‐based and traditional resources for education in anatomy , 2013, Anatomical sciences education.

[76]  Alberto Prats-Galino,et al.  Experimental evidence for improved neuroimaging interpretation using three‐dimensional graphic models , 2012, Anatomical sciences education.

[77]  E. Acosta,et al.  An interactive three‐dimensional virtual body structures system for anatomical training over the internet , 2006, Clinical anatomy.

[78]  A. Ziv,et al.  Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review , 2005, Medical teacher.

[79]  Fred Dech,et al.  Virtual reality: immersive hepatic surgery educational environment. , 2002, Surgery.

[80]  Donovan A. McFarlane,et al.  Evaluating Training Programs: The Four Levels , 2006 .

[81]  Athanasios K. Tsakalidis,et al.  easyHealthApps: e-Health Apps Dynamic Generation for Smartphones & Tablets , 2013, Journal of Medical Systems.

[82]  J E F Fitzgerald,et al.  Are we teaching sufficient anatomy at medical school? The opinions of newly qualified doctors , 2008, Clinical anatomy.

[83]  P. O'Sullivan,et al.  Perceptions of a mobile technology on learning strategies in the anatomy laboratory , 2013, Anatomical sciences education.

[84]  B S Kuszyk,et al.  An interactive computer-based tool for teaching the segmental anatomy of the liver: usefulness in the education of residents and fellows. , 1997, AJR. American journal of roentgenology.

[85]  Bipasha Choudhury,et al.  Virtual reality anatomy: Is it comparable with traditional methods in the teaching of human forearm musculoskeletal anatomy? , 2011, Anatomical sciences education.

[86]  J. Kooloos,et al.  Exploring the validity of assessment in anatomy: Do images influence cognitive processes used in answering extended matching questions? , 2014, Anatomical sciences education.

[87]  Matthias Holzer,et al.  Student learning preferences and the impact of a multimedia learning tool in the dissection course at the University of Munich. , 2009, Annals of anatomy = Anatomischer Anzeiger : official organ of the Anatomische Gesellschaft.