Immersive Virtual Reality and Cadaveric Bone are Equally Effective in Skeletal Anatomy Education: A Randomized Crossover Noninferiority Trial

Elsevier

Available online 5 May 2023

Journal of Surgical EducationAuthor links open overlay panel, , , , , , , Objective

Immersive virtual reality (IVR) technology is transforming medical education. Our aim was to compare the effectiveness of IVR with cadaveric bone models in teaching skeletal anatomy.

Setting

Anatomy laboratory of a large medical school.

Participants

Incoming first-year medical students. Participants were randomized to IVR or cadaveric groups studying upper limb skeletal anatomy, and then were crossed over to use the opposite tool, to study lower limb skeletal anatomy. Participants in both groups completed a pre-and postintervention knowledge test. The primary endpoint of the study was change in performance from the pre-to postintervention knowledge test. Surveys were completed to assess participant's impressions on IVR as an educational tool.

Results

Fifty first-year medical students met inclusion criteria and were randomized. Among all students, the average score on the preintervention knowledge test was 14.6% (standard deviation (SD) = 18.2%) and 25.0% (SD = 17%) for upper and lower limbs, respectively. Percentage increase in scores between pre-and postintervention knowledge test, was 15.0% in the upper limb IVR group, and 16.7% for upper limb cadaveric bones (p = 0.286). For the lower limb, score increase was 22.6% in the IVR and 22.5% in the cadaveric bone group (p = 0.936). 79% of participants found that IVR was most valuable for teaching 3-dimensional orientation, anatomical relationships, and key landmarks. Majority of participants were favorable towards combination use of traditional methods and IVR technology for learning skeletal anatomy (LSM>3).

Conclusions

In this randomized controlled trial, there was no significant difference in knowledge after using IVR or cadaveric bones for skeletal anatomy education. These findings have further implications for medical schools that face challenges in acquiring human cadavers and cadaveric parts.

Section snippetsINTRODUCTION

Novel immersive virtual reality (IVR) technology is an area of active research in medical education. Virtual anatomy education using head-mounted displays creates a sense of realistic presence for the user with complete immersion into the virtual environment of interest.1 IVR software has the potential to allow users to interact with virtual objects, move within the virtual rooms, and interact with other users.1

Traditionally, undergraduate medical anatomy education consists of didactic

METHODS

A crossover noninferiority randomized controlled trial was conducted to assess the efficacy of IVR for skeletal anatomy education compared to cadaveric bone models. Research Ethics Board (REB) approval was obtained from the University of Toronto and study abided by the Consolidated Standards of Reporting Trials (CONSORT) guidelines. This study did not meet criteria for trial registration on ClinicalTrials.gov.

Baseline Demographics

Sixty-one students initially completed the baseline demographic survey, of which 50 met inclusion criteria. Reasons for exclusion included previous undergraduate/graduate studies in anatomy (n = 4), previous work experience as an anatomy teaching assistant (n = 2), previous research in anatomy (n = 2), lack of response from student after completion of baseline surveys (n = 2), and being a nonfirst year medical student (n = 1). Included students were randomized to upper limb IVR (n = 25) or

DISCUSSION

In the present study, we performed the first cross-over RCT comparing IVR to cadaveric models in context of teaching anatomy. There was no significant difference between student performances in knowledge tests after using IVR or cadaveric bones at various stages. IVR and cadaveric bones were shown to be equally effective in skeletal anatomy education. There was a higher mean postintervention scores for the IVR group learning lower limbs, while the cadaveric group scored higher for upper limbs,

CONCLUSION

In this noninferiority crossover randomized controlled trial, we found no significant difference between student performance in knowledge tests after using IVR or cadaveric bones. IVR and cadaveric bones were equally effective in skeletal anatomy education. IVR created an enjoyable learning experience for participants, with very few adverse events from the headsets. However, a majority of students preferred a combination of IVR and cadaveric teaching in their anatomy education. Going forward,

Acknowledgment

Figures 1 and 4 were created using Biorender.com.

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© 2023 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

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