Using immersive virtual reality to enhance anatomical understanding

A way forward for the teaching and learning of anatomy?

Dr Rob Appleyard, Dr Heidi Probst

Spatial anatomical cognition

• Essential in medical/health care education• Developed via combination of didactic

teaching, anatomical textbooks and:

Study aims

1. Evaluate the educational potential of an immersive virtual environment (IVE) to enhance health care students’ spatial anatomical cognition of the brain.

2. Establish a coherent explanatory framework for how students develop this spatial anatomical cognition using an IVE.

Study design – convergent parallel mixed methods design

Quantitative strand:Pre and post-test RCT to assess extent to which a VR model of the brain enhances spatial cognition of anatomy compared with a comparable plastic model

Qualitative strand:Constructivist Grounded Theory using semi-structured interviews to determine models for how participants interpret and use VR and plastic models to construct spatial anatomical cognition

Comparison:Use of a triangulation protocol to identify where data converges and diverges

Interpretation:Generation of a coherent, explanatory framework for the use of a VR environment to enhance spatial anatomical cognition

n=106

n=24

Assessing spatial anatomical cognition

• 26 items– 8 ‘rods’– 10 ‘BEV’– 8 ‘slice’

• All unusual orientations

• Cronbach’s Alpha: 0.7

IVE and plastic model

Enhancement in spatial anatomical knowledge

-60

-55

-50

-45

-40

-35

-30

-25

-20

-15

-10

-5 0 5 10 15 20 25 30 35 40 45 50 55 600

2

4

6

8

10

12

14

16

InterventionControl

% score

Freq

uenc

y

Mean improvement:18.8% vs 10.8%

Diff. 8% ± 5.2% (95%CIdiff),p = 0.003

d = 0.59BESD1 = 0.29CLES2 = 0.66

1. Binomial effect size display2. Common language effect size

Impact of spatial ability?

0 5 10 15 20 25 30 350.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Intervention Linear (Intervention) ControlLinear (Control)

Spatial ability score

Pre-

inte

rven

tion

MCQ

scor

e

0 5 10 15 20 25 30 350.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Intervention Linear (Intervention)Control Linear (Control)

Spatial ability score

Post

-inte

rven

tion

MCQ

scor

e

rint. = 0.571, rcont. = 0.385

rint. = 0.432, rcont. = 0.437

But no impact on enhancement

0 5 10 15 20 25 30 35

-40.0%

-30.0%

-20.0%

-10.0%

0.0%

10.0%

20.0%

30.0%

40.0%

Intervention Linear (Intervention) Control Linear (Control)

Spatial ability score

Enha

ncem

ent i

n sp

atial

ana

tom

ical

cog

nitio

n

rint. = -0.08, rcont. = 0.119

Participant experiences significantly better in virtual reality group for:

• Enjoyment• Ease of use• Perceived enhancement of anatomical

cognition• Promoting 3D visualisation of anatomy• Promoting importance of spatial anatomical

knowledge

Regression analysis

• Only “the extent to which the model was perceived to enhance visualisation of anatomy” and “pre-intervention MCQ score” were significant predictors of variation in spatial knowledge enhancement (Adjusted R2 = 0.284).• The intervention was not a significant predictor when added

to the model

• So ...–Although spatial knowledge in the intervention group was significantly

higher this was not necessarily attributable to VR alone.–Differences in how learners interpret and use VR models to develop

spatial understanding are important.

A few key points about HOW students develop spatial anatomical cognition?

• MOST students do not visualise anatomy in 3D.• Adopt a predominantly vocationally orientated strategy

– Imaging based– Reconstruct/mentally rotate to recognisable key views

• Adopt a learning strategy to recall the info in a structured way:– Bottom to top, front to back etc.– Predominantly employ a ‘surface’ approach to learning

• A more positive learning experience and the additional interaction afforded by the IVE are the most likely explanation for the difference in effect.

A theory for the development of spatial anatomical cognition

Conclusions• Engagement with a virtual model of the brain in an IVE resulted in significantly

enhanced spatial knowledge of brain anatomy and better reported experiences compared to engagement with plastic anatomical models

• Pre-existing spatial anatomical knowledge is a significant indicator of knowledge enhancement

• Much of the variation in differences in knowledge enhancement can be ascribed to differences in learners' experience and the user-defined interaction afforded by the virtual model– User-control of orientation and viewpoint/transparency

• Most learners do not visualise anatomy in 3D but mentally construct it in a vocationally orientated way

• Learners exploit individual traits, prior experiences and features of the model in order to apply personal learning strategies within a constructivist framework to enhance spatial cognition