Escolar Documentos
Profissional Documentos
Cultura Documentos
com
www.elsevier.com/locate/hpe
Abstract
Background: The aims of this study were to identify studies exploring three-dimensional (3D) anatomy models and their impact
on learning, and to assess the quality of research in this area.
Methods: PubMed, EMBASE, and the Web of Knowledge databases were searched using the following keywords "3D anatomy",
"three dimensional anatomy," "3D virtual reality anatomy," "3D VR anatomy," "3D anatomy model, 3D anatomy teaching", and
anatomy learning VR . Three evaluators independently assessed the quality of research using the Medical Education Research
Study Quality Instrument (MERSQI).
Results: Of the 94,616 studies identied initially, 30 studies reported data on the impact of using 3D anatomy models on learning.
The majority were of moderate quality with a mean MERSQI score 10.26 (SD 2.14, range 6.013.5). The rater intra-class
correlation coefcient was 0.79 (95% condence interval 0.750.88). Most studies were from North America (53%), and Europe
(33%) and the majority were from medical (73%) and Dental (17%) schools.
Conclusions: There was no solid evidence that the use of 3D models is superior to traditional teaching. However, the studies
varied in research quality. More studies are needed to examine the short- and long-term impacts of 3D models on learning using
valid and appropriate tools.
& 2016 King Saud bin Abdulaziz University for Health Sciences. Production and Hosting by Elsevier B.V. This is an open access
article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Keywords: Three dimensional anatomy; Anatomy teaching; 3-D models; MERSQ instrument; Research quality
Peer review under the responsibility of King Saud bin Abdulaziz University for Health Sciences.
n
Corresponding author at: Department of Medical Education, College of Medicine, King Saud University, PO Box 2925, Riyadh 11461, Saudi
Arabia. Tel.: +96614699178.
E-mail address: azer2000@optusnet.com.au (S.A. Azer), drsarahazer@gmail.com (S. Azer).
http://dx.doi.org/10.1016/j.hpe.2016.05.002
2452-3011/& 2016 King Saud bin Abdulaziz University for Health Sciences. Production and Hosting by Elsevier B.V. This is an open access
article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
S.A. Azer, S. Azer / Health Professions Education 2 (2016) 8098 81
world or imaged worlds. Most current virtual reality meeting until a nal consensus was reached. Copies of
environments are displayed either as a computer screen the full articles were obtained for the studies that appeared
or with special stereoscopic displays.4 to represent the best t with the research questions.
Second, using the same search words, the webpages of
the following medical education journals were searched 2.2.4. Stage 4: charting the data
Academic Medicine, Medical Education, Medical The data were charted on spread sheets to record the
Teacher, BMC Medical Education, Advances in title of the papers, authors, country of the rst author/
Health Sciences Education, Teaching and Learning in university where work was done, year of publication,
Medicine, European Journal of Dental Education, and journal/source, type of study, aims/objectives, what was
Journal of Dental Education. carried out, and other key information about results/
Third, the webpages of the following journals on conclusions. Data were summarized using numerical
anatomy and anatomy education were searched: Anato- summary. The numerical summary included number of
mical Science International, Journal of anatomy, participants, and key information found.12
Surgical and Radiologic Anatomy, The Anatomical
Record, Anatomical Science Education, Clinical
Anatomy and Annals of Anatomy. The same search 2.2.5. Stage 5: collating, summarizing and reporting
words were used in searching the journals websites. Other the results
sources for eligible studies were the list of references of Systematic examination of the methodological rigor of
related systematic reviews and research papers identied the studies enabled the grouping of the studies. Extracted
in this search. Because there were a few papers published data were synthesised descriptively to map different
on the research topic during the years 20002004, it was aspects of the literature as outlined in the study key
decided to focus the search for papers from 01 January questions. Studies were grouped according to country of
2000 up to the end of December 2014. origin of the rst author, settings and study participants,
study design and research methodology used, outcomes
2.2.3. Stage 3: inclusion and exclusion criteria and measured, and the year of publication.
study selection 2.3. MERSQI scoring of studies
Studies were included if they were assessing the impact
of using 3D anatomy models on students learning. Only The MERSQI has been used in assessing the quality of
studies in the English language that addressed 3D published medical education research.8 The instrument
anatomy in undergraduate medical, dental and allied comprises 10 items in six domains: study design, sampling
health courses were included. method (number of institutes and response rate), type of
The exclusion criteria were as follows: (1) descriptive data, validity of the evaluation instrument, data analysis,
studies on the use of 3D models in teaching without and outcomes. For each domain the maximum score is
assessing the impact on learning, (2) studies descripting the 3 and the total possible MERSQI score is 18 with a range
development of 3D models, (3) studies on the use of 3D in of 518.9 Higher scores indicate that the study is well
veterinary medicine, (4) the use of 3D in planning surgical, designed, has valid instruments and provided measurable
orthopedic or anesthetic procedures, (5) advanced 3D outcomes beyond gain of knowledge and skills. The use of
models used in enhancing surgical skills, and advanced the MERSQI in this study follows the study by Reed et
training, (6) use of 3D in understanding malformation, rare al.8 and was carried out at the following stages: First, three
conditions or design of surgical technique, (7) history of evaluators (the author and two research assistants)
3D development, (8) use of 3D models in studying reviewed the use of the instrument and practiced its use
comparative anatomy, (9) abstracts, conference proceed- independently to assess seven studies other than those
ings, discussion papers on 3 technologies and gross included in the study. Second, the scores obtained were
anatomy, (10) reviews, commentaries, debates, letters to reviewed in a meeting with the aim to clarify the meaning
the Editors, editorials on using 3D models in anatomy, of each item in the scoring scheme, orient the researchers
(11) papers in languages other than English, and (12) to the use of the instrument and improve consistency
duplicate papers. among all raters. The raters also documented their
The assessors independently reviewed all databases decisions about applying MERSQI coding in a written
using the above stated criteria. Papers identied were manual for future references. Third, the 30 studies were
placed on an Excel sheet (Microsoft Corporation, Red- rated independently by the three evaluators using the
mond, WA, USA). Each evaluator applied the exclusion MERSQI scoring manual. The scores obtained from the
criteria independently. Disagreements were discussed in a three evaluators were used to calculate The rater intra-class
S.A. Azer, S. Azer / Health Professions Education 2 (2016) 8098 83
correlation coefcient (IIC) to determine inter-rater relia- Anatomical Science International 266, Journal of
bility.811 Anatomy 698, Surgical and Radiologic Anatomy 501,
The Anatomical Record 914, Anatomical Science
3. Results Education 249, Clinical Anatomy 651, Annals of
Anatomy 306. Other searches from the list of refer-
3.1. Studies included in this review ences yielded 32 articlesmaking a total of 4223.
After excluding duplicates, a total of 4807 articles were
The search results of PubMed, EMBASE and the identied. On applying the exclusion and inclusion
Web of Knowledge databases yielded 90,393 articles criteria by two evaluators independently, a total of 83
and 4223 articles were identied from searching eight papers were assessed for eligibility. Finally after read-
journals on medical and dental education and seven ing the full text of articles, 53 articles were excluded
anatomy journals (Fig. 1). The results were as follows: making a total of 30 articles meeting the criteria for
Academic Medicine 21, Medical Education 27, Med- synthesis in this review.1342
ical Teacher 40, BMC Medical Education 10, Most studies were conducted in North America (16/
Advances in Health Education 19, Teaching and 30; 53%), and Europe (10/30; 33%). The remaining
Learning in Medicine 6, European Journal of Dental were from Asia (3/30; 10%), and Australia (1/30; 3%).
Education 22, and Journal of Dental Education 461, No studies from Africa or South America were found
Fig. 1. Results of search strategies and selection procedure for a systematic review for studies on 3D anatomy models and impact on learning.
84 S.A. Azer, S. Azer / Health Professions Education 2 (2016) 8098
(Table 1). The majorities of the studies (15/30, 50%) models,21,28 laparoscopic dissection,42 arthroscopic
were published in 20092014 and (9/30; 30%) were examination,29 anatomy glove learning system,39 and
published in 20092011. Only (5/30,17%) were pub- colour coded models.23 Interestingly some of the 3D
lished in 20062008 and (1/30, 3%) were published in digital anatomy models were integrated tools covering
20002005 (Table 1). gross anatomy and related radiological knowledge.27,40
Author, year 3D teaching tool University/ Type of Research question/aim Participants (number) What was carried out/measured Results/limitations
[Reference] used Hospital, study
country
Garg et al., 3D computer McMaster Randomised Examining the role of multiple Undergraduate medical Students were allocated to Certain key or canonical
200213 anatomy model University, controlled orientations in learning students (n87) either multiple-view (MV) viewpoints of an object are
Canada. study anatomy from 3D computer group (any of 36 possible critically important for spatial
models. angles) of rotation or a key- learning. Multiple orientations
view and wiggle group provided by the computer-
(KVW where students can based anatomy software may
85
86
Table 2 (continued )
Author, year 3D teaching tool University/ Type of Research question/aim Participants (number) What was carried out/measured Results/limitations
[Reference] used Hospital, study
country
87
88
Table 2 (continued )
Author, year 3D teaching tool University/ Type of Research question/aim Participants (number) What was carried out/measured Results/limitations
[Reference] used Hospital, study
country
89
90
Table 2 (continued )
Author, year 3D teaching tool University/ Type of Research question/aim Participants (number) What was carried out/measured Results/limitations
[Reference] used Hospital, study
country
classical cross-sectional and Northeastern Spain. The identifying brain structures, than conventional 2D
images (2D). participants level of education execution time, and level of visualization
was classied under two condence in the response
categories: novices and experts were measured.
(n 80).
Khot et al., Virtual reality University of Randomized Examine the effectiveness of Undergraduate medical and Students had ten minutes to Computer-based learning
201335 (VR) computer- Western controlled the three formats of anatomy dental students (n60). study the names of 20 different resources appear to have
91
92 S.A. Azer, S. Azer / Health Professions Education 2 (2016) 8098
Three-dimensional anatomy
terms.
assessment of each of these factors and under-
standing strategies that can maximize learning by
as well as dissection-based
dissection-based teaching,
specimens.
Erasmus
country
alities.20,25,26,29,34,3638,40
[Reference] used
Domain MERSQI item Studies no. Item possible Maximum Item mean Domain mean
(%) score domain (SD) (SD)
93
94 S.A. Azer, S. Azer / Health Professions Education 2 (2016) 8098
1.40 (0.24)
10.26 (2.14)
remaining had the number of participants less than
100. One study had the number of participants as
low as 16 students.16
(SD)
1.40 (0.24)
Item mean
All comments in parentheses are meant for clarication. OSCEobjective structured clinical examination, SPstandardized patient, SD standard deviation.
methods used. The authors tried a number of
Maximum
controlled stu-
dies,20,25,28,32,34,39,41 and crossover studies.19,29,33
However, the assessment of impact was based on
Item possible
practical examinations.25
1.5
1
1
2
2
3
Studies no.
22 (73.3)
22(73.3)
8 (26.6)
7 (23.3)
1 (3.33)
10. Outcomes
design and the type of data and the data analysis was
beyond descriptive analysis. However, the outcomes of
the study were at the level of knowledge and skills
obtained and did not explore higher levels of outcomes
outlined by MERSQ instrument.
The study with the lowest MERSQI score reported the
use of LINDSAY Virtual Human Project. The study did
Table 3 (continued )
design and the outcomes were about satisfaction of the participation in student-run clinics.45 The aims of such
students that participated in the study. assessment were (1) to assess the quality of the literature
on 3D anatomy models and the impact of using such
4. Discussion approaches on learning, (2) to explore whether the
available literature on this area has provided quality studies
4.1. General discussion that can answer our questions in regard to the place of 3D
models in the teaching and learning, and (3) to enable the
A total of 30 studies were identied from searching research community to clearly see the overall pictures and
PubMed, EMBASE, the Web of Knowledge databases, the gaps in the literature that needs further studies and
eight journals on medical and dental education and seven assessment.
anatomy journals. These models were 3D web-based The MERSQI scores obtained from this study are
models, 3D computer- and mobile-based models and 3D comparable with the mean scores obtained from the
non-digital (physical) models. Interestingly these physical systematic reviews of simulated-based training for laparo-
models comprised a range of innovative ideas and were scopic surgery (mean 11.9),46 undergraduate medical
from different countries including USA,23,28 Canada,39 the education in substance abuse (mean 10.42),47 and use
Netherlands,42 Germany,29 and Korea.21 The use of of simulation in neurosurgical education (mean 9.21).48
physical model indicates that schools are not only moving In the presence of several variables among these systematic
into 3D digital models but also there is a place for physical reviews such as the topic researched, the nature of the
model in teaching anatomy; although the major trend is research conducted, the journals in which these studies
directed to digital models. were published and others, such comparisons on the
It is obvious from these studies that students favoured quality of educational studies may reect a common
the use of 3D anatomy models and found these models deciency in the literature particularly in regard to the
more satisfactory when compared to traditional teaching, assessment of validity to support the tools being used in
textbooks and lectures.19,20,24,26,28,30,31,33,39 However, not educational studies; a common deciency also observed in
all studies demonstrated that 3D anatomy models are the studies included in this systematic review.
superior to 2D images or enhanced students' performance
in anatomy. One study showed that 3D anatomy models 4.2. Implications for anatomy teaching
has several disadvantages compared to traditional teach-
ing,35 and a number of studies showed that there was no Although a number of factors affecting learning by
differences between 3D anatomy models and traditional using 3D models have been identied from these studies,
teaching or 2D images.19,20,24,2628,30,33,39 The studies that we are still in need of research that carefully assesses the
showed an impact on learning, mainly demonstrated impact of these factors while using 3D anatomy models.
an improvement in performance on short-term These factors can be grouped into three categories:
basis.14,18,21,22,34,37,38,42 (i) factors related to the 3D model such as the design of
Of these 30 studies, the rst study that was indexed in the model, availability of visual and auditory information
PubMed was published in (year 2002).13 However, nearly simultaneously, and orientations produced by the soft-
80% of the studies found were published in the last 6 years ware,13,33,39 (ii) factors related to the learner characteris-
indicating progressive interest in 3D anatomy models. tics,13,1517,32,35,36,38,41 and (iii) factors related to the
Most studies were from North America and Europe. Only curriculum and the learning environment,16,18,19,32,39 These
one study was from Australia and no studies were from factors should be considered by designers of new 3D
Africa or South America. The majority of the studies were models and course designers, as well as teaching staff.
from Medicine and Dentistry. Very few studies were from Given the increasing interest in 3D anatomy models
other allied health schools. as evidenced from the increasing number of published
Because of the variability in the outcomes from these research in this area, there is a need for multi-
studies, it was decided to assess the quality of the studies institutional studies that examine theories behind learn-
using a standardized measure such as MERSQ instrument. ing by using 3D tools and impact of learning by 3D
MERSQ instrument has been widely used in the literature models on the enhancement of knowledge, comprehen-
to examine studies on training health care professionals sion, clinical skills, integration, and application. Cur-
across the education continuum on chronic disease care,43 rently most studies focused on testing knowledge learnt
coaching to enhance surgeons' operative performance,9 the by answering quiz questions to evaluate their knowl-
impact of physicians' occupational well-being on the edge of 3D relationships,14,16,26 theoretical post-test
quality of patient care,44 and learning outcomes of examinations,20,24,26 and practical examinations.25
96 S.A. Azer, S. Azer / Health Professions Education 2 (2016) 8098
While these methods may provide limited information 5. Conclusions and future research directions
about the usefulness of 3D anatomy models, there is a
need for in-depth research in this new area that can There is evidence of progressive interest in the use of
provide answers to questions about the purpose of 3D anatomy models over the last 6 years as evidenced
using 3D anatomy models in the curriculum, and the from the number of publications. These studies showed
place of 3D anatomy teaching in the undergraduate that 3D anatomy models in digital and non-digital
curriculum and how we can assess the impact of using (physical) format are favored by students in medical,
3D models on students learning. Other questions that dental and other allied health schools and can be used
need answers, will 3D anatomy models prepare stu- to support the curriculum and enhance students skills
dents in a better way to clinical examination and in spatial visualization of anatomical relationships.
understanding of clinical subjects such as surgery and First, factors affecting learning by using 3D models:
medicine? What are the long-term impacts of learning although a few factors have been identied from these
by using 3D anatomy model? Can 3D models help in studies, there are a number of factors that need to be
learning surface anatomy not just gross anatomy and studied. For example, students learning needs, stu-
related subjects?49 dents learning style, educational design of 3D model,
This systematic review is not without limitations. In digital versus physical models, and effect of training
order to ensure that most papers on the topic have been prior to using 3D models. More important, is to
considered, it was decided to design a search strategy understand the interactions between learners and 3D
covering three major databases: PubMed, EMBASE, technologies in order to identify potential advantages
and the Web of Knowledge. Seven keywords were and limitations and ideal methods to be used in
used in searching these databases, as well as the assessing the impact of 3D models on learning.
websites of eight medical and dental education journals Second, exploring the medium-term and long-term
as well as seven anatomy journals. Also, the lists of impacts of learning by using 3D anatomy models. For
references in related research papers identied were example, is learning by using 3D models prepare
searched for any paper related to this review. This students and trainees to surgical procedures. Apart
rigorous approach of study selection and explicit from the enhancement of students skills in anatomy
assessment of relevance of papers as per the inclusion performance, what are other skills developed by
and exclusion criteria resulted in the inclusion of 30 learners when they use 3D anatomy models in their
studies in this systematic review. However, despite learning?
these precautions, the restriction of study retrieval from Third, There is a need for new studies of high
medical, and dental education and anatomy journals research quality by considering the limitations identi-
may not be optimal as no search of other allied health ed in this review in their design.
care journals was conducted. Because journals from With these recommendations for research in mind,
allied health disciplines such as nursing, physiotherapy, this review presents a framework with which research-
and occupational therapy were not searched, there may ers interested in 3D anatomy models will be able to
be studies from these disciplines that were not develop a pedagogical technology to enhance students
included. However, a few papers from these disciplines learning skills and undertake comparative studies of
were found from searching the three databases and it is research relating to 3D anatomy models and their
unlikely that any more data will make signicant impact in undergraduate medical, dental and allied
changes to the outcomes of this review. healthcare curricula.
This review focused only on papers in the English
language. It is possible that there are papers in the Conict of interest
literature addressing the inclusion criteria and the aims
of the study and were not included because they were The author declare that they have no competing
in languages other than English. interest.
Finally, extraction and coding of data, as it is the
case with other reviews, can be subject to opinion of Authors contribution
the observers. To minimize this possible confounding
factor, it was decided to pilot the study and to use a SAA, started the design of the study and its
systematic approach, secure consensus between the methodology, SAA and SA searched the databases,
evaluators at different stages of data charting, collec- collected the data, analysed the ndings, and created
tion and critical evaluation.46 the two lists, SAA and SA interpreted the ndings,
S.A. Azer, S. Azer / Health Professions Education 2 (2016) 8098 97
ranked the articles, creation of tables, created the 12. McCrae N, Purssell E. Eligibility criteria in systematic reviews
gures and drafted the manuscript. SAA and SA published in prominent medical journals: a methodological
contributed to the revision of the manuscript and review. J Eval Clin Pract 2015;21(6):10521058.
13. Garg AX, Norman GR, Eva KW, Spero L, Sharan S. Is there any
approved the nal manuscript for submission.
real virtue of virtual reality?: the minor role of multiple
orientations in learning anatomy from computers. Acad Med
Funding/support 2002;77(10 Suppl):S97S99.
14. Nicholson DT, Chalk C, Funnell WR, Daniel SJ. Can virtual
reality improve anatomy education? A randomised controlled
This work was funded by the College of Medicine study of a computer-generated three-dimensional anatomical ear
Research Center, Deanship of Scientic Research, model. Med Educ 2006;40:10811087.
King Saud University, Riyadh, Saudi Arabia. 15. Guillot A, Champely S, Batier C, Thiriet P, Collet C. Relation-
ship between spatial abilities, mental rotation and functional
anatomy learning. Adv Health Sci Educ Theory Pract 2007;12
Acknowledgements (4):491507.
16. Hisley KC, Anderson LD, Smith SE, Kavic SM, Tracy JK.
The authors would like to thank Diana Azer for her Coupled physical and digital cadaver dissection followed by a
assistance and reviewing the manuscript. Also thanks visual test protocol provides insights into the nature of anatomi-
Dr. Lily Scott for her assistance in this work and Ms. cal knowledge and its evaluation. Anat Sci Educ 2008;1(1):
Mae Eustaquio for her secretarial help. 2740.
17. Levinson AJ, Weaver B, Garside S, McGinn H, Norman GR.
Virtual reality and brain anatomy: a randomised trial of e-
References learning instructional designs. Med Educ 2007;41:495501.
18. Marsh KR, Gifn BF, Lowrie Jr. DJ. Medical student retention
1. Azer SA, Eizenberg N. Do we need dissection in an integrated of embryonic development: impact of the dimensions added by
problem-based learning medical course? Perceptions of rst- and multimedia tutorials. Anat Sci Educ 2008;1(6):252257.
second-year students. Surg Radiol Anat 2007;29(2):173180. 19. Donnelly L, Patten D, White P, Finn G. Virtual human dissector
2. Berney S, Btrancourt M, Molinari G, Hoyek N. How spatial as a learning tool for studying cross-sectional anatomy. Med
abilities and dynamic visualizations interplay when learning Teach 2009;31(6):553555.
functional anatomy with 3D anatomical models. Anat Sci Educ 20. Hu J, Yu H, Shao J, Li Z, Wang J, Wang Y. Effects of dental 3D
2015;8(5):452462. multimedia system on the performance of junior dental students
3. Langlois J, Wells GA, Lecourtois M, Bergeron G, Yetisir E, in preclinical practice: a report from China. Adv Health Sci Educ
Martin M. Spatial abilities of medical graduates and choice of Theory Pract 2009;14(1):123133.
residency programs. Anat Sci Educ 2015;8(2):111119. 21. Oh CS, Kim JY, Choe YH. Learning of cross-sectional anatomy
4. Vandenberg SG, Kuse AR. Mental rotations, a group test of using clay models. Anat Sci Educ 2009;2(4):156159.
three-dimensional spatial visualization. Percept Mot Skills 22. Abid B, Hentati N, Chevallier JM, Ghorbel A, Delmas V,
1978;47(2):599604. Douard R. Traditional versus three-dimensional teaching of
5. Ullman S. Three-dimensional object recognition based on the peritoneal embryogenesis: a comparative prospective study. Surg
combination of views. Cognition 1998;67(12):2144. Radiol Anat 2010;32(7):647652.
6. Yiannakopoulou E, Nikiteas N, Perrea D, Tsigris C. Virtual 23. Estevez ME, Lindgren KA, Bergethon PR. A novel three-
reality simulators and training in laparoscopic surgery. Int J Surg dimensional tool for teaching human neuroanatomy. Anat Sci
2015;13:6064. Educ 2010;3(6):309317.
7. Arksey H, OMalley L. Scoping studies: towards a methodolo- 24. Hu A, Wilson T, Ladak H, Haase P, Doyle P, Fung K.
gical framework. Int J Soc Res Methodol Theory Pract 2005;8: Evaluation of a three-dimensional educational computer model
1932.
of the larynx: voicing a new direction. J Otolaryngol Head Neck
8. Reed DA, Cook DA, Beckman TJ, Levine RB, Kern DE, Wright
Surg 2010;39(3):315322.
SM. Association between funding and quality of published
25. Codd AM, Choudhury B. Virtual reality anatomy: is it compar-
medical education research. J Am Med Assoc 2007;298(9):
able with traditional methods in the teaching of human forearm
10021009.
musculoskeletal anatomy?. Anat Sci Educ 2011;4(3):119125.
9. Min H, Morales DR, Orgill D, Smink DS, Yule S. Systematic
26. Keedy AW, Durack JC, Sandhu P, Chen EM, O'Sullivan PS,
review of coaching to enhance surgeons' operative performance.
Surgery 2015;158(5):11681191. Breiman RS. Comparison of traditional methods with 3D
10. Reed DA, Beckman TJ, Wright SM, Levine RB, Kern DE, Cook computer models in the instruction of hepatobiliary anatomy.
DA. Predictive validity evidence for medical education research Anat Sci Educ 2011;4(2):8491.
study quality instrument scores: quality of submissions to JGIM's 27. Vuchkova J, Maybury TS, Farah CS. Testing the educational
Medical Education Special Issue. J Gen Intern Med 2008;23(7): potential of 3D visualization software in oral radiographic
903907. interpretation. J Dent Educ 2011;75(11):14171425.
11. Cook DA, Reed DA. Appraising the quality of medical education 28. Bareither ML, Arbel V, Growe M, Muszczynski E, Rudd A,
research methods: the medical education research study quality Marone JR. Clay modeling versus written modules as effective
instrument and the NewcastleOttawa scale-education. Acad Med interventions in understanding human anatomy. Anat Sci Educ
2015;90(8):10671076. 2013;6(3):170176.
98 S.A. Azer, S. Azer / Health Professions Education 2 (2016) 8098
29. Knobe M, Carow JB, Ruesseler, M, et al. Arthroscopy or 40. Murakami T, Tajika Y, Ueno, H, et al. An integrated teaching
ultrasound in undergraduate anatomy education: a randomized method of gross anatomy and computed tomography radiology.
cross-over controlled trial. BMC Med Educ 2012;12:85. Anat Sci Educ 2014;7(6):438449.
30. Maggio MP, Hariton-Gross K, Gluch J. The use of independent, 41. Nguyen N, Mulla A, Nelson AJ, Wilson TD. Visuospatial
interactive media for education in dental morphology. J Dent anatomy comprehension: the role of spatial visualization ability
Educ 2012;76(11):14971511. and problem-solving strategies. Anat Sci Educ 2014;7(4):
31. Metzler R, Stein D, Tetzlaff, R, et al. Teaching on three- 280288.
dimensional presentation does not improve the understanding of 42. ten Brinke B, Klitsie PJ, Timman R, Busschbach JJ, Lange JF,
according CT images: a randomized controlled study. Teach
Kleinrensink GJ. Anatomy education and classroom versus
Learn Med 2012;24(2):140148.
laparoscopic dissection-based training: a randomized study at
32. Nguyen N, Nelson AJ, Wilson TD. Computer visualizations:
factors that inuence spatial anatomy comprehension. Anat Sci one medical school. Acad Med 2014;89(5):806810.
Educ. 2012;5(2):98108. 43. Bogetz JF, Rassbach CE, Bereknyei S, Mendoza FS, Sanders
33. Roach VA, Brandt MG, Moore CC, Wilson TD. Is three- LM, Braddock 3rd CH. Training health care professionals for
dimensional videography the cutting edge of surgical skill 21st-century practice: a systematic review of educational inter-
acquisition?. Anat Sci Educ 2012;5(3):138145. ventions on chronic care. Acad Med 2015;90(11):15611572.
34. Ruisoto P, Juanes JA, Contador I, Mayoral P, Prats-Galino A. 44. Scheepers RA, Boerebach BC, Arah OA, Heineman MJ,
Experimental evidence for improved neuroimaging interpretation Lombarts KM. A systematic review of the impact of physicians'
using three-dimensional graphic models. Anat Sci Educ 2012;5 occupational well-being on the quality of patient care. Int J
(3):132137. Behav Med 2015;22(6):683698.
35. Khot Z, Quinlan K, Norman GR, Wainman B. The relative 45. Schutte T, Tichelaar J, Dekker RS, van Agtmael MA, de Vries
effectiveness of computer-based and traditional resources for TP, Richir MC. Learning in student-run clinics: a systematic
education in anatomy. Anat Sci Educ 2013;6(4):211215. review. Med Educ 2015;49(3):249263.
36. Tworek JK, Jamniczky HA, Jacob C, Hallgrmsson B, Wright B. 46. Zendejas B, Brydges R, Hamstra SJ, Cook DA. State of the
The LINDSAY Virtual Human Project: an immersive approach evidence on simulation-based training for laparoscopic surgery: a
to anatomy and physiology. Anat Sci Educ 2013;6(1):1928.
systematic review. Ann Surg 2013;257(4):586593.
37. Mller-Stich BP, Lb N, Wald, D, et al. Regular three-
47. Kothari D, Gourevitch MN, Lee, JD, et al. Undergraduate
dimensional presentations improve in the identication of
medical education in substance abuse: a review of the quality of
surgical liver anatomy a randomized study. BMC Med Educ
the literature. Acad Med 2011;86(1):98112.
2013;13:131.
38. Hoyek N, Collet C, Di Rienzo F, De Almeida M, Guillot A. 48. Kirkman MA, Ahmed M, Albert AF, Wilson MH, Nandi D,
Effectiveness of three-dimensional digital animation in teaching Sevdalis N. The use of simulation in neurosurgical education and
human anatomy in an authentic classroom context. Anat Sci Educ training. A systematic review. J Neurosurg 2014;121(2):
2014;7(6):430437. 228246.
39. Lisk K, McKee P, Baskwill A, Agur AM. Student perceptions 49. Azer SA. The place of surface anatomy in the medical literature
and effectiveness of an innovative learning tool: anatomy glove and undergraduate anatomy textbooks. Anat Sci Educ 2013;6(6):
learning system. Anat Sci Educ 2015;8(2):140148. 415432.