Our meta-analysis of randomized controlled studies examined the effectiveness of VR-based technology in anatomy teaching. In this study, the authors discovered that VR interventions have a moderate enhancement (SMD = 0.53) in test scores of learners in comparation with conventional or other 2D digital methods (p < 0.01). As is well-known, more interactive VR interventions could moderately improve medical learners’ academic scores in anatomy. Among 15 studies, only 5 studies assessed satisfaction scores as a secondary outcome with a result that most of students more interested in using VR to learn anatomy. Naturally, the fact that no included randomized controlled researches were found in databases before 2004 suggests that VR is an emerging academic method [25], attracting increasing interest from the world of education. In general, the risk of bias for most studies was unclear for a lack of description or data. Potentially high risk of incomplete reporting bias identified in some studies. However, results of sensitivity and subgroup analyses were nonsignificant for variables (year, country, learners, course, intervention, comparator, and duration) on the outcome variables. Since the different types of learners and interventions in researches in this review, inconsistent methodological method makes it difficult to draw accurate conclusions.
In the subgroup analysis for levels of learners, the source of high heterogeneity could be diverse phases of participants’ medical education among included studies. In several studies, learners are first-year medical students [17, 26], while others are forth-year medical students [14, 15]. Of course, the longer learners got more knowledge of anatomy, which leads to comparing results complex or paradoxical. As Hattie et al. had concluded, the different expertise degrees of learners are remarkable in education [27]. Therefore, medical students in school could be easier motivated and effective in front of fictitious scenarios, since of their less clinical experience versus residents. In addition, various organs or body parts learned present different levels of complexity, leading to the heterogeneity in results. For example, learning the anatomy of the brain is harder than learning skeletal parts [17, 18]. In terms of duration, the results of this review showed that a course for 1 day or longer had a larger effect size than a course for several hours (0.71 vs 0.35). Thus, the learning duration has influenced the educational efficiency of VR methods, which should be considered and adjusted in practice.
Types of comparator is another source of variation. Only 5 of 15 studies were found where this technology was compared to traditional methods such as lectures, dissection or textbooks. However, it would be more meaningful to conduct evaluations of studies that compare the different features of digital-based methods rather than those which compare digital-based to traditional methods [19]. Dissection is regarded as the standard teaching method for anatomy all the time. in this review, only 2 of 15 studies compared VR with dissection for anatomy teaching [14, 19]. In fact, VR could be used as an adjunct to dissection in class with fewer lab hours or resources. For example, a study found that better results for group with dissection for anatomy teaching compared to computer-based teaching group, while the best scores came from the group who were taught by blended methods of both [28].
For satisfaction scores, the pooled result of the comparison of VR versus others was significantly in favor of VR, which could be due in part to the novelty of the method. Most of the participants in the studies reported that the VR methods were easier and more enjoyable to use. Some researchers had revealed that there is a significant positive correlation between motivation and academic record of students [29]. However, due to the complicated anatomical configuration, in one study, some participants found the VR methods disorienting and frustrating [22]. Thus, more studies should focus on the adverse effect caused by this new technology as well as the attitude of participates.
As a fast-moving technology, the cost of VR will be a critical aspect when considering to apply it into education especially for low-income settings. In this review, only one study is from Brazil [30], which reduces the applicability of innovative educational methods to developing regions. Unfortunately, none random controlled study on cost-effectiveness of VR comparing with others.