Virtual Anatomy System in Third Military Medical University
With the help of Shandong Digital Human Corporation, the Third Military Medical University established a local network of VAS. Detailed information on the VAS is available at the website (http://www.digihuman.com/). The software can be viewed at http://www.digihuman.com/en. This VAS is online system, so one can access it whenever and wherever they want, which is an easy and convenient way for medical students to study human anatomy. A web version of the VAS was also created. In this version, teachers and students can use the software with any personal computer using the local area network of the university.
This VAS offers three learning modules, the male systematic anatomy module, the male regional anatomy module, and the female systematic anatomy module. In the systematic anatomy module, the main 10 category includes 9 anatomical systems including locomotor, alimentary, respiratory, urinary, male genital, vasculature, sensory, nervous and endocrine system (Fig. 1). In the male and the female regional anatomical modules, the catalogue includes the head, neck, thorax, abdomen, pelvis, vertebral column, upper limb, and lower limb region.
The framework for these three modules has three parts, an anatomical structures catalogue and explanation section, a sectional anatomical image display section, and a 3D reconstructed model display section. In the catalogue area which occupies the left part of the interface, nearly all human organs are shown on the list, and they are included in the catalogue containing human system classifications (Fig. 1). The sectional anatomical image display area includes coronal, sagittal, and transverse sections. Students can move the scroll bar easily to display any plane of the human anatomy. In the 3D reconstructed model display area, students can easily translate, rotate, and amplify any of the 3D reconstructed models and then observe the 3D organ model in any direction and from any angle. Students can also make the superficial 3D structures semi-transparent to observe the deep structures. All parts and structures were mapped as realistic pictures, making them more accurate and attractive. Some vessels and bone markers can be observed on the surface of the bone (Fig. 2A, C, D). The muscle bellies, tendons, and muscle fibers can be observed on the muscle surface, and the orientation of the muscle fiber follow the orientation of the real muscle fiber (Fig. 2A, C). Additionally, the skin texture mapping used the texture of real human skin, making it appear more realistic on the screen, and the skin encompasses nearly all structures in the human body (Fig. 2B).
In total, 170 undergraduate students in their first year at the Third Military Medical University were assigned to this study (Table 1). Their first semester consisted of a basic science curriculum, which included mathematics, physics, chemistry, and English. In subsequent semesters, medical students began their basic medical curriculum, which included systematic anatomy courses. Based on the scores obtained in previous medical compulsory courses, students were divided into a combining virtual anatomy (CVA) group and a traditional anatomy (TA) group, 66 students in the CVA group and 104 students in the TA group. According to the principle, these two group students have the same equivalent score. Because the limitation of website and teaching space of VAS, only 66 students take part in combing virtual anatomy system.
Before participation in the study, the teachers and the medical students were familiar with the study rules. The teachers gave participating students instructor materials including the important and complex anatomical structures which need to understand, comprehend and master. The medical students were military students, and they all strictly obeyed the principle of informed consent. Before the course, the average scores on the basic science curriculum were not significantly different between the CVA group and the TA group (P<0.05). Each group had a group leader who was in charge of all members and collected the study information. The group leader was the communicator between students and teachers. To determine the students’ progress, a pre-test including 20 multiple choice questions and 5 essay questions was administered before the beginning of the course, and the differences in test scores between the two groups were analyzed. This pre-knowledge test indicates the prior knowledge of the students and was verified by our authorship team. Table 1 shows the basic characteristics of the CVA and TA groups.
All students took typical courses in human regional anatomy. The regional anatomical courses in the Third Military University include basic theoretical courses (16 class hours) and practical courses (69 class hours). All the anatomical courses including theoretical and practical course will take one entire term which lasts 5 months. This course included lower limb, upper limb, thorax, abdomen, pelvic and perineum, head and neck dissection.
In the practical course of the CVA group, medical students studied human anatomy with VAS for 1/3 class hours, for a total of 23 class hours, which accounted for one-third of the practical course. They studied the location, 3D shape and spatial relationship of human anatomy through translating, rotating and zooming the anatomy model in the VAS. They studied the location, 3D shape and spatial relationship of human anatomy through translating, rotating and zooming the anatomy model in the VAS. During the other two-thirds of the practical course, they studied human anatomy in the traditional mode including cadaver dissection and observation. In the practical course of the TA group, medical students studied human anatomy just through the traditional anatomy teaching mode including cadaver dissection and observation. Both in the CVA group and the TA group, medical students studied regional anatomy mainly by themselves and anatomical teacher worked as a tutor to help students to study human anatomy.
After the basic theoretical and practical course, all medical students had an additional 6 hours for review. In the review course, the CVA group students reviewed the information through the VAS, while the TA group students reviewed the information by observing specimens and reading reference books.
The teachers of the VAS course were trained before teaching the medical students. The courses for these two groups were launched synchronously. In the practical part of the course, all the medical students followed the guide to adhere to the same learning objectives. The VAS contains instructions that can be used to guide the user, and the user only needs to move the mouse or use the keyboard to easily operate the VAS.
Fourteen days after the last anatomical lesson, all students took an examination on regional anatomy, which included both written and practical portions. The written portion of the examination included 150 questions which was composed of single-choice questions, multiple-choice questions, and essay questions, and most of the questions were single-choice questions. Some of the questions in the pre-test examination was also repeated in this written examination.
The practical examination is a “bell-ringer” style practical examination. This examination was on the anatomical structure of a real cadaver that was present in the classroom, with labels on anatomical structures. The students wrote down the full name of each noted structure within a designated time limit. The medical students stayed at each station, each of which contained two anatomical structures, for only 70 seconds. A full score on both the written examination and the practical examination was 100 points. In written examination, some questions were 0.5 point and some question was 1.0 point, and the full score of the written examination was also 100 points. The two groups of students were divided into five subgroups based on their scores on the examination. The score in Failure, Pass, Normal, Good and Excellent part is <60, 60-70, 70-80, 80-90, 90-100 separately. We compared the ratio of this subgroup in these two groups.
Questionnaires administered to the students and teachers
In order to evaluate the attention, 3D spatial thinking, interesting and satisfaction of the students studying human anatomy with the VAS, questionnaires were distributed to the students in the CVA group. The items in the questionnaire are listed in Table 2 (This table is placed at the end of the document text file). The questionnaires given to the students had 20 questions. After we drafted this questionnaire, 5 specialists examined and modified it.
The items were measured on a five-point Likert scale ranging from 1 to 5 as follows: 5–strongly agree; 4–agree; 3–undecided; 2–disagree; 1–strongly disagree. In addition, students had the opportunity to comment on the content of the VAS.
The eight teachers who participated in the CTA group were invited to complete a self-structured questionnaire which was composed of 10 questions adapted from the questionnaire in Singh’s study (Table 3). In the studies by Singh and Tian, the authors designed the questions, and the students responded to questions according to the questionnaire table in the study [2, 20]. The completed questionnaires were strictly anonymous.
Statistical Product and Service Solutions (SPSS) 13 (SPSS Inc., Chicago, IL, USA) was used for the statistical analyses. The examination scores for both the CVA group and the TA group were analyzed using a 2-sided independent samples t-test. Cohen’s d calculation was used to indicate the standardized difference between two means of the CVA and the TA groups’ examination. P < 0.05 was considered statistically significant. The analysis was conducted in a manner that prevents the identification of individuals.