Comparative Study of Augmented Reality vs Traditional Learning in Anatomy Education

Anatomy is a central part in medical training and is traditionally taught through lectures, textbooks, videos and cadaver dissections. Cadaver dissections are important to understand spatial relationships and individual variations of anatomical structures. In many universities, however, financial and ethical considerations, as well as uncommon circumstances such as the COVID-19 pandemic, have restricted access to cadaver dissections. Consequently, new teaching methods based on visual technologies such as augmented reality (AR) are being implemented worldwide. AR can generate realistic 3-dimensional (3D) images overlaid in the real-word environment, merging real and virtual world to provide an interactive learning experience. The use of such technologies in education is still in the early stages, and further research is needed to assess their beneficial impact in knowledge acquisition. The TEACHANATOMY project aim to develop a 3D, interactive AR teaching module focused on the anatomy of the cranial nerves. To assess its potential value in anatomy education, the investigators will perform a study to compare traditional learning methods based on textbooks, videos, and online resources, with the novel AR learning module using the HoloLens 2 (Microsoft Corporation). The goal is to assess whether AR technology can improve anatomical knowledge and enhance student's motivation and engagement.

• Augmented reality group (Other): * Study presentation: participants will be given a 10-minute general introduction on the study followed by a 20 minutes tutorial to introduce the HoloLens 2 and the TEACHANATOMY learning platform. * Study session: The study session consists of three learning blocks of approximately 20 minutes each, plus a repetition block to assess the acquired knowledge. During the study session participants will be given no time constraints and free breaks. * Assessment test: Participants will be assessed with a 30 minutes knowledge assessment test. * Final questionnaire: At the end participants will be given a questionnaire to assess adverse health symptoms and user experience.
• Traditional learning group (Other): * Study presentation: participants will be given a 10-minute general introduction on the study followed by a presentation to introduce the study session. * Study session: The study session consists of the learning resources most used by students: specific sections from four different neuroanatomy books, access to two websites, two 3D videos, and two online learning programs. During the study session participants will be given no time constraints and free breaks. * Assessment test: Participants will be assessed with a 30 minutes knowledge assessment test. * Final questionnaire: At the end participants will be given a questionnaire to assess adverse health symptoms and user experience.

Primary outcomes

• Knowledge acquisition [Immediately after the study session, Day 1]: The primary outcome will consist of the score in the final theoretical and practical tests. The theoretical test consist of 23 single and multiple-choice questions in which participants will be required to recognize and name the 12 cranial nerves, differentiate their main functions and the typology (sensory, motor, mixed), explain the relationships between their structure and function, and recognize lesions using case studies. In the practical part, participants will be required to mark specific nerves in a 3D-printed anatomical skull model. The duration of the test will be of 30 minutes.

Secondary outcomes

• Adverse Health Symptoms [Immediately after the knowledge acquisition test, Day 1.]: Secondary outcomes will include adverse health symptoms, evaluated with a questionnaire to assess presence and severity of general symptoms (General discomfort, Fatigue, Headache, Dizziness, Nausea, Concentration problems, Disorientation, Neck stiffness/neck pain, No symptoms) and eye-related symptoms (Blurred vision, Difficulty focusing, Double-vision, Dry eyes No symptoms). Presence and severity of symptoms will be rated on a Likert scale from 1 (almost imperceptible) to 10 (extreme).
• User experience [Immediately after the knowledge acquisition test, Day 1.]: User experience will be assessed using an adapted NASA Task Load Index (5 questions, range, 1-10, with lower scores indicating lower cognitive workload) plus additional 10-point Likert scale and open-ended questions, in which participants were asked to rank their comfort with the material and hardware and the teaching effectiveness of the software or of the traditional learning methods to learn the anatomy of the cranial nerves

Sex: All, ages: 18 Years to 25 Years, accepts healthy volunteers

Inclusion Criteria:

* Medical students attending the 1st or 2nd year of undergraduate medical education
* Must not have prior neuroanatomical education

Exclusion Criteria:

* Epilepsy
* Binocular vision disorder such as strabismus
* Current head and/or neck injuries
* Inflammation of the scalp and/or eye
* Amputations or partial amputations of the hands

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• Lukas Zingg, Cand. Med., Principal investigator, Balgrust University Hospital