Medical Students’ Perceptions of Advanced, High-End Tools in Anatomy Education: Insights from a Lower-Middle-Income Country
2024-06-26
BACKGROUND
Anatomy is a key preclinical subject in medical education, serving as the foundation for future medical practice. It is crucial for providing the necessary knowledge for clinical applications and ensuring safe medical care. However, teaching and learning anatomy pose significant challenges and require focused attention to be effective. Traditionally, anatomy has been taught through lectures with slideshow presentations and auditory explanations, along with prosections, dissections, clinical case studies, and self-directed learning using two-dimensional images and multimedia resources (Murgitroyd et al., 2015). This traditional approach, however, is not sufficient to prepare students for the rapid growth in medical knowledge expected in the 21st century.
Additionally, there is a considerable disparity in resources for medical education between developed and developing countries, especially in anatomy teaching. Developed countries often have access to advanced technologies, well-equipped laboratories, and plenty of cadaveric specimens, which are essential for thorough anatomy education. In contrast, low- to middle-income countries face severe shortages in these critical resources, impacting the quality of medical training (Chan et al., 2019). For example, the integration of advanced tools such as 3D printing and virtual dissection tables, which enhance learning in developed countries, is often not feasible in less affluent regions due to financial limitations and lack of infrastructure (Chan et al., 2019).
This gap in educational resources not only affects the immediate learning environment but also has long-term implications for healthcare quality. Medical students in developing countries often rely on limited and outdated materials, which can hinder their understanding of complex anatomical structures and reduce their ability to apply this knowledge in clinical settings (Balogun, 2019).
Medical Education in Vietnam
Vietnam, classified as a lower-middle-income nation in Southeast Asia, has seen minimal changes in its medical education system until recently, despite significant advancements in other societal areas and shifting healthcare needs (Fan et al., 2012). Current research underscores the necessity for healthcare system enhancements in low- and middle-income countries (LMICs) to adequately meet present and future healthcare demands (Duong et al., 2021). Reforming medical education is a crucial element of these improvements, and LMICs face substantial challenges in attracting, training, retaining, and equitably distributing a proficient physician workforce (Duong et al., 2021).
In recent years, Vietnam has joined many global institutions in undertaking curricular reforms aimed at better preparing physicians to address population health needs (Duong et al., 2021). Presently, Vietnam has 29 medical universities, each admitting an average of 400-600 medical students annually (Duong et al., 2021). There is broad consensus among Vietnamese policymakers on the necessity to reform and modernize the nation’s educational system (Duong et al., 2021).
Typically, medical programs in Vietnam last for six years, starting with two years dedicated to basic sciences with minimal early clinical exposure, followed by four years of clinical theory and hospital rotations across national and provincial hospitals (Fan et al., 2012). Anatomy is usually taught during the first or second year as a separate subject, using lectures and practical sessions with plastic models and cadaver dissections. However, the availability of cadavers is severely limited, mainly due to religious beliefs. For example, there are only two to four cadavers available annually at Hanoi Medical University (HMU), one of the largest medical schools in Vietnam, for approximately 800 students enrolled in anatomy courses (Ha et al., 2023). The lack of resources significantly impacts students’ learning and retention of anatomical knowledge, hindering their ability to understand and apply complex anatomical concepts in clinical settings. This underscores the urgent need for substantial modernization and investment in anatomy teaching tools and resources in Vietnam.
Anatomy Teaching at VinUniversity
Founded in 2020, VinUniversity is located in Hanoi, the capital city of Vietnam. The College of Health Sciences of VinUniversity offers a similar six-year medical doctor program like other medical schools in the country. However as a private medical institution which put emphasize on the quality of education, the annual intake is only 50–60 new students and antomy is taught in the second year (Ha et al. 2023).
Adopt the changes by many prestigious medical schools worldwide in the way anatomy is taught, Vinuniveristy have transformed the way of teaching anatomy by incorporating educational technologies, such as virtual dissection table, 3D anatomical simulation application and platinated cadavers into the course (Murgitroyd, 2015; Ha, 2023). Another key factor in driving the implementation of advanced teaching is the robust use of Canvas, a reliable Learning Management System (LMS) that has become widely used at other organizations (Ha, 2023). Canvas provides a centralized platform where students can access all course materials, including lecture notes, reading assignments, multimedia resources, and lab schedules. This centralized access ensures that students have all the necessary resources readily available, which enhances their ability to stay organized and manage their study time effectively (Ha, 2023).
Although a variety of models and technological platforms aligned with educational strategies have been explored and considered in order to determine whether adopting them will enhance the teaching and learning experience as well as enable students to achieve the desired outcomes (Ha et al. 2023).
METHOD
Research design
A cross-sectional study was designed to investigate the students’ perspective of having modern educational technologies and their impacts on achieving the learning outcomes of the anatomy course. Quantitave data collection with the survey method and analysis approach were performed in this study. The research’s quantitative dimension assessed the attitudes of medical students toward the provided learning resources in anatomy education at VinUniversity.
Study group
The research focused on 3 cohorts of medical students who took the anatomy course at the College of Health Sciences in the academic years of 2021-2022, 2022-2023, and 2023-2024. One hundred and thirty-one students responded out of 147 participants, giving a response rate of 89.1%. Of 131 students, 69 were males (52.7%) and 62 were females (47.3%). Of these students, 48 were the second-year students (36.6%), 40 were the third-year students (30.5%), and 43 were the fourth-year students (32.8%).
Data collection tools
The perceptions were rated on a Likert scale where 1 is the least useful and 5 is the most useful. for each teaching tool and overall satisfaction with the course. They were asked to fill a semi-structured questionnaire that consists of both closed-ended questions and open-ended questions regarding the provided teaching tools and teaching methodology. The were categorized into modernized learning tools and traditional learning resources. Modernized learning tools included Complete Anatomy application, YouTube and anatomy websites, plastinated cadavers, plastic models, and Pirogov table. Traditional learning resources include anatomy atlases and textbooks, materials on university’s Canvas, and laboratory printout materials.
Data collection
It was clarified that participation in this study was voluntarily. Students who did not want to participate did not have to fill out the questionnaire. The students were instructed to respond to the closed-end questions about their perspectives toward teaching tools and overall satisfaction with the course, and two open-ended questions about which improvements in current teaching tools can be addressed to enhance the learning experience and whether any other tools students would like to have implemented.
Data analysis
The normality of the data distribution was assessed by the Shapiro-Wilk test. The results implied that the data distribution was not normal. Therefore, the non-parametric Mann Whitney U and Kruskal-Wallis tests implemented in RStudio was performed for analyzing the data. The significance level was considered to be .05 in this study. Descriptive statistics for quantitative variables were summarized using means, standard deviations and 95% confidence interval.
The qualitative data collected as a part of the questionnaire was evaluated by the number of responses and typical answers for each question. The data was originally inserted into an MS Excel sheet to analyze the answers of the open-ended questions. Then, the opinion of students reported in those questions were reviewed and reported.
RESULT
Quantitative analyses of medical students’ perceptions on learning resources and anatomy teaching
The quantitative analyses focus on the medical students’ perceptions with regard to different learning resources and their overall satisfaction towards the provided learning resources and anatomy teaching. The tools were rated on a Likert scale where 1 is the least useful and 5 is the most useful.
Table 1: Demographic data of participants
| Variable | N = 1311 |
|---|---|
| Cohort | |
| Cohort 1 | 43 (33%) |
| Cohort 2 | 40 (31%) |
| Cohort 3 | 48 (37%) |
| Age | 21.59 (± 2.00) |
| Gender | |
| Female | 62 (47%) |
| Male | 69 (53%) |
| Hometown | |
| Rural | 22 (17%) |
| Urban (Hanoi, Hochiminh) | 109 (83%) |
| Highschool | |
| Most Prestigious High School for the Gifted | 43 (33%) |
| Other High School for the Gifted | 24 (18%) |
| Private/International High School | 42 (32%) |
| Public Highschools | 22 (17%) |
| Cumulative GPA | |
| < 3.20 | 57 (44%) |
| 3.20 to 3.59 | 51 (39%) |
| 3.60 to 4.00 | 23 (18%) |
| Scholarship | |
| Undisclosed | 10 (7.6%) |
| < 50% | 39 (30%) |
| 50 - 89% | 45 (34%) |
| 90 - 100% | 37 (28%) |
| Family Annual Income (in USD) | |
| Undisclosed | 19 (15%) |
| < 4,800 | 5 (3.8%) |
| 4,800 - 9,600 | 11 (8.4%) |
| 9,600 - 14,400 | 22 (17%) |
| 14,400 - 24,000 | 22 (17%) |
| > 24,000 | 52 (40%) |
| ⁺ Other includes the following hometowns: North (2.4%): Bac Ninh, Hai Duong, Ninh Binh; Central (8.1%): Binh Dinh, Binh Thuan, Buon Ma Thuot, Dong Thap, Gia Lai, Hue, Nha Trang, Thanh Hoa; South (4.8%): Ba Ria, Bien Hoa, Binh Duong, Dong Nai, Tay Ninh, Vung Tau; International (0.8%): Tokyo. | |
| 1 n (%); Mean (± SD) | |
Table 2: Comparison of Medical Students’ Perceptions of High and Low Investment Educational Tools in Anatomy Education
| Tools | Overall, N = 1311 | Cohort 1, N = 431 | Cohort 2, N = 401 | Cohort 3, N = 481 | p-value2 |
|---|---|---|---|---|---|
| High Investment Educational Tools | 3.77 (± 0.75) | 3.62 (± 0.72) | 3.79 (± 0.81) | 3.90 (± 0.72) | 0.2 |
| Plastinated Cadavers | 3.91 (± 1.03) | 3.60 (± 1.07) | 4.28 (± 1.04) | 3.88 (± 0.91) | 0.006 |
| Virtual Dissection Table | 2.92 (± 1.15) | 2.86 (± 1.10) | 2.63 (± 1.10) | 3.23 (± 1.19) | 0.058 |
| 3D Anatomical Simulation Application | 4.39 (± 0.84) | 4.37 (± 0.69) | 4.23 (± 1.05) | 4.54 (± 0.74) | 0.3 |
| Advanced Plastic Anatomical Model Set | 3.86 (± 0.95) | 3.63 (± 0.90) | 4.03 (± 1.03) | 3.94 (± 0.91) | 0.054 |
| Low Investment Educational Tools | 3.70 (± 0.76) | 3.53 (± 0.70) | 3.73 (± 0.75) | 3.82 (± 0.82) | 0.2 |
| Anatomy Atlases and Textbooks | 3.56 (± 1.23) | 3.40 (± 1.22) | 3.85 (± 1.14) | 3.46 (± 1.29) | 0.2 |
| University Canvas’ materials | 3.66 (± 1.08) | 3.44 (± 1.01) | 3.60 (± 1.22) | 3.90 (± 0.99) | 0.13 |
| Laboratory Printout Materials | 3.35 (± 1.18) | 2.95 (± 1.13) | 3.40 (± 1.08) | 3.67 (± 1.23) | 0.013 |
| Online Open-Access Anatomy Resources | 4.24 (± 1.06) | 4.35 (± 0.97) | 4.08 (± 1.14) | 4.27 (± 1.07) | 0.6 |
| 1 Mean (± SD) | |||||
| 2 Kruskal-Wallis rank sum test | |||||
Figure 1: Comparison Among Three Cohorts of Students Regarding the Usefulness of High and Low Investment Tools in Anatomy Education
Table 3: Comparison of Satisfaction with High and Low Investment Educational Tools Across Various Demographic and Academic Characteristics
| Tools | Overall, N = 1311 | Female, N = 621 | Male, N = 691 | p-value2 |
|---|---|---|---|---|
| High Investment Educational Tools | 3.77 (± 0.75) | 3.80 (± 0.71) | 3.75 (± 0.79) | 0.8 |
| Low Investment Educational Tools | 3.70 (± 0.76) | 3.77 (± 0.81) | 3.64 (± 0.72) | 0.3 |
| 1 Mean (± SD) | ||||
| 2 Wilcoxon rank sum test | ||||
| Tools | Overall, N = 1311 | Female, N = 621 | Male, N = 691 | p-value2 |
|---|---|---|---|---|
| High Investment Educational Tools | 3.77 (± 0.75) | 3.80 (± 0.71) | 3.75 (± 0.79) | 0.8 |
| Plastinated Cadavers | 3.91 (± 1.03) | 3.87 (± 1.08) | 3.94 (± 1.00) | 0.8 |
| Virtual Dissection Table | 2.92 (± 1.15) | 2.95 (± 1.11) | 2.90 (± 1.20) | 0.8 |
| 3D Anatomical Simulation Application | 4.39 (± 0.84) | 4.44 (± 0.74) | 4.35 (± 0.92) | 0.9 |
| Advanced Plastic Anatomical Model Set | 3.86 (± 0.95) | 3.94 (± 0.92) | 3.80 (± 0.98) | 0.4 |
| Low Investment Educational Tools | 3.70 (± 0.76) | 3.77 (± 0.81) | 3.64 (± 0.72) | 0.3 |
| Anatomy Atlases and Textbooks | 3.56 (± 1.23) | 3.52 (± 1.24) | 3.59 (± 1.23) | 0.7 |
| University Canvas’ materials | 3.66 (± 1.08) | 3.74 (± 1.10) | 3.58 (± 1.06) | 0.3 |
| Laboratory Printout Materials | 3.35 (± 1.18) | 3.44 (± 1.21) | 3.28 (± 1.16) | 0.4 |
| Online Open-Access Anatomy Resources | 4.24 (± 1.06) | 4.37 (± 0.89) | 4.12 (± 1.18) | 0.3 |
| 1 Mean (± SD) | ||||
| 2 Wilcoxon rank sum test | ||||
| Tools | Overall, N = 1311 | Rural, N = 221 | Urban (Hanoi, Hochiminh), N = 1091 | p-value2 |
|---|---|---|---|---|
| High Investment Educational Tools | 3.77 (± 0.75) | 3.50 (± 0.74) | 3.83 (± 0.75) | 0.045 |
| Low Investment Educational Tools | 3.70 (± 0.76) | 3.44 (± 0.90) | 3.75 (± 0.73) | 0.2 |
| 1 Mean (± SD) | ||||
| 2 Wilcoxon rank sum test | ||||
| Tools | Overall, N = 1311 | Rural, N = 221 | Urban (Hanoi, Hochiminh), N = 1091 | p-value2 |
|---|---|---|---|---|
| High Investment Educational Tools | 3.77 (± 0.75) | 3.50 (± 0.74) | 3.83 (± 0.75) | 0.045 |
| Plastinated Cadavers | 3.91 (± 1.03) | 3.86 (± 1.04) | 3.92 (± 1.04) | 0.8 |
| Virtual Dissection Table | 2.92 (± 1.15) | 2.64 (± 1.18) | 2.98 (± 1.15) | 0.2 |
| 3D Anatomical Simulation Application | 4.39 (± 0.84) | 3.82 (± 1.05) | 4.50 (± 0.74) | <0.001 |
| Advanced Plastic Anatomical Model Set | 3.86 (± 0.95) | 3.68 (± 0.72) | 3.90 (± 0.99) | 0.2 |
| Low Investment Educational Tools | 3.70 (± 0.76) | 3.44 (± 0.90) | 3.75 (± 0.73) | 0.2 |
| Anatomy Atlases and Textbooks | 3.56 (± 1.23) | 3.36 (± 1.26) | 3.60 (± 1.23) | 0.4 |
| University Canvas’ materials | 3.66 (± 1.08) | 3.23 (± 1.27) | 3.74 (± 1.02) | 0.086 |
| Laboratory Printout Materials | 3.35 (± 1.18) | 3.00 (± 1.23) | 3.42 (± 1.17) | 0.2 |
| Online Open-Access Anatomy Resources | 4.24 (± 1.06) | 4.18 (± 1.14) | 4.25 (± 1.05) | 0.9 |
| 1 Mean (± SD) | ||||
| 2 Wilcoxon rank sum test | ||||
| Tools | Overall, N = 1311 | 3.20 to 3.59, N = 511 | 3.60 to 4.00, N = 231 | < 3.20, N = 571 | p-value2 |
|---|---|---|---|---|---|
| High Investment Educational Tools | 3.77 (± 0.75) | 3.71 (± 0.83) | 3.82 (± 0.63) | 3.81 (± 0.73) | 0.8 |
| Low Investment Educational Tools | 3.70 (± 0.76) | 3.79 (± 0.85) | 3.55 (± 0.56) | 3.68 (± 0.75) | 0.3 |
| 1 Mean (± SD) | |||||
| 2 Kruskal-Wallis rank sum test | |||||
| Tools | Overall, N = 1311 | 3.20 to 3.59, N = 511 | 3.60 to 4.00, N = 231 | < 3.20, N = 571 | p-value2 |
|---|---|---|---|---|---|
| High Investment Educational Tools | 3.77 (± 0.75) | 3.71 (± 0.83) | 3.82 (± 0.63) | 3.81 (± 0.73) | 0.8 |
| Plastinated Cadavers | 3.91 (± 1.03) | 3.82 (± 1.20) | 3.96 (± 0.93) | 3.96 (± 0.93) | >0.9 |
| Virtual Dissection Table | 2.92 (± 1.15) | 2.86 (± 1.18) | 2.78 (± 1.09) | 3.04 (± 1.16) | 0.5 |
| 3D Anatomical Simulation Application | 4.39 (± 0.84) | 4.41 (± 0.73) | 4.39 (± 0.78) | 4.37 (± 0.96) | >0.9 |
| Advanced Plastic Anatomical Model Set | 3.86 (± 0.95) | 3.73 (± 1.00) | 4.13 (± 0.76) | 3.88 (± 0.96) | 0.3 |
| Low Investment Educational Tools | 3.70 (± 0.76) | 3.79 (± 0.85) | 3.55 (± 0.56) | 3.68 (± 0.75) | 0.3 |
| Anatomy Atlases and Textbooks | 3.56 (± 1.23) | 3.75 (± 1.20) | 3.17 (± 1.23) | 3.54 (± 1.24) | 0.14 |
| University Canvas’ materials | 3.66 (± 1.08) | 3.84 (± 1.07) | 3.39 (± 1.08) | 3.60 (± 1.08) | 0.15 |
| Laboratory Printout Materials | 3.35 (± 1.18) | 3.35 (± 1.20) | 3.48 (± 1.24) | 3.30 (± 1.16) | 0.8 |
| Online Open-Access Anatomy Resources | 4.24 (± 1.06) | 4.24 (± 1.01) | 4.17 (± 1.11) | 4.26 (± 1.09) | 0.9 |
| 1 Mean (± SD) | |||||
| 2 Kruskal-Wallis rank sum test | |||||
| Tools | Overall, N = 1211 | 50 - 89%, N = 451 | 90 - 100%, N = 371 | < 50%, N = 391 | p-value2 |
|---|---|---|---|---|---|
| High Investment Educational Tools | 3.74 (± 0.77) | 3.69 (± 0.76) | 3.85 (± 0.72) | 3.69 (± 0.83) | 0.6 |
| Low Investment Educational Tools | 3.70 (± 0.77) | 3.54 (± 0.83) | 3.67 (± 0.65) | 3.90 (± 0.79) | 0.12 |
| 1 Mean (± SD) | |||||
| 2 Kruskal-Wallis rank sum test | |||||
| Tools | Overall, N = 1211 | 50 - 89%, N = 451 | 90 - 100%, N = 371 | < 50%, N = 391 | p-value2 |
|---|---|---|---|---|---|
| High Investment Educational Tools | 3.74 (± 0.77) | 3.69 (± 0.76) | 3.85 (± 0.72) | 3.69 (± 0.83) | 0.6 |
| Plastinated Cadavers | 3.85 (± 1.04) | 3.87 (± 1.08) | 3.92 (± 0.92) | 3.77 (± 1.11) | >0.9 |
| Virtual Dissection Table | 2.92 (± 1.17) | 2.80 (± 1.16) | 3.08 (± 1.16) | 2.90 (± 1.19) | 0.6 |
| 3D Anatomical Simulation Application | 4.36 (± 0.86) | 4.29 (± 1.04) | 4.43 (± 0.69) | 4.38 (± 0.78) | >0.9 |
| Advanced Plastic Anatomical Model Set | 3.83 (± 0.96) | 3.80 (± 0.89) | 3.97 (± 0.93) | 3.72 (± 1.07) | 0.6 |
| Low Investment Educational Tools | 3.70 (± 0.77) | 3.54 (± 0.83) | 3.67 (± 0.65) | 3.90 (± 0.79) | 0.12 |
| Anatomy Atlases and Textbooks | 3.52 (± 1.25) | 3.40 (± 1.36) | 3.35 (± 1.27) | 3.82 (± 1.07) | 0.2 |
| University Canvas’ materials | 3.65 (± 1.06) | 3.47 (± 1.16) | 3.62 (± 1.04) | 3.90 (± 0.94) | 0.2 |
| Laboratory Printout Materials | 3.33 (± 1.19) | 3.02 (± 1.22) | 3.43 (± 1.17) | 3.59 (± 1.14) | 0.11 |
| Online Open-Access Anatomy Resources | 4.28 (± 1.00) | 4.27 (± 0.94) | 4.27 (± 1.07) | 4.31 (± 1.03) | 0.8 |
| 1 Mean (± SD) | |||||
| 2 Kruskal-Wallis rank sum test | |||||
| Tools | Overall, N = 1311 | Most Prestigious High School for the Gifted, N = 431 | Other High School for the Gifted, N = 241 | Private/International High School, N = 421 | Public Highschools, N = 221 | p-value2 |
|---|---|---|---|---|---|---|
| High Investment Educational Tools | 3.77 (± 0.75) | 3.91 (± 0.73) | 3.54 (± 0.75) | 3.79 (± 0.75) | 3.73 (± 0.79) | 0.2 |
| Low Investment Educational Tools | 3.70 (± 0.76) | 3.62 (± 0.80) | 3.58 (± 0.69) | 3.88 (± 0.79) | 3.66 (± 0.71) | 0.3 |
| 1 Mean (± SD) | ||||||
| 2 Kruskal-Wallis rank sum test | ||||||
| Tools | Overall, N = 1311 | Most Prestigious High School for the Gifted, N = 431 | Other High School for the Gifted, N = 241 | Private/International High School, N = 421 | Public Highschools, N = 221 | p-value2 |
|---|---|---|---|---|---|---|
| High Investment Educational Tools | 3.77 (± 0.75) | 3.91 (± 0.73) | 3.54 (± 0.75) | 3.79 (± 0.75) | 3.73 (± 0.79) | 0.2 |
| Plastinated Cadavers | 3.91 (± 1.03) | 4.02 (± 0.99) | 3.63 (± 1.17) | 3.98 (± 1.05) | 3.86 (± 0.94) | 0.5 |
| Virtual Dissection Table | 2.92 (± 1.15) | 3.02 (± 1.22) | 2.88 (± 1.15) | 2.86 (± 1.09) | 2.91 (± 1.19) | 0.9 |
| 3D Anatomical Simulation Application | 4.39 (± 0.84) | 4.56 (± 0.77) | 4.21 (± 0.83) | 4.43 (± 0.80) | 4.18 (± 1.01) | 0.2 |
| Advanced Plastic Anatomical Model Set | 3.86 (± 0.95) | 4.02 (± 0.96) | 3.46 (± 0.78) | 3.88 (± 1.04) | 3.95 (± 0.84) | 0.049 |
| Low Investment Educational Tools | 3.70 (± 0.76) | 3.62 (± 0.80) | 3.58 (± 0.69) | 3.88 (± 0.79) | 3.66 (± 0.71) | 0.3 |
| Anatomy Atlases and Textbooks | 3.56 (± 1.23) | 3.42 (± 1.37) | 3.63 (± 0.97) | 3.71 (± 1.27) | 3.45 (± 1.14) | 0.6 |
| University Canvas’ materials | 3.66 (± 1.08) | 3.56 (± 1.12) | 3.42 (± 1.06) | 3.93 (± 1.05) | 3.59 (± 1.05) | 0.2 |
| Laboratory Printout Materials | 3.35 (± 1.18) | 3.16 (± 1.31) | 3.21 (± 1.10) | 3.60 (± 1.06) | 3.41 (± 1.22) | 0.5 |
| Online Open-Access Anatomy Resources | 4.24 (± 1.06) | 4.33 (± 1.06) | 4.08 (± 1.02) | 4.26 (± 1.06) | 4.18 (± 1.14) | 0.6 |
| 1 Mean (± SD) | ||||||
| 2 Kruskal-Wallis rank sum test | ||||||
| Tools | Overall, N = 1121 | 14,400 - 24,000, N = 221 | 4,800 - 9,600, N = 111 | 9,600 - 14,400, N = 221 | < 4,800, N = 51 | > 24,000, N = 521 | p-value2 |
|---|---|---|---|---|---|---|---|
| High Investment Educational Tools | 3.71 (± 0.77) | 3.92 (± 0.69) | 3.64 (± 0.65) | 3.53 (± 0.81) | 3.45 (± 0.72) | 3.73 (± 0.82) | 0.4 |
| Low Investment Educational Tools | 3.67 (± 0.77) | 3.59 (± 0.78) | 3.48 (± 0.51) | 3.48 (± 0.76) | 3.45 (± 0.87) | 3.86 (± 0.80) | 0.2 |
| 1 Mean (± SD) | |||||||
| 2 Kruskal-Wallis rank sum test | |||||||
| Tools | Overall, N = 1121 | 14,400 - 24,000, N = 221 | 4,800 - 9,600, N = 111 | 9,600 - 14,400, N = 221 | < 4,800, N = 51 | > 24,000, N = 521 | p-value2 |
|---|---|---|---|---|---|---|---|
| High Investment Educational Tools | 3.71 (± 0.77) | 3.92 (± 0.69) | 3.64 (± 0.65) | 3.53 (± 0.81) | 3.45 (± 0.72) | 3.73 (± 0.82) | 0.4 |
| Plastinated Cadavers | 3.80 (± 1.06) | 3.77 (± 1.15) | 4.00 (± 0.89) | 3.64 (± 1.00) | 4.00 (± 1.00) | 3.83 (± 1.10) | 0.9 |
| Virtual Dissection Table | 2.91 (± 1.13) | 3.23 (± 1.02) | 3.09 (± 0.94) | 2.36 (± 1.09) | 2.60 (± 1.14) | 3.00 (± 1.17) | 0.039 |
| 3D Anatomical Simulation Application | 4.33 (± 0.87) | 4.77 (± 0.53) | 3.73 (± 0.90) | 4.41 (± 0.91) | 3.60 (± 1.67) | 4.31 (± 0.78) | 0.006 |
| Advanced Plastic Anatomical Model Set | 3.79 (± 0.97) | 3.91 (± 1.02) | 3.73 (± 0.65) | 3.73 (± 0.94) | 3.60 (± 0.89) | 3.79 (± 1.05) | 0.8 |
| Low Investment Educational Tools | 3.67 (± 0.77) | 3.59 (± 0.78) | 3.48 (± 0.51) | 3.48 (± 0.76) | 3.45 (± 0.87) | 3.86 (± 0.80) | 0.2 |
| Anatomy Atlases and Textbooks | 3.53 (± 1.22) | 3.45 (± 1.44) | 3.27 (± 0.90) | 3.18 (± 1.33) | 4.00 (± 0.71) | 3.71 (± 1.16) | 0.4 |
| University Canvas’ materials | 3.62 (± 1.06) | 3.68 (± 0.99) | 3.45 (± 0.93) | 3.09 (± 1.19) | 3.00 (± 1.22) | 3.90 (± 0.96) | 0.036 |
| Laboratory Printout Materials | 3.29 (± 1.16) | 3.23 (± 1.23) | 3.09 (± 0.70) | 3.23 (± 1.19) | 3.00 (± 1.58) | 3.42 (± 1.18) | 0.8 |
| Online Open-Access Anatomy Resources | 4.26 (± 1.00) | 4.00 (± 1.27) | 4.09 (± 0.70) | 4.41 (± 0.91) | 3.80 (± 1.30) | 4.38 (± 0.93) | 0.3 |
| 1 Mean (± SD) | |||||||
| 2 Kruskal-Wallis rank sum test | |||||||
Table 4: Overall Satisfaction with Educational Tools by Various Demographic and Academic Characteristic
| Tools | Overall, N = 1311 | Cohort 1, N = 431 | Cohort 2, N = 401 | Cohort 3, N = 481 | p-value2 |
|---|---|---|---|---|---|
| Overall Satisfaction with Educational Tools | 4.04 (± 0.77) | 3.77 (± 0.87) | 4.23 (± 0.73) | 4.13 (± 0.64) | 0.021 |
| 1 Mean (± SD) | |||||
| 2 Kruskal-Wallis rank sum test | |||||
| Tools | Overall, N = 1311 | Female, N = 621 | Male, N = 691 | p-value2 |
|---|---|---|---|---|
| Overall Satisfaction with Educational Tools | 4.04 (± 0.77) | 4.05 (± 0.56) | 4.03 (± 0.92) | 0.7 |
| 1 Mean (± SD) | ||||
| 2 Wilcoxon rank sum test | ||||
| Tools | Overall, N = 1311 | Rural, N = 221 | Urban (Hanoi, Hochiminh), N = 1091 | p-value2 |
|---|---|---|---|---|
| Overall Satisfaction with Educational Tools | 4.04 (± 0.77) | 4.09 (± 0.68) | 4.03 (± 0.79) | 0.8 |
| 1 Mean (± SD) | ||||
| 2 Wilcoxon rank sum test | ||||
| Tools | Overall, N = 1311 | 3.20 to 3.59, N = 511 | 3.60 to 4.00, N = 231 | < 3.20, N = 571 | p-value2 |
|---|---|---|---|---|---|
| Overall Satisfaction with Educational Tools | 4.04 (± 0.77) | 4.02 (± 0.71) | 4.26 (± 0.62) | 3.96 (± 0.87) | 0.3 |
| 1 Mean (± SD) | |||||
| 2 Kruskal-Wallis rank sum test | |||||
| Tools | Overall, N = 1211 | 50 - 89%, N = 451 | 90 - 100%, N = 371 | < 50%, N = 391 | p-value2 |
|---|---|---|---|---|---|
| Overall Satisfaction with Educational Tools | 4.04 (± 0.72) | 3.91 (± 0.82) | 4.16 (± 0.69) | 4.08 (± 0.62) | 0.4 |
| 1 Mean (± SD) | |||||
| 2 Kruskal-Wallis rank sum test | |||||
| Tools | Overall, N = 1311 | Most Prestigious High School for the Gifted, N = 431 | Other High School for the Gifted, N = 241 | Private/International High School, N = 421 | Public Highschools, N = 221 | p-value2 |
|---|---|---|---|---|---|---|
| Overall Satisfaction with Educational Tools | 4.04 (± 0.77) | 4.16 (± 0.69) | 3.92 (± 0.93) | 4.02 (± 0.68) | 3.95 (± 0.90) | 0.7 |
| 1 Mean (± SD) | ||||||
| 2 Kruskal-Wallis rank sum test | ||||||
| Tools | Overall, N = 1121 | 14,400 - 24,000, N = 221 | 4,800 - 9,600, N = 111 | 9,600 - 14,400, N = 221 | < 4,800, N = 51 | > 24,000, N = 521 | p-value2 |
|---|---|---|---|---|---|---|---|
| Overall Satisfaction with Educational Tools | 4.03 (± 0.73) | 4.23 (± 0.61) | 3.91 (± 0.83) | 3.86 (± 0.83) | 3.60 (± 0.89) | 4.08 (± 0.68) | 0.3 |
| 1 Mean (± SD) | |||||||
| 2 Kruskal-Wallis rank sum test | |||||||
Table 5: Comparison of Perceived Usefulness of Educational Tools Among Students Pursuing Surgical and Non-Surgical Careers
| Tools | Overall, N = 1291 | Non-Surgical Specialities Group, N = 821 | Surgical Specialities Group, N = 471 | p-value2 |
|---|---|---|---|---|
| High Investment Educational Tools | 3.78 (± 0.75) | 3.73 (± 0.72) | 3.87 (± 0.80) | 0.2 |
| Plastinated Cadavers | 3.89 (± 1.03) | 3.88 (± 0.97) | 3.91 (± 1.14) | 0.6 |
| Virtual Dissection Table | 2.95 (± 1.14) | 2.90 (± 1.06) | 3.04 (± 1.27) | 0.5 |
| 3D Anatomical Simulation Application | 4.41 (± 0.79) | 4.32 (± 0.84) | 4.57 (± 0.65) | 0.11 |
| Advanced Plastic Anatomical Model Set | 3.86 (± 0.95) | 3.82 (± 0.98) | 3.94 (± 0.89) | 0.5 |
| Low Investment Educational Tools | 3.72 (± 0.75) | 3.65 (± 0.71) | 3.86 (± 0.80) | 0.2 |
| Anatomy Atlases and Textbooks | 3.53 (± 1.23) | 3.39 (± 1.17) | 3.79 (± 1.28) | 0.044 |
| University Canvas’ materials | 3.70 (± 1.04) | 3.56 (± 1.01) | 3.94 (± 1.05) | 0.039 |
| Laboratory Printout Materials | 3.38 (± 1.17) | 3.41 (± 1.09) | 3.32 (± 1.30) | 0.8 |
| Online Open-Access Anatomy Resources | 4.28 (± 1.01) | 4.22 (± 1.03) | 4.38 (± 0.97) | 0.3 |
| 1 Mean (± SD) | ||||
| 2 Wilcoxon rank sum test | ||||
Qualitative analyses of medical students’ perceptions on learning resources and anatomy teaching
Table 9: Summary of Themes and Responses
Discussion
The Complete 3D Anatomy (CA) software by Elsevier has been modernizing how anatomy and physiology are taught in higher education (Danish, 2016). According to Danish and Sadat (2016), innovations in teaching methods have incorporated such advanced technologies to enhance the learning experience. The use of 3D anatomy software allows students to visualize and manipulate anatomical structures in a three-dimensional space, providing a more comprehensive understanding of spatial relationships and complex anatomical concepts. This technology facilitates self-directed learning and enables repeated practice, which can improve retention and comprehension of anatomical knowledge. Moreover, 3D software can simulate clinical scenarios, thereby bridging the gap between theoretical knowledge and practical application, which is crucial for medical education. A key feature of CA is augmented reality (AR). Instructors and students can use this function on their mobile phones to project a model onto a flat and textured surface (eg, tabletop). Multiple users can also share a model view in real time, meaning that one user can host a model or a cadaveric dissection, and other users in the same class can join. An instructor may use this feature to emphasize a specific structure or demonstrate a virtual dissection to the entire class. This feature is available on most smart handheld devices with a user-friendly interface (Danish, 2016).
Plastinated cadavers offer several significant advantages in medical education, substantially enhancing the anatomical learning experience for students. These specimens are dry, odorless, and durable, making them easier to handle and store compared to traditional cadavers preserved in formaldehyde, which are often toxic and require special facilities (Riederer, 2014). Students appreciate plastinated specimens for their detailed and realistic representation of anatomical structures, which allow for a clear understanding of spatial relationships crucial for medical education. Research indicates that students find plastinated specimens beneficial for their anatomical knowledge and exam performance, with a notable improvement in the retention of anatomical details (Bayko et al., 2018). Moreover, using plastinated specimens eliminates the exposure to harmful chemicals used in traditional preservation methods, thereby reducing health risks for students and educators, an important consideration in educational settings (Nurunnabi et al., 2023).
Furthermore, plastinated specimens can be used outside the traditional dissection lab, providing greater flexibility in teaching environments. They can be utilized in lecture rooms and small group sessions, making anatomical education more accessible and versatile (Fang, 2020). Surveys show that students have a positive perception of plastinated specimens, finding them valuable for understanding complex anatomical details and appreciating the three-dimensional nature of human anatomy. This positive feedback indicates a strong preference for integrating plastinates into anatomy curricula, with many students recommending their use alongside traditional dissection methods to enhance learning outcomes (Klaus et al., 2018). Thus, the use of plastinated cadavers in medical education provides a safe, durable, and effective tool for teaching anatomy, improving students’ learning experiences and knowledge retention, and addressing many of the challenges associated with traditional cadaver dissection.
Virtual dissection tables, such as the Anatomage Table, offer numerous advantages in medical education, significantly enhancing the learning experience for students. These advanced anatomy visualization systems provide high-resolution, life-sized 3D representations of the human body, allowing students to interactively explore anatomical structures in a more detailed and realistic manner than traditional methods. Studies have shown that virtual dissection improves students’ understanding of spatial relationships and the clinical relevance of anatomy, which are crucial for their future medical practice (Darras et al., 2019). Additionally, virtual dissection tables facilitate small group learning and problem-based learning approaches, which have been found to be highly effective in medical education (Custer & Michael, 2015).
Moreover, integrating virtual dissection with traditional cadaver-based learning can enhance the educational experience by providing a comprehensive understanding of anatomy. This combination has been shown to improve students’ performance in anatomy exams and their ability to apply anatomical knowledge in clinical settings (Darras et al., 2019). Virtual dissection tables also address the limitations of cadaver availability and the ethical concerns associated with cadaveric dissection, making anatomy education more accessible and flexible (Macchiarelli et al., 2017). Overall, the incorporation of virtual dissection tables in medical curricula represents a significant advancement, providing a safe, effective, and engaging tool for anatomy education.
Traditional cadaver-based training does not tackle the critical need for growing healthcare advancements (Wickramasinghe, 2022). Textual explanation of three-dimensional structures is often inefficient for students to comprehend them (Fairén et al. 2017). In the era of digitalization, a new generation of learners expects their education to be a technology-rich learning environment with varying levels of technology integration (Guze et al. 2015). Anatomy education has been evolving towards “cadaverless” teaching, with anatomists increasingly utilizing virtual platforms and innovative technologies, combines augmented reality (AR) technology with 3D printed models to provide a three-dimensional and topographical learning approach for medical students (Cercenelli et al., 2022). This innovative approach enhances students’ motivation for learning and increases long-term retention of anatomical knowledge by allowing them to explore and manipulate detailed models (Cercenelli et al., 2022). Furthermore, traditional anatomy education methods, such as lectures and gross dissection classes, are being supplemented or replaced by problem-based learning, plastic models, computer-assisted learning, and curriculum integration. According to Papa and Vaccarezza (2014), these methods address various logistical, ethical, and financial challenges associated with cadaver-based learning, making anatomy education more accessible and adaptable to modern educational needs (Vaccarezza & Papa, 2014).
Recommendations
Based on the findings of this study, the following recommendations are proposed to enhance anatomy education:
- Invest in Modern learning resources: Prioritize the integration and accessibility of modern learning resources such as the Complete Anatomy App and plastinated cadavers. These tools have shown higher mean scores and are preferred by students for their interactive and engaging nature.
- Extend Access to Digital Resources: Extend the access period for digital tools like the Complete Anatomy App to all cohorts, not just those currently studying anatomy. This would provide ongoing support and resources for students as they progress through their medical education.
- Enhance Clinical Cases Integration: Increase the use of clinical cases in the curriculum to bridge theoretical knowledge and practical application. This approach can enhance students’ understanding and retention of anatomical concepts, making their learning experience more relevant and impactful.
- Improve Traditional Resources: Update and integrate traditional resources with modern technology to improve engagement. For example, adding digital components or interactive elements to traditional textbooks and printouts could make these resources more appealing and effective.
- Uniform Implementation of Improvements: Since no significant differences were found among various demographics and backgrounds, improvements should be uniformly applied to benefit all students. This ensures that enhancements in educational tools and methods are accessible to everyone, promoting equality in educational opportunities.
- Personalized Learning Support: While overall trends indicate uniform satisfaction, individual students may still benefit from tailored support. Educational programs should consider providing supplementary resources or targeted interventions for students based on their unique backgrounds and needs.
- Focus on Language Support: Given the importance of localization and language support highlighted in the qualitative responses, educational programs should consider providing bilingual teaching materials and additional language support to assist non-native English speakers.
- Enhance Labeling and Guides: Improve the labeling and guides for anatomical models and resources. Providing detailed guides and full labels can help students accurately identify and learn anatomical structures, addressing one of the common concerns highlighted in the qualitative feedback.
There is a strong demand (20 responses) for increasing the availability of practical resources such as real cadavers and plastinated models, which are essential for hands-on learning experiences.
Improving the labeling and guides for anatomical models also emerged as a high priority, with 18 responses highlighting the need for detailed guides to aid in the accurate identification of anatomical structures. Furthermore, integrating more interactive tools and visual aids, such as videos and 3D models, received considerable support (15 responses), underscoring the need for engaging and dynamic learning resources.
Moderate priority should be given to incorporating additional tools and methods (12 responses) and providing localization and language support (10 responses), which would benefit non-native English speakers and enhance overall comprehension. Lastly, extending access to the Complete Anatomy App, although mentioned by fewer students (8 responses), remains a relevant suggestion for improving continuous learning support across all cohorts.
By prioritizing these recommendations, educational programs can significantly enhance the effectiveness and engagement of anatomy education for medical students.
Financial considerations when implementing modern learning resoureces
Even though the advantages of modern learning resources bringing to the students are undeniable, the financial considerations play an important role when deciding which learning resources should one go for. The combined cost of plastinated models (Gubener Plastinate GmbH), which included 2 full bodies, one hemisphere, one heart, one superficially-dissect foot, and head and neck specimen for approximately 245,000 USD*. Besides, more than 300 plastic models (from brands such as 3B Scientific, SOMSO, Denoyer-Geppert Science, etc.) were invested for approximately 88,000 USD*. The Pirogov table (Razvitiye LLC) also costed 64,000 USD*, and lastly, the annual subscription fee for Complete Anatomy app (3D4Medical Ltd.) was 40 USD* per students. However, most investment is one-time purchase that can be used by many generations of students. Having the course instructors, teaching assistants, and students familiarized themselves with new learning resources are also crucial to deliver the course effectively.