Sex‐based Differences in Visual‐Spatial Reasoning Do Not Impact Exam Performance in Musculoskeletal Anatomy Among Physical Therapy Students
Authors: Waite Jordan , Harmon Derek , Topp Kimberly , Smoot Betty , Farkas Gary 
Published: April 2020

Introduction

Previous research has investigated visual‐spatial reasoning in the acquisition of anatomical knowledge and has identified sex‐based differences in this reasoning among various student populations. However, to date, no studies have evaluated if sex‐based differences exist in visual‐spatial reasoning among doctor of physical therapy (DPT) students and if these differences impact examination performance in musculoskeletal (MSK) gross anatomy.

Aim

The purpose of this study was to (1) investigate sex‐based differences in visual‐spatial reasoning and (2) determine if these differences impacted exam performance among DPT students enrolled in a MSK anatomy course. We hypothesized, visual‐spatial reasoning would be greater in male DPT students versus female DPT students, and positively correlate with exam performance.

Methods

Fifty first‐year DPT students were voluntarily recruited during the first week of a 10‐week MSK anatomy course to complete the Vandenberg Mental Rotation Test (VMRT), rate their level of confidence in MSK anatomy (1=low, 5=high confidence), and provide demographic information (self‐identified gender, sex, age) in this IRB‐approved study. At the end of the course, scores on written (n=3) and practical (n=3) examinations were collected. A total examination score was determined, and a ratio was calculated for the total number of correct to the total number of attempted VMRT questions. Groups were dichotomized by sex and data were checked for normality with the Shapiro‐Wilk test. Comparisons between groups were analyzed with the Mann–Whitney U‐test. Sex‐based correlations were assessed with Spearman’s rho. Alpha<0.05.

Results

No significant differences in age were found between male (n=16) and female (n=34) DPT students (M: 25.6±4.2 vs. F: 25.9±4.6, p=0.71). VMRT scores among males were significantly higher than females (M: 17.8±3.9 vs. F: 11.0±3.9, p<0.0001). The number of VMRT questions attempted was also significantly higher among males compared to females (M: 21.9±3.6 vs. F: 15.8±3.8, p<0.0001). No significant differences between the groups were found in the number of questions answered incorrectly on the VMRT (M: 4.13±2.7 vs. F: 4.84±3.75, p=0.69) or the ratio number of VMRT questions correct to the number attempted (M: 0.81±0.11 vs. F: 0.70±0.19, p=0.082). Scores for practical exam (M: 67.3±4.3 vs. F: 67.0±4.3), written exam (M: 68.9±3.6 vs. F: 68.9±3.4), and combined total score (M: 136.2±6.7 vs. F: 135.9±7.0) did not differ between groups (p>0.05). There was a significant correlation between age and total exam score in females (r=−0.42, p=0.013), but not in males (r=−0.29, p=0.27). No other significant correlations were detected.

Discussion/Conclusion

These results demonstrate that visual‐spatial reasoning is higher among first‐year male DPT students compared to female DPT students, but do not impact exam performance in a MSK anatomy course. Understanding sex‐based differences in anatomical knowledge acquisition may help anatomy instructors improve learning outcomes. Future research is needed to determine if female PT students compensate with alternate learning strategies and whether these strategies are sex‐specific.