The Creation and Evaluation of a Novel Anatomical Mental Rotation Test for Medical Education Research
Authors: Keeler Molika E , Stabio Maureen E , Royer Danielle F 
Published: November 2023

Medical trainees must thoroughly understand the structure of the human body in order to develop competency with clinical procedures, imaging, and diagnosis. Learning, retaining, and applying human anatomy requires mentally visualizing and orienting anatomical structures and relationships, skills broadly classified as spatial ability. Evidence shows one type of spatial ability, mental rotation (MR), is influenced by factors outside of the classroom and can be trained in order to improve student outcomes in anatomy courses. However, there are few anatomically‐based training interventions targeting MR skills. This preliminary study aimed to 1) create a novel Anatomical Mental Rotation Test (AMRT), 2) determine its concurrent validity in relation to the validated Mental Rotation Test (MRT), and 3) determine the reliability of the anatomical images in the AMRT at targeting MR ability. Fourteen participants with graduate education in human anatomy were recruited. Each participant completed an anonymous survey using forced‐response, free response, and Likert items to establish baseline knowledge of demographics, self‐perceived spatial ability, and prior experiences related to visual‐spatial skills (e.g. teaching anatomy, work, hobbies). Participants were then given a timed, digital version of the MRT followed by the AMRT. The MRT utilized cube figures, while the AMRT utilized anatomical structures; each test consisted of 24 questions. Each question contained a target figure and four stimulus figures (including rotated and rotated‐mirror image figures). Participants were asked to select the two stimulus figures that correctly matched the target figure. Data comparing participant MRT score to AMRT score was analyzed using Spearman's correlation test. A Mann‐Whitney U test with Bonferroni correction evaluated if MRT and AMRT scores differ based on three participant criteria: self‐perceived spatial ability (high vs low), work experience (with vs without prior visual‐spatial work experience), and teaching experience (with vs without prior anatomy teaching). Results indicate a significant positive correlation between MRT and AMRT scores (r = 0.75, p = 0.002). No significant differences (p > 0.05) were found in either MRT or AMRT scores based on self‐perceived spatial ability, prior visual‐spatial work experience, and prior anatomy teaching experience. This preliminary study suggests the AMRT has concurrent validity to effectively capture students’ MR abilities, and the anatomical representations of the AMRT reliably target MR abilities. The next step is to use the AMRT images to develop an anatomical MR‐focused intervention. This anatomical MR‐focused training will be compared to a non‐anatomical MR‐focused intervention in order to further study the impact of specific types of targeted‐MR training on outcomes in a human anatomy course. The development of anatomically‐based interventions targeting MR skills could lead to better understanding, recall, and application of anatomical knowledge for medical trainees, and is a rich avenue for medical education research.