Teaching cutaneous sensory distribution of the upper limb using interactive virtual reality
Authors: Shearer Brian , Ramirez Kristen , Dorsainville Greg , Harnik Victoria , Rosenfeld Mel 
Published: April 2020

Understanding the normal distribution of dermatomes and the named sensory nerves that innervate the skin of the upper limb is a critical clinical tool for the medical student, as it can allow them to diagnose a spinal or peripheral nervous system pathology without advanced imaging. The anatomy of dermatomes and named sensory nerves is traditionally taught using 2‐dimensional (2D) images, with separate ventral and dorsal views that students labor to connect into a whole construct, which may not easily translate to 3‐dimensions (3D) for interacting with patients. We observed that this is a potential area for implementation of Virtual Reality (VR) innovation, which can more easily convey 3D concepts and thereby provide students with a novel method of learning that will more accurately reflect real‐world anatomy. We therefore designed a student‐lead, interactive VR group activity that would allow for better visualization of sensory nerve distributions to improve the anatomical and clinical connections for pre‐clinical medical students.An unmarked 3D model of a human male body in anatomical position was provided for students (n=103) in the program Medium with the Oculus Virtual Reality system. During a 45 minute lab session on upper limb anatomy, small groups (4–6 students) were assigned the goal of “painting” the unmarked 3D model with color‐coded segments to reflect 2D reference images of dermatome distribution for the upper limbs. One student per group volunteered to digitally paint the model in VR while their group mates watched their actions on a projection and verbally instructed them on translating the 2D reference images onto the 3D virtual model using anatomical terminology to reinforce understanding. After the activity, students were provided with a marked version of the 3D dermatome/named nerve maps created by the instructors as an independent study resource.No significant differences were noted on exam scores between cohorts that were provided VR activity (2019) and those that were taught using traditional 2D images (2018), with inconsistent performance on two exam questions among the anatomy cohorts. The dermatome question increased in percent correct (2018: 47%, 2019: 54%) while the named cutaneous nerve question decreased in correct responses (2018: 70%, 2019: 60%). These remain among the lowest scoring questions in terms of correct responses in our exam despite the VR intervention. Furthermore, student feedback on the activity was mixed. The instructor‐created independent study resource netted a high click‐through rate and student interactivity relative to other provided resources, though 66% of students reported not finding the activity useful. In future iterations of the exercise, time constraints will be removed by creating group assignments to be done outside of existing lab times. With adjustments, we predict these exercises will enhance student understanding of nerve/skin associations and will therefore deepen their clinically relevant knowledge on the presentations of pathological conditions. The 3D cutaneous nerve distribution model provides a more accurate and understandable reference for students to build their clinical knowledge than 2D references.