First German experience using augmented reality for neuroanatomy education in undergraduate medical students: a feasibility and questionnaire-based study
Authors: Zhao Yining , Bozhkov Yavor , Chen Xiaolei , Fuchs Katharina , Buchfelder Michael , Fester Lars , Oliveira Daniela Souza , Vecchio Alessandro Del , Kinfe Thomas M. 
Published: June 2023

Abstract
Introduction: To date, neuroanatomy education courses are still based on two-dimensional (2D) illustrations combined with cadaver dissections. To gain a more comprehensive understanding of neuroanatomy, we offered mixed reality experience using a head-mounted device(HMD) for medical students during their neuroanatomy course. This pilot study aimed to evaluate the feasibility of using mixed reality in neuroanatomy education and the acceptance and effectiveness of the mixed reality anatomy seminar for medical students.
Methods: A virtual model including major neuroanatomical structures was generated from a MRI dataset using computer software. Major structureswere displayed and annotated in different combinations and scenes using an HMD. Along with the 3D virtual model, the original MRI was presented in a virtual form inside the HMD. Conventional 2D anatomical atlaseswere also used during the seminar. 30 medical students in their second year at Friedrich-Alexander University Erlangen-Nürnberg were recruited for this study via open invitation during neuroanatomy lectures. Participants were asked to wear the HMDs and to take a 2-hour neurosurgery-oriented mixed reality seminar given by a neurosurgical teacher in small groups (3 per group). A questionnaire comprising five levels of options was designed and used to evaluate the acceptance / effectiveness of this seminar.
Results: The mixed reality enviroment, comprising virtual 3D models of major brain structures, virtual MRI, and conventional 2D anatomical graphs, was uncomplicated and feasible for neuroanatomy education of the medical students. According to our survey, all participants (30/30) strongly agreed that the 3D visualization of the spatial relationships between anatomical structures was easy to use as a meaningful supplement. Twenty-one of the participants strongly agreed and nine quite agreed that they had more interest in neuroanatomy. Eighty-seven percentof the participants were strongly satisfied with the mixed reality seminar versus conventional neuroanatomy seminars, and the other 13% were quite satisfied with the mixed reality approach. Most of the participants (20/30) strongly agreed that mixed reality helped them memorize the anatomical structures, and 9/30 participants quite agreed. Seventy-four percentof the participants agreed that immersive mixed reality is better than 3D models presented in 2D devices. Over half of the participants could wear the HMD for over 60 minutes (65%) without any ophthalmic discomfort, and the HMD was reported to be well tolerable (57%). Nearly three-fourthsof the participants found that handling the device was extremely simple, and the other part indicated that it was quite simple. No health issues or discomfort on the forehead occurred. As a consequence, the seminar has been officially classified as an elective neuroanatomy course for second-year medical students.
Conclusions: Using mixed reality with HMDs to conduct neuroanatomy education to supplement conventional lectures and cadaver dissection is feasible. The mixed-reality seminar described in our study was quite acceptable for medical students and promoted increased interest in neurosurgery. Most importantly, mixed reality could help medical students more efficiently understand and memorize the major structures and their dimensional relationships in neuroanatomy.