Evaluation of a Mixed Reality Approach to Teaching in a Physician‐Associate Gross Anatomy Course
Authors: Rahawi Anthony H. , Crofton Andrew , Enterline Rebecca , Lewis Jensen , Lord Cynthia , Griswold Mark , Wish‐Baratz Susanne 
Published: May 2022

Introduction & ObjectiveWhile cadaveric dissection has been recognized as the gold standard for anatomical education historically, mixed‐reality devices have recently been implemented in medical school gross anatomy courses due to improved spatial learning and time‐savings relative to dissection. HoloAnatomy (HA), a mixed‐reality application for Microsoft HoloLens, places three‐dimensional virtual cadavers in real space for full appreciation of spatial relationships of anatomical structures. Previous studies focused on HA suggest that there are no significant differences in exam performance between mixed reality and cadaveric dissection. No study has evaluated the efficacy of mixed reality as a learning resource for Physician Associate (PA) students. Therefore, we hypothesized that students would perform equally well on a mixed‐reality (HA) exam versus cadaveric exam regardless of the modality (HA vs dissection) used for learning in a PA gross anatomy course.Materials and MethodsThe PA gross anatomy course at Case Western Reserve University is divided into four units based on anatomical regions. Participating students (n=30) were randomly placed into one of two cohorts. Both cohorts performed dissection during the first unit of the course. In Unit 2, cohort 1 utilized HA, while cohort 2 performed dissection. At the end of the unit, students in each cohort took two lab exams: one on HA and one on cadavers. Cohorts alternated the modality on which they learned each unit. Cohort 1 utilized mixed reality twice and performed dissection once, while cohort 2 utilized mixed reality once and performed dissection twice. Students utilizing HA were allowed to view cadavers to study, but students dissecting cadavers were not allowed to use HA. Mean exam scores were compared both between the different exam modalities within a cohort as well as between the two cohorts on the same exam modality through performance of unpaired t‐tests. Linear regressions were utilized to compare individual cohort performance per exam (HA vs cadaver) to determine distribution of scores. A post‐course survey was distributed to the participants to rate subjective thoughts between the two modalities and their effectiveness in the course.ResultsAcross all units, PA students consistently achieved significantly higher scores on HA exams regardless of the modality on which they learned. Cohort 2 consistently scored higher on the exam corresponding to the modality on which they learned, while cohort 1 consistently performed better better on the HA exams. When comparing exam means within cohorts, the difference between those means was less significant for the cohort who performed cadaveric dissection. Linear regressions performed to compare performance of individual students on both modalities show a normal distribution of scores. Based on the post‐course survey, PA students found HA to be more enjoyable than cadaveric dissection and made learning anatomy easier overall. However, more students expressed that the knowledge they gained from performing cadaveric dissection was more transferable to HA than the reciprocal.ConclusionAlthough the exam score data and post‐course survey posits that learning gross anatomy through cadaveric dissection seems to enable students to better transfer knowledge to different contexts, HA appears to be a viable and preferential alternative approach to teaching gross anatomy to PA students.