Comparative Study of Augmented Reality vs Traditional Learning in Anatomy Education

Study Overview
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Brief Summary
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The goal of this clinical trial is to assess the efficacy of augmented reality (AR) in anatomy teaching. The main question to answer is: Is 3-Dimensional AR technology more effective than traditional learning methods in anatomy education? In this clinical trial undergraduate medical students with no prior anatomy education will be recruited. Participants in the AR group will learn the anatomy of the cranial nerves with an AR application using Microsoft HoloLens 2, whereas participants in the control group will learn with traditional learning methods (textbooks, atlases, videos, and online learning programs).

Detailed Description
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Anatomy is a central part in medical training and is traditionally taught through lectures, textbooks, videos and cadaver dissections. Cadaver dissections are important to understand spatial relationships and individual variations of anatomical structures. In many universities, however, financial and ethical considerations, as well as uncommon circumstances such as the COVID-19 pandemic, have restricted access to cadaver dissections. Consequently, new teaching methods based on visual technologies such as augmented reality (AR) are being implemented worldwide. AR can generate realistic 3-dimensional (3D) images overlaid in the real-word environment, merging real and virtual world to provide an interactive learning experience. The use of such technologies in education is still in the early stages, and further research is needed to assess their beneficial impact in knowledge acquisition. The TEACHANATOMY project aim to develop a 3D, interactive AR teaching module focused on the anatomy of the cranial nerves. To assess its potential value in anatomy education, the investigators will perform a study to compare traditional learning methods based on textbooks, videos, and online resources, with the novel AR learning module using the HoloLens 2 (Microsoft Corporation). The goal is to assess whether AR technology can improve anatomical knowledge and enhance student's motivation and engagement.

Official Title
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Effectiveness of Augmented Reality in Anatomy Education: The TEACHANATOMY Randomized Clinical Trial

Conditions
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Augmented Reality, Anatomy Education

Intervention / Treatment
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* Other: Augmented reality group
* Other: Traditional learning group


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Medical students attending the 1st or 2nd year of undergraduate medical education Must not have prior neuroanatomical education Exclusion Criteria: Epilepsy Binocular vision disorder such as strabismus Current head and/or neck injuries Inflammation of the scalp and/or eye Amputations or partial amputations of the hands

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 25 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Augmented Reality (AR) group.<br>- The experimental group will consist of approximately 20 undergraduate medical students. Participants will use the TEACHANATOMY learning application with the HoloLens 2. | Other: Augmented reality group<br>* Study presentation: participants will be given a 10-minute general introduction on the study followed by a 20 minutes tutorial to introduce the HoloLens 2 and the TEACHANATOMY learning platform. Study session: The study session consists of three learning blocks of approximately 20 minutes each, plus a repetition block to assess the acquired knowledge. During the study session participants will be given no time constraints and free breaks. Assessment test: Participants will be assessed with a 30 minutes knowledge assessment test. Final questionnaire: At the end participants will be given a questionnaire to assess adverse health symptoms and user experience.<br>|
| Active Comparator: Traditional learning (TL) group.<br>- The control group will consist of approximately 20 undergraduate medical students. Participants will use traditional learning methods with textbooks, atlases, videos, and online learning programs, | Other: Traditional learning group<br>* Study presentation: participants will be given a 10-minute general introduction on the study followed by a presentation to introduce the study session. Study session: The study session consists of the learning resources most used by students: specific sections from four different neuroanatomy books, access to two websites, two 3D videos, and two online learning programs. During the study session participants will be given no time constraints and free breaks. Assessment test: Participants will be assessed with a 30 minutes knowledge assessment test. Final questionnaire: At the end participants will be given a questionnaire to assess adverse health symptoms and user experience.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Knowledge acquisition | The primary outcome will consist of the score in the final theoretical and practical tests. The theoretical test consist of 23 single and multiple-choice questions in which participants will be required to recognize and name the 12 cranial nerves, differentiate their main functions and the typology (sensory, motor, mixed), explain the relationships between their structure and function, and recognize lesions using case studies. In the practical part, participants will be required to mark specific nerves in a 3D-printed anatomical skull model. The duration of the test will be of 30 minutes. | Immediately after the study session, Day 1 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Adverse Health Symptoms | Secondary outcomes will include adverse health symptoms, evaluated with a questionnaire to assess presence and severity of general symptoms (General discomfort, Fatigue, Headache, Dizziness, Nausea, Concentration problems, Disorientation, Neck stiffness/neck pain, No symptoms) and eye-related symptoms (Blurred vision, Difficulty focusing, Double-vision, Dry eyes No symptoms). Presence and severity of symptoms will be rated on a Likert scale from 1 (almost imperceptible) to 10 (extreme). | Immediately after the knowledge acquisition test, Day 1. | 
| User experience | User experience will be assessed using an adapted NASA Task Load Index (5 questions, range, 1-10, with lower scores indicating lower cognitive workload) plus additional 10-point Likert scale and open-ended questions, in which participants were asked to rank their comfort with the material and hardware and the teaching effectiveness of the software or of the traditional learning methods to learn the anatomy of the cranial nerves | Immediately after the knowledge acquisition test, Day 1. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Anatomy teaching, Augmented reality, Microsoft HoloLens, Cranial nerves