Abstract
Clinical image interpretation is one of the most challenging activities for students when they first arrive at medical school. Interpretation of clinical images concerns the identification of three-dimensional anatomical features in two-dimensional cross-sectional computed tomography (CT) and magnetic resonance imaging (MRI) images in axial, sagittal and coronal planes, and the recognition of structures in ultrasound and plain radiographs. We propose that a cognitive transition occurs when initially attempting to interpret clinical images, which requires reconciling known 3D structures with previously unknown 2D visual information. Additionally, we propose that this 3D-2D transition is required when integrating an understanding of superficial 2D surface landmarks with an appreciation of underlying 3D anatomical structures during clinical examinations.
Based on educational theory and research findings, we recommend that 3D and 2D approaches should be simultaneously combined within radiological and surface anatomy education. With a view to this, we have developed and utilised digital and art-based methods to support the 3D-2D transition. We outline our observations and evaluations, and describe our practical implementation of these approaches within medical curricula to serve as a guide for anatomy educators. Furthermore, we define the theoretical underpinnings and evidence supporting the integration of 3D-2D approaches and the value of our specific activities for enhancing the clinical image interpretation and surface anatomy learning of medical students.
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References
Aggarwal R, Brough H, Ellis H (2006) Medical student participation in surface anatomy classes. Clin Anat 19:627–631. https://doi.org/10.1002/ca.20225
Al Qahtani F, Abdelaziz A (2014) Integrating radiology vertically into an undergraduate medical education curriculum: a triphasic integration approach. Adv Med Educ Pract 5:185–189. https://doi.org/10.2147/AMEP.S58858
Ausubel DP (2012) The acquisition and retention of knowledge: a cognitive view, 1st edn. Springer, Dordrecht
Azer SA (2011) Learning surface anatomy: which learning approach is effective in an integrated PBL curriculum? Med Teach 33:78–80. https://doi.org/10.3109/0142159X.2011.530704
Azer SA (2013) The place of surface anatomy in the medical literature and undergraduate anatomy textbooks. Anat Sci Educ 6:415–432. https://doi.org/10.1002/ase.1368
Backhouse M, Fitzpatrick M, Hutchinson J, Thandi CS, Keenan ID (2017) Improvements in anatomy knowledge when utilizing a novel cyclical “observe-reflect-draw-edit-repeat” learning process. Anat Sci Educ 10:7–22. https://doi.org/10.1002/ase.1616
Ballantyne L (2011) Comparing 2D and 3D Imaging. J Vis Commun Med 34:138–141
Barr R (2010) Transfer of learning between 2D and 3D sources during infancy: informing theory and practice. Dev Rev 30:128–154. https://doi.org/10.1016/j.dr.2010.03.001
Ben Awadh A, Lindsay S, Clark J, Clowry G, Keenan I (2019) Student perceptions of challenging topics and concepts in anatomy education. In: Anatomical Society summer meeting, University of Oxford, Oxford, 2018. J Anat 3:392–418. https://doi.org/10.1111/joa.12923
Bennett C (2014) Anatomic body painting: where visual art meets science. J Physician Assist Educ 25:52–54
Bergman EM, Sieben JM, Smailbegovic I, de Bruin AB, Scherpbier AJ, van der Vleuten CP (2013) Constructive, collaborative, contextual, and self-directed learning in surface anatomy education. Anat Sci Educ 6:114–124. https://doi.org/10.1002/ase.1306
Carroll JB (1993) Human cognitive abilities: a survey of factor-analytic studies. Cambridge University Press, Cambridge
Chau M et al (2013) Using 3D virtual environments to facilitate students in constructivist learning. Decis Support Syst 56:115–121. https://doi.org/10.1016/j.dss.2013.05.009
Chickering AW, Gamson ZF (1987) Seven principles for good practice in undergraduate education. Am Assoc High Educ Bull 39:3–7
Collins JP (2008) Modern approaches to teaching and learning anatomy. BMJ 337:a1310. https://doi.org/10.1136/bmj.a1310
Dalgarno B (2002) The potential of 3D virtual learning environments: a constructivist analysis electronic. J Instr Sci Technol 5:90–95
Davis CR, Bates AS, Ellis H, Roberts AM (2014) Human anatomy: let the students tell us how to teach. Anat Sci Educ 7:262–272. https://doi.org/10.1002/ase.1424
de Barros N, Rodrigues CJ, Rodrigues AJ Jr, de Negri Germano MA, Cerri GG (2001) The value of teaching sectional anatomy to improve CT scan interpretation. Clin Anat 14:36–41. https://doi.org/10.1002/1098-2353(200101)14:1<36::aid-ca1006>3.0.co;2-g
Dennick R (2008) Theories of learning: constructive experience. In: Matheson D (ed) An introduction to the study of education. David Fulton, London
Dettmer S, Tschernig T, Galanski M, Pabst R, Rieck B (2010) Teaching surgery, radiology and anatomy together: the mix enhances motivation and comprehension. Surg Radiol Anat 32:791–795. https://doi.org/10.1007/s00276-010-0694-5
Dewey J (1938) Experience and education. Simon and Schuster, New York, p 2007
Donnelly L, Patten D, White P, Finn G (2009) Virtual human dissector as a learning tool for studying cross-sectional anatomy. Med Teach 31:553–555. https://doi.org/10.1080/01421590802512953
Eagleton S (2015) An exploration of the factors that contribute to learning satisfaction of first-year anatomy and physiology students. Adv Physiol Educ 39:158–166. https://doi.org/10.1152/advan.00040.2014
Evgeniou E, Loizou P (2012) The theoretical base of e-learning and its role in surgical education. J Surg Educ 69:665–669. https://doi.org/10.1016/j.jsurg.2012.06.005
Fasel JH, Morel P, Gailloud P (2005) A survival strategy for anatomy. Lancet 365:754. https://doi.org/10.1016/s0140-6736(05)17981-1
Fernandez R, Dror IE, Smith C (2011) Spatial abilities of expert clinical anatomists: comparison of abilities between novices, intermediates, and experts in anatomy. Anat Sci Educ 4:1–8. https://doi.org/10.1002/ase.196
Finn GM (2010) Twelve tips for running a successful body painting teaching session. Med Teach 32:887–890. https://doi.org/10.3109/0142159x.2010.507708
Finn GM, McLachlan JC (2010) A qualitative study of student responses to body painting. Anat Sci Educ 3:33–38. https://doi.org/10.1002/ase.119
Finn GM, White PM, Abdelbagi I (2011) The impact of color and role on retention of knowledge: a body-painting study within undergraduate medicine. Anat Sci Educ 4:311–317. https://doi.org/10.1002/ase.253
Fogg QA (2007) The virtual human dissector by touch of life technologies and University of Colorado, www.toltech.net. Clin Anat 20:226–227
Foster N (2011) Analysis of short-answer question styles versus gender in pre-clinical veterinary education. J Vet Med Educ 38:67–73
Freeman S, Eddy SL, McDonough M, Smith MK, Okoroafor N, Jordt H, Wenderoth MP (2014) Active learning increases student performance in science, engineering, and mathematics. Proc Natl Acad Sci U S A 111:8410–8415. https://doi.org/10.1073/pnas.1319030111
Garg AX, Norman G, Sperotable L (2001) How medical students learn spatial anatomy. Lancet 357:363–364
General Medical Council (2009) Tomorrow’s doctors: an improvement if evaluated. Lancet 374:851–851
Gibbs G (2010) Dimensions of quality. Higher Education Academy. https://www.heacademy.ac.uk/system/files/dimensions_of_quality.pdf . Accessed 15th May 2019
Greene SJ (2018) The use and effectiveness of interactive progressive drawing in anatomy education. Anat Sci Educ 11:445–460. https://doi.org/10.1002/ase.1784
Guillot A, Champely S, Batier C, Thiriet P, Collet C (2007) Relationship between spatial abilities, mental rotation and functional anatomy learning. Adv Health Sci Educ 12:491–507
Gunderman RB, Stephens CD (2009) Teaching medical students about imaging techniques. AJR Am J Roentgenol 192:859–861. https://doi.org/10.2214/ajr.08.1738
Hake RR (1998) Interactive-engagement versus traditional methods: a six-thousand-student survey of mechanics test data for introductory physics courses. Am J Phys 66:64–74. https://doi.org/10.1119/1.18809
Healey M, Flint A, Harrington K (2014) Engagement through partnership: students as partners in learning and teaching in higher education. Higher Education Academy https://www.heacademy.ac.uk/engagement-through-partnership-students-partners-learning-and-teaching-higher-education . Accessed 15th May 2019
Hiraumi H, Sato H, Ito J (2017) Papercraft temporal bone in the first step of anatomy education. Auris Nasus Larynx 44:277–281. https://doi.org/10.1016/j.anl.2016.07.017
Huang H-M, Rauch U, Liaw S-S (2010) Investigating learners’ attitudes toward virtual reality learning environments: based on a constructivist approach. Comput Educ 55:1171–1182. https://doi.org/10.1016/j.compedu.2010.05.014
Huk T (2006) Who benefits from learning with 3D models? The case of spatial ability. J Comput Assist Learn 22:392–404
Jang HW, Oh CS, Choe YH, Jang DS (2018) Use of dynamic images in radiology education: movies of CT and MRI in the anatomy classroom. Anat Sci Educ 11:547–553. https://doi.org/10.1002/ase.1793
Keenan ID, Ben Awadh A (2019) Integrating 3D visualisation technologies in undergraduate anatomy education. Adv Exp Med Biol 1120:39–53. https://doi.org/10.1007/978-3-030-06070-1_4
Keenan ID, Hutchinson J, Bell K (2017) Twelve tips for implementing artistic learning approaches in anatomy education. MedEdPublish 6(2):1–13. https://doi.org/10.15694/mep.2017.000106
Kelly S, Dennick R (2009) Evidence of gender bias in true-false-abstain medical examinations. BMC Med Educ 9:32. https://doi.org/10.1186/1472-6920-9-32
Kerr JP, Knapp D, Frake B, Sellberg M (2000) “True” color surface anatomy: mapping the visible human to patient-specific CT data. Comput Med Imaging Graph 24:153–164
Khalil MK, Paas F, Johnson TE, Payer AF (2005) Design of interactive and dynamic anatomical visualizations: the implication of cognitive load theory. Anat Rec B New Anat 286:15–20
Khan N, Coppola W, Rayne T, Epstein O (2009) Medical student access to multimedia devices: most have it, some don’t and what’s next? Inform Health Soc Care 34:100–105. https://doi.org/10.1080/17538150902779550
Knudsen L, Nawrotzki R, Schmiedl A, Muhlfeld C, Kruschinski C, Ochs M (2018) Hands-on or no hands-on training in ultrasound imaging: a randomized trial to evaluate learning outcomes and speed of recall of topographic anatomy. Anat Sci Educ 11:575–591. https://doi.org/10.1002/ase.1792
Kolb DA (1984) The process of experiential learning. In: experiential learning : experience as the source of learning and development. Prentice-Hall, Englewood Cliffs, p 22
Kraft M, Sayfie A, Klein K, Gruppen L, Quint L (2018) Introducing first-year medical students to radiology. Implement Impact Acad Radiol 25:780–788. https://doi.org/10.1016/j.acra.2018.02.002
Land R, Cousin G, Meyer JHF, Davies P (2005) Threshold concepts and troublesome knowledge (3): implications for course design and evaluation improving student learning–equality and diversity. OCSLD, Oxford
Langlois J, Bellemare C, Toulouse J, Wells GA (2017) Spatial abilities and anatomy knowledge assessment: a systematic review. Anat Sci Educ 10:235–241. https://doi.org/10.1002/ase.1655
Lawson R, Humphreys GW, Watson DG (1994) Object recognition under sequential viewing conditions: evidence for viewpoint-specific recognition procedures. Perception 23(5):595–614
Lewin K (1942) Field theory and learning. In: Cartwright D (ed) Field theory in social science: selected theoretical papers. Social Science Paperbacks, London
Link TM, Marz R (2006) Computer literacy and attitudes towards e-learning among first year medical students. BMC Med Educ 6:34. https://doi.org/10.1186/1472-6920-6-34
Lodge JM, Hansen L, Cottrell D (2016) Modality preference and learning style theories: rethinking the role of sensory modality in learning. Learn Res Pract 2:4–17. https://doi.org/10.1080/23735082.2015.1083115
Lufler RS, Zumwalt AC, Romney CA, Hoagland TM (2012) Effect of visual-spatial ability on medical students’ performance in a gross anatomy course. Anat Sci Educ 5:3–9. https://doi.org/10.1002/ase.264
Luursema J-M, Verwey WB, Kommers PA, Geelkerken RH, Vos HJ (2006) Optimizing conditions for computer-assisted anatomical learning. Interact Comput 18:1123–1138
Luursema J-M, Verwey WB, Kommers PA, Annema J-H (2008) The role of stereopsis in virtual anatomical learning. Interact Comput 20:455–460
Lyon P, Letschka P, Ainsworth T, Haq I (2013) An exploratory study of the potential learning benefits for medical students in collaborative drawing: creativity, reflection and ‘critical looking’. BMC Med Educ 13:86. https://doi.org/10.1186/1472-6920-13-86
Marks SC (2000) The role of three-dimensional information in health care and medical education: the implications for anatomy and dissection. Clin Anat 13:448–452
Marr D, Vision A (1982) A computational investigation into the human representation and processing of visual information. WH Freeman and Company, San Francisco
May H, Cohen H, Medlej B, Kornreich L, Peled N, Hershkovitz I (2013) Computed tomography-enhanced anatomy course using enterprise visualization. Anat Sci Educ 6:332–341. https://doi.org/10.1002/ase.1340
McLachlan JC (2004) New path for teaching anatomy: living anatomy and medical imaging vs. dissection. Anat Rec B New Anat 281:4–5. https://doi.org/10.1002/ar.b.20040
McMenamin PG (2008) Body painting as a tool in clinical anatomy teaching. Anat Sci Educ 1:139–144. https://doi.org/10.1002/ase.32
Meyer J, Land R (2003) Threshold concepts and troublesome knowledge: linkages to ways of thinking and practising within the disciplines. University of Edinburgh, Edinburgh
Meyer JHF, Land R (2005) Threshold concepts and troublesome knowledge (2): epistemological considerations and a conceptual framework for teaching and learning. High Educ 49:373–388
Meyer JHF, Land R, Baillie C (2010) Threshold concepts and transformational learning. Sense Publishers, Rotterdam
Miles KA (2005) Diagnostic imaging in undergraduate medical education: an expanding role. Clin Radiol 60:742–745. https://doi.org/10.1016/j.crad.2005.02.011
Moffett J (2015) Twelve tips for “flipping” the classroom. Med Teach 37:331–336. https://doi.org/10.3109/0142159X.2014.943710
Naug HL, Colson NJ, Donner DG (2011) Promoting metacognition in first year anatomy laboratories using plasticine modeling and drawing activities: a pilot study of the “blank page” technique. Anat Sci Educ 4:231–234. https://doi.org/10.1002/ase.228
Nguyen N, Mulla A, Nelson AJ, Wilson TD (2014) Visuospatial anatomy comprehension: the role of spatial visualization ability and problem-solving strategies. Anat Sci Educ 7:280–288. https://doi.org/10.1002/ase.1415
Nicholson LL, Reed D, Chan C (2016) An interactive, multi-modal anatomy workshop improves academic performance in the health sciences: a cohort study. BMC Med Educ 16:7. https://doi.org/10.1186/s12909-016-0541-4
Nyhsen CM, Lawson C, Higginson J (2011) Radiology teaching for junior doctors: their expectations, preferences and suggestions for improvement. Insights Imaging 2:261–266. https://doi.org/10.1007/s13244-010-0052-5
Nyhsen CM, Steinberg LJ, O’Connell JE (2013) Undergraduate radiology teaching from the student’s perspective. Insights Imaging 4:103–109. https://doi.org/10.1007/s13244-012-0206-8
O’Mahony SM, Sbayeh A, Horgan M, O’Flynn S, O’Tuathaigh CM (2016) Association between learning style preferences and anatomy assessment outcomes in graduate-entry and undergraduate medical students. Anat Sci Educ 9(4):391–399. https://doi.org/10.1002/ase.1600
O’Rourke JC, Smyth L, Webb AL, Valter K (2019) How can we show you, if you can’t see it? Trialing the use of an interactive three-dimensional micro-CT model in medical education. Anat Sci Educ. https://doi.org/10.1002/ase.1890
Oh CS, Kim JY, Choe YH (2009) Learning of cross-sectional anatomy using clay models. Anat Sci Educ 2:156–159. https://doi.org/10.1002/ase.92
Patten D (2007) What lies beneath: the in living anatomy teaching. Clin Teach 4:10–14. https://doi.org/10.1111/j.1743-498X.2007.00136.x
Piaget J (1970) Genetic epistemology. Norton, New York
Pickering JD (2017) Measuring learning gain: comparing anatomy drawing screencasts and paper-based resources. Anat Sci Educ 10:307–316. https://doi.org/10.1002/ase.1666
Preece D, Williams SB, Lam R, Weller R (2013) “Let’s get physical”: advantages of a physical model over 3D computer models and textbooks in learning imaging anatomy. Anat Sci Educ 6:216–224. https://doi.org/10.1002/ase.1345
Provo J, Lamar C, Newby T (2002) Using a cross section to train veterinary students to visualize anatomical structures in three dimensions. J Res Sci Teach 39:10–34
Reid S, Shapiro L, Louw G (2018) How haptics and drawing enhance the learning of anatomy. Anat Sci Educ 12(2):164–172. https://doi.org/10.1002/ase.1807
Royal College of Radiologists (2019) Undergraduate radiology. Royal College of Radiologists. https://www.rcr.ac.uk/ursa . Accessed 15th May 2019
Silén C, Wirell S, Kvist J, Nylander E, Smedby Ö (2008) Advanced 3D visualization in student-centred medical education. Med Teach 30:e115–e124. https://doi.org/10.1080/01421590801932228
Shapiro L, Bell K, Dhas K, Branson T, Louw G, Keenan ID (2019) Focused multisensory anatomy observation and drawing for enhancing social learning and three-dimensional spatial understanding. Anat Sci Educ
Slon V, Hershkovitz I, May H (2014) The value of cadaver CT scans in gross anatomy laboratory. Anat Sci Educ 7:80–82. https://doi.org/10.1002/ase.1400
Smith CF et al (2016) The anatomical society core regional anatomy syllabus for undergraduate medicine. J Anat 228:15–23. https://doi.org/10.1111/joa.12405
Smith-Bindman R, Miglioretti DL, Larson EB (2008) Rising use of diagnostic medical imaging in a large integrated health system. Health Aff (Millwood) 27:1491–1502. https://doi.org/10.1377/hlthaff.27.6.1491
Sugand K, Abrahams P, Khurana A (2010) The anatomy of anatomy: a review for its modernization. Anat Sci Educ 3:83–93. https://doi.org/10.1002/ase.139
Svirko E, Mellanby J (2008) Attitudes to e-learning, learning style and achievement in learning neuroanatomy by medical students. Med Teach 30:e219–e227. https://doi.org/10.1080/01421590802334275
Sweeney K, Hayes JA, Chiavaroli N (2014) Does spatial ability help the learning of anatomy in a biomedical science course? Anat Sci Educ 7:289–294
Sweller J (1988) Cognitive load during problem solving: effects on learning. Cogn Sci 12:257–285
Tarr MJ, Bülthoff HH (1998) Image-based object recognition in man, monkey and machine. Cognition 67:1–20
Touch of Life Technologies (2019) VH dissector for medical education. http://www.toltech.net/anatomy-software/solutions/vh-dissector-for-medical-education . Accessed 15th May 2019
Van Merriënboer JJ, Sweller J (2010) Cognitive load theory in health professional education: design principles and strategies. Med Educ 44:85–93
Vygotsky L (1978) Mind in society: the development of higher psychological processes. Harvard University Press, Cambridge, MA
Wainman B, Wolak L, Pukas G, Zheng E, Norman GR (2018) The superiority of three-dimensional physical models to two-dimensional computer presentations in anatomy learning. Med Educ 52:1138–1146. https://doi.org/10.1111/medu.13683
Ward PJ, Walker JJ (2008) The influence of study methods and knowledge processing on academic success and long-term recall of anatomy learning by first-year veterinary students. Anat Sci Educ 1:68–74. https://doi.org/10.1002/ase.12
Wood D, Bruner JS, Ross G (1976) The role of tutoring in problem solving. J Child Psychol Psychiatry 17:89–100
World Health Organization (2019) Diagnostic imaging. World Health Organization. http://www.who.int/diagnostic_imaging/en/ . Accessed 15th May 2019
Wu B, Klatzky RL, Stetten G (2010) Visualizing 3D objects from 2D cross sectional images displayed in-situ versus ex-situ. J Exp Psychol Appl 16:45–59. https://doi.org/10.1037/a0018373
Wu B, Klatzky RL, Stetten GD (2012) Mental visualization of objects from cross-sectional images. Cognition 123:33–49
Zilverschoon M, Kotte EMG, van Esch B, Ten Cate O, Custers EJ, Bleys R (2019) Comparing the critical features of e-applications for three-dimensional anatomy education. Ann Anat/Anatomischer Anzeiger 222:28–39. https://doi.org/10.1016/j.aanat.2018.11.001
Acknowledgements
The authors would like to acknowledge Newcastle University MBBS graduates Dr. Gokulan Suthermaraj, who pursued a Newcastle University Research Scholarship project in 2014 and Dr. Amy Tiri, who conducted a Newcastle University MBBS Student Selected Component in 2015, both involving work related to 2D-3D anatomy learning under the supervision of Dr. Keenan. The authors would also like to acknowledge Abdullah Ben Awadh, a doctoral research student within the Institute of Neuroscience at Newcastle University under the supervision of Dr. Keenan, pursuing a project titled ‘Digital and 3D approaches for enhancing human anatomy education’, and Leonard Shapiro for his expertise and insights into art-based and haptic learning. We would like to thank the Medical Education Programme at Newcastle University and Prof Steve McHanwell for Master’s project supervision. We would also like to acknowledge Touch of Life Technologies for providing access and permission to use images of the Virtual Human Dissector. This work was part-funded by a Newcastle University Institute of Creative Arts Practice Award. Ethical assessment for student participation in research has been approved by the Newcastle University Faculty of Medical Sciences Ethics Committee.
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Dr. Iain D Keenan BSc (Hons) PhD MMedEd SFHEA is a Senior Lecturer in Anatomy within the School of Medical Education at Newcastle University. He graduated with a Master’s degree in Medical Education from Newcastle University in 2016, having investigated the 3D-2D transition in clinical image interpretation for his dissertation project.
Megan Powell BSc (Hons) is a student at King’s College London studying for an MBBS degree. During her Biomedical Science BSc at the School of Biomedical Sciences at Newcastle University, she undertook a Newcastle University Research Scholarship project in summer 2015 investigating the 3D-2D transition in clinical image interpretation under the supervision of Dr. Keenan.
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Keenan, I.D., Powell, M. (2020). Interdimensional Travel: Visualisation of 3D-2D Transitions in Anatomy Learning. In: Rea, P. (eds) Biomedical Visualisation . Advances in Experimental Medicine and Biology, vol 1235. Springer, Cham. https://doi.org/10.1007/978-3-030-37639-0_6
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