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Table.  Responses to a Survey by 177 Students About a Remote Anatomy Lesson Using HoloAnatomya
Responses to a Survey by 177 Students About a Remote Anatomy Lesson Using HoloAnatomya
1.
Barsom  EZ, Graafland  M, Schijven  MP.  Systematic review on the effectiveness of augmented reality applications in medical training.   Surg Endosc. 2016;30(10):4174-4183. doi:10.1007/s00464-016-4800-6PubMedGoogle ScholarCrossref
2.
Wish-Baratz  S, Gubatina  AP, Enterline  R, Griswold  MA.  A new supplement to gross anatomy dissection: HoloAnatomy.   Med Educ. 2019;53(5):522-523. doi:10.1111/medu.13845 PubMedGoogle ScholarCrossref
3.
Stojanovska  M, Tingle  G, Tan  L,  et al.  Mixed reality anatomy using Microsoft HoloLens and cadaveric dissection: a comparative effectiveness study.   Med Sci Educ. 2020;30:173-178. doi:10.1007/s40670-019-00834-xGoogle ScholarCrossref
4.
Henderson  S, Feiner  S.  Exploring the benefits of augmented reality documentation for maintenance and repair.   IEEE Trans Vis Comput Graph. 2011;17(10):1355-1368. doi:10.1109/TVCG.2010.245 PubMedGoogle ScholarCrossref
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    Research Letter
    Medical Education
    September 17, 2020

    Assessment of Mixed-Reality Technology Use in Remote Online Anatomy Education

    Author Affiliations
    • 1School of Medicine, Case Western Reserve University, Cleveland, Ohio
    • 2Interactive Commons, Case Western Reserve University, Cleveland, Ohio
    JAMA Netw Open. 2020;3(9):e2016271. doi:10.1001/jamanetworkopen.2020.16271
    Introduction

    The coronavirus disease 2019 (COVID-19) pandemic has presented challenges for education worldwide, especially in medical schools that rely on cadaver-based dissection for anatomy. The advent of commercial mixed-reality (MR) technology, such as the HoloLens (Microsoft Corporation), offers new possibilities for anatomy education.1 At Case Western Reserve University (CWRU), the state of Ohio’s shelter in place order meant that students did not return from spring break in 2020, requiring an urgent modification to the anatomy curriculum, which has featured MR technology since 2018.2 We report our initial experience using MR to teach anatomy remotely to students located throughout North America.

    Methods

    This survey study used a modification of the HoloAnatomy Software Suite (CWRU)2 that allowed headsets to communicate across different Wi-Fi networks and a system to allow instructors and students to digitally point at an object to ask and answer questions. The CWRU institutional review board classified this study as exempt because the survey responses were completely anonymized. Informed consent was implied by completion of the survey. The study followed the American Association for Public Opinion Research (AAPOR) reporting guideline.

    On March 11, 2020, CWRU began shipping MR headsets to all 185 students in the CWRU School of Medicine first-year class. To minimize the potential for COVID-19 transmission, devices were cleaned with 70% isopropyl alcohol and exposure to high intensity UV-C light for 1 minute (Cleanbox) and individually shipped overnight. The 185 students who participated in the study were divided into 4 groups. Each group attended an equivalent 50-minute anatomy lesson focused on the bronchi, lungs, vasculature, and lymphatics. The lessons were held on 2 separate days (March 24 and 26, 2020). Real-time audio and chat were transmitted using the Zoom teleconferencing application (Video Communications, Inc). Class content lasted 35 minutes, with the remaining time set aside for potential technical issues. After each session, students were sent a survey to assess their experience and the technology’s performance. Statistical analysis of the survey responses was performed using Excel (Microsoft Corporation).

    Results

    All 185 students successfully completed the anatomy sessions. As shown in the Table, 177 students (96%) responded to the postinstruction survey. No demographics were recorded from respondents, but the class comprised 95 women and 90 men aged 21 through 34 years. Following AAPOR guidelines, all returned surveys were considered complete, and we classified nonresponders as participants of unknown eligibility. Only 28 students (16%) reported experiencing technical issues that they had not previously experienced in the in-person class, whereas 143 (81%) reported that the remote anatomy sessions were equivalent to or better than the in-person class. When given a choice, 102 students (58%) preferred remote delivery to in-person classes, and 148 (84%) reported believing that students can effectively learn human anatomy using this remote MR application. A total of 143 respondents (81%) reported seeing advantages of remote sessions compared with in-person sessions. Analysis of the 131 qualitative responses about remote sessions showed that the most common advantages reported by students were the ability to study on their own time (67 [51%]) and having more physical space to move around the anatomical models (32 [24%]). The most common disadvantage mentioned was difficulty interacting with the teacher and other students to ask questions (32 [24%]).

    Discussion

    Previous studies have found that students achieve the same level of acquired knowledge in approximately half the time using MR in both medical1-3 and nonmedical situations.4 To our knowledge, this study was the first to show positive learning experiences for an entire class of medical students using MR remotely. The primary limitation of this study is that it was conducted at only a single institution and with students who had prior MR experience.

    Outside the current pandemic, these results also address an everyday situation affecting students worldwide owing to the cost of maintaining cadaver laboratories, the lack of qualified faculty, or other societal reasons. The minimum required infrastructure to run applications, such as HoloAnatomy, is an MR headset and basic Wi-Fi connectivity. Similar to most computer technology, MR headsets are likely to become more affordable over time. Thus, MR has the potential to address cost and access issues to enable high-quality medical education around the world.

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    Article Information

    Accepted for Publication: June 28, 2020.

    Published: September 17, 2020. doi:10.1001/jamanetworkopen.2020.16271

    Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Wish-Baratz S et al. JAMA Network Open.

    Corresponding Author: Mark A. Griswold, PhD, Interactive Commons, Case Western Reserve University, 11111 Euclid Ave, LL-50, Cleveland, OH 44106 (mark.griswold@case.edu).

    Author Contributions: Drs Wish-Baratz and Griswold had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

    Concept and design: All authors.

    Acquisition, analysis, or interpretation of data: All authors.

    Drafting of the manuscript: Wish-Baratz, Crofton, Henninger, Griswold.

    Critical revision of the manuscript for important intellectual content: All authors.

    Statistical analysis: Wish-Baratz, Henninger, Griswold.

    Obtained funding: Henninger, Griswold.

    Administrative, technical, or material support: Wish-Baratz, Gutierrez, Henninger, Griswold.

    Supervision: Wish-Baratz, Henninger, Griswold.

    Conflict of Interest Disclosures: Dr Wish-Baratz, Ms Henninger, and Dr Griswold reported receiving nonfinancial support from Microsoft during the conduct of the study and outside the submitted work and having a patent pending for mixed-reality classroom tools during the conduct of the study. No other disclosures were reported.

    Funding/Support: This study was funded by Case Western Reserve University as part of an internal initiative.

    Role of the Funder/Sponsor: Case Western Reserve University participated in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

    References
    1.
    Barsom  EZ, Graafland  M, Schijven  MP.  Systematic review on the effectiveness of augmented reality applications in medical training.   Surg Endosc. 2016;30(10):4174-4183. doi:10.1007/s00464-016-4800-6PubMedGoogle ScholarCrossref
    2.
    Wish-Baratz  S, Gubatina  AP, Enterline  R, Griswold  MA.  A new supplement to gross anatomy dissection: HoloAnatomy.   Med Educ. 2019;53(5):522-523. doi:10.1111/medu.13845 PubMedGoogle ScholarCrossref
    3.
    Stojanovska  M, Tingle  G, Tan  L,  et al.  Mixed reality anatomy using Microsoft HoloLens and cadaveric dissection: a comparative effectiveness study.   Med Sci Educ. 2020;30:173-178. doi:10.1007/s40670-019-00834-xGoogle ScholarCrossref
    4.
    Henderson  S, Feiner  S.  Exploring the benefits of augmented reality documentation for maintenance and repair.   IEEE Trans Vis Comput Graph. 2011;17(10):1355-1368. doi:10.1109/TVCG.2010.245 PubMedGoogle ScholarCrossref
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