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Medical students often have difficulty achieving a conceptual understanding of 3-dimensional (3D) anatomy, such as bone alignment, muscles, and complex movements, from 2-dimensional (2D) images. To this end, animated and interactive 3-dimensional computer graphics (3DCG) can provide better visual information to users. In medical fields, research on the advantages of 3DCG in medical education is relatively new.
To determine the educational effectiveness of interactive 3DCG.
We divided 100 participants (27 men, mean (SD) age 17.9 (0.6) years, and 73 women, mean (SD) age 18.1 (1.1) years) from the Health Sciences University of Mongolia (HSUM) into 3DCG (n = 50) and textbook-only (control) (n = 50) groups. The control group used a textbook and 2D images, while the 3DCG group was trained to use the interactive 3DCG shoulder model in addition to a textbook. We conducted a questionnaire survey via an encrypted satellite network between HSUM and Tokushima University. The questionnaire was scored on a 5-point Likert scale from strongly disagree (score 1) to strongly agree (score 5).
Interactive 3DCG was effective in undergraduate medical education. Specifically, there was a significant difference in mean (SD) scores between the 3DCG and control groups in their response to questionnaire items regarding content (4.26 (0.69) vs 3.85 (0.68),
Interactive 3DCG materials have positive effects on medical education when properly integrated into conventional education. In particular, our results suggest that interactive 3DCG is more efficient than textbooks alone in medical education and can motivate students to understand complex anatomical structures.
The Internet has become a social platform where millions of health consumers access and share health information [
Modern human anatomy pedagogy includes cadaver dissection, multimedia presentations, practical procedures, surface and clinical anatomy, and radiological imaging [
Students often have difficulty achieving a spatial understanding of 3D anatomy from 2-dimensional (2D) images and text. This can increase cognitive load and hinder anatomy learning for students with poor spatial skills [
This study was conducted by researchers at the Health Sciences University of Mongolia (HSUM) and the University of Tokushima, Japan. We chose a high-speed satellite communication network because the Internet has not completely spread to rural areas of Mongolia, which is the fifth-largest country in Asia with 2.6 million people (as of 2007). Mongolia has clear skies and annual precipitation as low as 200 mm per year, creating ideal conditions for satellite communication. Our study was selected by the Ministry of Internal Affairs and Communications of Japan as an experimental application for data collection and as a developmental application for satellite communication authorized by the Association of Radio Industries and Businesses for Japan [
Improvements in personal computer performance have led to an increase in the development of 3DCG content. The use of 3DCG models has advantages over traditional anatomy instruction methods; however, their development and adoption are time consuming and costly. Thus, new educational information and communication technology instruction methods are needed. To this end, we aimed to determine the educational effectiveness of interactive 3DCG using an interactive 3DCG shoulder model.
We selected the shoulder for this experiment given its anatomical complexity and because it is considered one of the most difficult joints for medical students to understand in human anatomy. The Department of Anatomy and Developmental Neurobiology, University of Tokushima carefully examined anatomical accuracy, such as the relative spatial relationship of each structure, at every development stage to ensure that our interactive 3DCG models would be of high quality and accurate (see
The process of model creation is not trivial. We built the models in LightWave 3D (NewTek, Inc., San Antonio, TX, USA) and exported them as object files to Blender (an open source 3D program; blender.org, Amsterdam, the Netherlands). Blender was used to generate clean U and V space texture maps for the models. The models were then sent back to LightWave as object files. We created the textures in Photoshop (Adobe Systems Incorporated, San Jose, CA, USA) from photo references, applied them to U and V space maps in LightWave 3D, then exported them in Filmbox format and imported them into Unity3D [
We used the Vicon MX motion capture system (Vicon Motion Systems, Oxford, United Kingdom) at Tokushima University Hospital [
The menu for the 3DCG interactive manipulation tools on the left side of the screen has two functional components: one for anatomy and the other for shoulder movements, with labeling ability in English or Japanese.
We used Wideband InterNetworking engineering test and Demonstration Satellite for the communication system, which was jointly developed by the Japan Aerospace Exploration Agency and the National Institute of Information and Communications Technology of Japan. A small antenna 1.2 m in diameter receives up to 155 Mbps of data and transmits up to 6 Mbps, while an antenna approximately 5 m in diameter enables 2-way communication up to 1.2 Gbps [
Anatomical view of the 3-dimensional computer graphic showing the shoulder area.
Movement view of the 3-dimensional computer graphic of the shoulder bones and upper extremity.
Network architecture.
Round-trip time is the signal delay between the University of Tokushima and HSUM via the satellite network and the Internet. The round-trip time was between 1499.3 ms and 643.8 ms, with an average of 729.6 ms. The congestion window is a Transmission Control Protocol parameter that regulates the send window. The congestion window of Windows XP ranges from 16 KB in default to 64 KB. Therefore, the maximum throughput available in the Transmission Control Protocol is 0.795 Mbps, which is used for Hypertext Transfer Protocol. However, the actual throughput value was 0.384 Mbps or less.
All activity associated with the course was hosted on a Linux-based server running the Apache Web server (Apache Software Foundation, Los Angeles, CA, USA), the PostgreSQL database server (PostgreSQL Global Development Group, http://www.postgresql.org/), and the CentOS operating system (CentOS Project, http://www.centos.org/). Our proprietary learning management system (LMS) allowed us to create a course website with a unique log-in password and ID for each student. We developed the interactive 3DCG model, textbook, and questionnaires, and embedded them into this LMS. These components were used for the related experimental section. We applied Java Web applications for the system and adopted Unity3D for the 3DCG container, which is an integrated 3D platform for 3D games and interactive content on the Web.
Study design. 2D = 2-dimensional, 3DCG = 3-dimensional computer graphics, HSUM = Health Sciences University of Mongolia.
Statistical analysis was performed using SPSS (version 16.0 for Windows; IBM Japan Inc., Tokyo, Japan). We conducted both the independent-samples
A total of 100 first-year medical students (27 men and 73 women;
Gender distribution in the two study groups (n = 100).
Gender | 3DCGa group |
Control group |
Male | 13 | 14 |
Female | 37 | 36 |
a 3-dimensional computer graphics.
The questionnaire had 24 items grouped into four categories: content (3 items), teaching methods (6 items), Web (3 items), and 3DCG model interface (12 items). Each item was scored based on a 5-point Likert scale: strongly agree (score 5), agree (score 4), neutral (score 3), disagree (score 2), and strongly disagree (score 1).
Questionnaire scores for content, teaching methods, and Web items (n = 100).
Questionnaire item | Response | Mean |
|||||
Strongly |
Agree | Neutral | Disagree | Strongly |
|||
Q1 | The content is useful. | 30 | 51 | 19 | 0 | 0 | 4.11 |
Q2 | The content is easy to read and understand. | 19 | 55 | 22 | 4 | 0 | 3.89 |
Q3 | The content is well formatted and well designed. | 25 | 52 | 21 | 2 | 0 | 4.00 |
Q4 | The support for my study is effective. | 31 | 52 | 17 | 0 | 0 | 4.14 |
Q5 | This teaching method can improve my knowledge. | 27 | 59 | 13 | 1 | 0 | 4.12 |
Q6 | This teaching method can help my learning. | 27 | 53 | 19 | 1 | 0 | 4.06 |
Q7 | This teaching method motivates me when I learn. | 38 | 40 | 18 | 4 | 0 | 4.12 |
Q8 | This teaching method gives me enough time in the lesson. | 24 | 40 | 26 | 9 | 1 | 3.77 |
Q9 | This lesson is appropriate for my learning demand. | 31 | 43 | 25 | 1 | 0 | 4.04 |
Q10 | The webpage is attractive. | 25 | 58 | 15 | 1 | 1 | 4.05 |
Q11 | The screen design is clear. | 26 | 53 | 18 | 2 | 1 | 4.01 |
Q12 | The menu is easy to use. | 25 | 57 | 17 | 0 | 1 | 4.05 |
Questionnaire scores for the 3-dimensional computer graphics (3DCG) model interface (n = 50).
Questionnaire item | Response | Mean |
|||||
Strongly |
Agree | Neutral | Disagree | Strongly |
|||
Q13 | The interface for interacting with the 3Da content is accessible. | 17 | 26 | 7 | 0 | 0 | 4.2 |
Q14 | The volume of information in the 3D module is appropriate. | 15 | 26 | 8 | 1 | 0 | 4.1 |
Q15 | I am satisfied with the 360° rotation of the model. | 32 | 17 | 1 | 0 | 0 | 4.62 |
Q16 | I am satisfied with the selection menu. | 13 | 35 | 2 | 0 | 0 | 4.22 |
Q17 | I am satisfied with the show-and-hide function. | 21 | 20 | 9 | 0 | 0 | 4.24 |
Q17 | I am satisfied with the transparent and opaque function. | 13 | 30 | 7 | 0 | 0 | 4.12 |
Q19 | I am satisfied with the zoom function. | 29 | 18 | 3 | 0 | 0 | 4.52 |
Q20 | The screen size is appropriate. | 11 | 26 | 13 | 0 | 0 | 3.96 |
Q21 | I am satisfied with clicking the mouse to show anatomical terminology. | 29 | 20 | 1 | 0 | 0 | 4.56 |
Q22 | I am interested in 3DCG. | 33 | 14 | 3 | 0 | 0 | 4.6 |
Q23 | I am satisfied with the movement menu. | 26 | 21 | 3 | 0 | 0 | 4.46 |
Q24 | The 3DCG content is of high quality. | 18 | 31 | 1 | 0 | 0 | 4.34 |
a 3-dimensional.
Comparison of mean (SD) questionnaire scoresa between 3-dimensional computer graphics (3D G) and control groups.
Category | Questionnaire item | 3DCG group | Control group |
|
Content | The content is useful. | 4.34 (0.63) | 3.88 (0.69) | .001b |
The content is easy to read and understand. | 3.90 (0.70) | 3.88 (0.80) | .97 | |
The content is well formatted and well designed. | 4.18 (0.75) | 3.82 (0.69) | .01b | |
Teaching methods | The support for my study is effective. | 4.36 (0.63) | 3.92 (0.66) | .001b |
This teaching method can improve my knowledge. | 4.40 (0.61) | 3.84 (0.58) | <.001b | |
This teaching method can help my learning. | 4.28 (0.64) | 3.84 (0.71) | .002b | |
This teaching method motivates me when I learn. | 4.52 (0.58) | 3.72 (0.88) | <.001b | |
This teaching method gives me enough time in the lesson. | 4.14 (0.70) | 3.40 (1.03) | <.001b | |
This lesson is appropriate for my learning demand. | 4.32 (0.71) | 3.76 (0.74) | <.001b | |
Web | The webpage is attractive. | 4.26 (0.56) | 3.84 (0.82) | .006b |
The screen design is clear. | 4.10 (0.61) | 3.92 (0.92) | .45 | |
The menu is easy to use. | 4.14 (0.61) | 3.96 (0.81) | .29 |
a 5-point Likert scale from strongly disagree (score 1) to strongly agree (score 5).
b Significant difference (Mann-Whitney
Combined scores for the three categories are shown in
Mean scores of the 3-dimensional computer graphics (3DCG) and control groups for the three main categories. LMS = learning management system, n.s. = not significant.
Questionnaire scores by gender.
In this study, we investigated the educational effectiveness of using an interactive 3DCG model as a supplement to conventional learning methods. Our results show that the interactive 3DCG model is effective in undergraduate medical education and can enhance the motivation of medical students. We employed an LMS with two kinds of content. Content for the 3DCG group included Unity3D-based material, while content for the control group included only text and 2D images.
Responses of all participants (n = 100) on common questionnaire items in three categories are presented in
Comments from participants also suggested that interactive 3DCG increased the motivation to learn a large number of anatomical structures and clarified anatomy. Students generally dislike memorizing many names and learning the complexity of nerves and blood vessels and how joints move, in a short period of time. Scores of male participants tended to be higher than scores of female participants. Some research has revealed that women have higher computer anxiety [
Some studies have attempted to evaluate the effectiveness of learning tools. Findings include that animated visual tools are more effective than static visual tools [
We conclude that interactive 3DCG materials have positive effects on medical education when properly integrated into conventional education. In particular, the interactive 3DCG motivated participants to understand a complex anatomical structure.
Examples of screenshots and pictures of the web-based learning management system and development of the interactive 3D CG.
2-dimensional
3-dimensional
3-dimensional computer graphics
Health Sciences University of Mongolia
learning management system
We would like to thank the Japan Manned Space Systems Corporation, Professor Yoshihiro Fukui and Hiromi Sakata, MD, at the University of Tokushima Graduate School Department of Anatomy and Developmental Neurobiology, Professor Natsuki Yasui and Shinjiro Takata at the Tokushima University Hospital Department of Orthopedics, and Professor Tserenkhuu Lkhagvasuren at the Health Sciences University of Mongolia.
None declared.