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A Pilot Study for the Evaluation of 3D Anatomy Application 'Complete Anatomy' as an Additional Non-Mandatory Study Tool for the Functional Anatomy Classes of First Year Physical Therapy Students

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Title: A Pilot Study for the Evaluation of 3D Anatomy Application 'Complete Anatomy' as an Additional Non-Mandatory Study Tool for the Functional Anatomy Classes of First Year Physical Therapy Students
Language: English
Authors: Michael E. J. Stouthandel (ORCID 0000-0003-4276-8926), Lena Van Beek, Joris Van de Velde (ORCID 0000-0003-0003-1416), Carl Vangestel (ORCID 0000-0003-1024-8213), Tom Van Hoof (ORCID 0000-0002-9207-2217)
Source: Anatomical Sciences Education. 2024 17(6):1336-1344.
Availability: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
Peer Reviewed: Y
Page Count: 9
Publication Date: 2024
Document Type: Journal Articles
Reports - Research
Education Level: Higher Education
Postsecondary Education
Descriptors: College Freshmen, Physical Therapy, Allied Health Occupations Education, Visual Aids, Anatomy, Computer Assisted Instruction, Academic Achievement, Computer Software Evaluation, Time on Task
DOI: 10.1002/ase.2491
ISSN: 1935-9772
1935-9780
Abstract: For this pilot study, the use of the digital 3D anatomy application Complete Anatomy was evaluated as a non-mandatory additional study tool throughout the semester. The aim of the study was to investigate if the Complete Anatomy usage time had an effect on final exam grades and how the app was used post-COVID-19. This cross-sectional study asked first year bachelor/freshman university students of Physical Therapy and Rehabilitation Sciences to fill out a questionnaire to gauge Complete Anatomy usage time, the student's exam results, and how the app was used, for example, in relation to other study tools. A positive correlation was found between the proportion of students that passed the final exam and the number of hours of Complete Anatomy usage (r[subscript s] (4) = 0.94, p = 0.016). Compared to students who didn't use Complete Anatomy, these positive effects were observed when students used Complete Anatomy for at least 10 h (p = 0.04). The app was well-used with almost half of the respondents reporting >10 h of usage time. The results from this study provide a good overview of how and how often Complete Anatomy is used. Although a positive correlation between the hours of use and the number of passing grades was found in this pilot study, a future study to prove the causality between these two factors is warranted to further investigate the effect of Complete Anatomy as an additional non-mandatory study tool.
Abstractor: As Provided
Entry Date: 2024
Accession Number: EJ1437539
Database: ERIC
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  Value: <anid>AN0179320312;[8z8k]01sep.24;2024Sep02.01:56;v2.2.500</anid> <title id="AN0179320312-1">A pilot study for the evaluation of 3D anatomy application 'Complete Anatomy' as an additional non‐mandatory study tool for the functional anatomy classes of first year physical therapy students </title> <p>For this pilot study, the use of the digital 3D anatomy application Complete Anatomy was evaluated as a non‐mandatory additional study tool throughout the semester. The aim of the study was to investigate if the Complete Anatomy usage time had an effect on final exam grades and how the app was used post‐Covid19. This cross‐sectional study asked first year bachelor/freshman university students of Physical Therapy and Rehabilitation Sciences to fill out a questionnaire to gauge Complete Anatomy usage time, the student's exam results, and how the app was used, for example, in relation to other study tools. A positive correlation was found between the proportion of students that passed the final exam and the number of hours of Complete Anatomy usage (rs (<reflink idref="bib4" id="ref1">4</reflink>) = 0.94, p = 0.016). Compared to students who didn't use Complete Anatomy, these positive effects were observed when students used Complete Anatomy for at least 10 h (p = 0.04). The app was well‐used with almost half of the respondents reporting >10 h of usage time. The results from this study provide a good overview of how and how often Complete Anatomy is used. Although a positive correlation between the hours of use and the number of passing grades was found in this pilot study, a future study to prove the causality between these two factors is warranted to further investigate the effect of Complete Anatomy as an additional non‐mandatory study tool.</p> <p>Keywords: anatomy education; Complete Anatomy; digital 3D anatomy atlas; learning effectiveness; study tool preference</p> <hd id="AN0179320312-2">INTRODUCTION</hd> <p>Good knowledge of human anatomy is the foundation of medical education. It forms the basis for understanding other subjects throughout the curriculum and is directly relevant to clinical practice.[[<reflink idref="bib1" id="ref2">1</reflink>], [<reflink idref="bib3" id="ref3">3</reflink>]] Anatomy can be taught in several ways, with the traditional teaching format including lectures, whole‐body donor dissections or prosection practical classes, the use of physical (plastic) anatomical models, surface anatomy, and radiological anatomy. Traditional study methods include attending lectures and dissection/prosection classes in the dissection facility, taking notes, and using textbooks and atlases. More recently, computer‐assisted alternatives became available to teach and study anatomy, for example digital 3D atlases.[<reflink idref="bib3" id="ref4">3</reflink>] The development and use of digital 3D atlases skyrocketed as a result of the lockdowns related to the Covid19 pandemic, since dissection/prosection practical classes were unavailable and an alternative way to acquire a visuo‐spatial understanding of the human body was required.[[<reflink idref="bib4" id="ref5">4</reflink>]] Ghent University adopted the digital 3D anatomical atlas application 'Complete Anatomy' for this purpose. Complete Anatomy is an interactive 3D atlas by 3D4medical from Elsevier that allows the user to virtually dissect and visualize a body in 3D while rotating it freely. Functionalities include a search function to quickly locate anatomical structures, and the application also contains labels for the structures, along with descriptions of selected structures and educational videos.[<reflink idref="bib6" id="ref6">6</reflink>]</p> <p>Given the rapid integration of 3D anatomical atlases into the curriculum of universities over the past few years, it has become a study tool that can no longer be ignored when considering future anatomy education. Now that the pandemic is over and the full spectrum of traditional teaching options is available again, the use of 3D anatomical applications is no longer a forced necessity to replace different study methods, like going to practical classes. This does not mean that 3D anatomical applications should be immediately removed from the curriculum, because they could still provide an added benefit as non‐mandatory study tools. For this pilot study, the Complete Anatomy license was continued post‐Covid19 to look further into the effects of providing 3D anatomical applications as a non‐mandatory study tool.</p> <p>Only limited research was found with a specific focus on the use of a digital 3D anatomy app as a non‐mandatory study tool.[[<reflink idref="bib2" id="ref7">2</reflink>], [<reflink idref="bib7" id="ref8">7</reflink>], [<reflink idref="bib9" id="ref9">9</reflink>]] Most studies test the use of additional study tools only during a specifically designed exercise at a single timepoint during the course,[[<reflink idref="bib2" id="ref10">2</reflink>], [<reflink idref="bib8" id="ref11">8</reflink>]] thereby not really giving the student a chance to study with the tool and overlooking the possible effect of prolonged use. Other studies compare 2D and virtual 3D methods, rather than looking at the additional value of digital 3D methods.[[<reflink idref="bib9" id="ref12">9</reflink>]] Finally, none of the studies above correlated the time that the 3D anatomical application was used to the grades on a final test.[[<reflink idref="bib2" id="ref13">2</reflink>], [<reflink idref="bib7" id="ref14">7</reflink>], [<reflink idref="bib9" id="ref15">9</reflink>]] By linking the exam grade to the number of hours that Complete Anatomy was used throughout the semester, the overall use and the possible effect of prolonged use of the study tool can be evaluated. Therefore, the goal of this study was to investigate if Complete Anatomy usage (in hours) affected student's final exam grades when the app is offered as a non‐mandatory study material throughout the semester. As a secondary goal, the study investigated how the app was used, for example, in relation to other study tools, to gain additional insights.</p> <p>The use of digital 3D atlases was shown to help students understand and visualize the 3D structure of the human body, and the use of 3D models provided additional motivation to study anatomy.[[<reflink idref="bib2" id="ref16">2</reflink>], [<reflink idref="bib11" id="ref17">11</reflink>]] 3D anatomy applications also give the student the ability to choose the best working view for themselves, rather than being confined to 2D atlas plates.[<reflink idref="bib12" id="ref18">12</reflink>] Because 3D insight into the structure of the human body is very important for the anatomy course, we hypothesize that the app will continue to be used post‐Covid19, and that more hours of Complete Anatomy usage will be associated with higher final exam grades.</p> <p>To assess whether the time spent with Complete Anatomy as an additional study tool had an effect on the grades of the final anatomy exam, a survey was conducted among the students. The survey contained questions on (<reflink idref="bib1" id="ref19">1</reflink>) the time spent with the Complete Anatomy tool and (<reflink idref="bib2" id="ref20">2</reflink>) how the app was used, for example, in relation to other study tools.</p> <p>Findings from this study could have an impact on the way anatomy is taught at universities, and they could impact how teaching budgets are allocated. For example, if the app is not used at all, or there is no demonstrated benefit in terms of study results, the software license could be discontinued, and an alternative study tool could be offered instead. On the contrary, if a positive effect on the exam scores is observed as a result of using the app, a short introduction to the software and its functions could be integrated into lectures.</p> <hd id="AN0179320312-3">MATERIALS AND METHODS</hd> <p></p> <hd id="AN0179320312-4">Data collection</hd> <p>This analytical cross‐sectional study was carried out at Ghent University at the Faculty of Medicine and Health Sciences and the Faculty of Psychology and Educational Sciences. The major strength of this study is that it was conducted under actual learning conditions during an entire semester. Ethical approval for this study was obtained from the Ghent University Ethics Committee (2022‐148). The study took place among first year bachelor/freshman university students of Physical Therapy and Rehabilitation Sciences (PT‐RS). Inclusion criteria for students that both had to be met were being enrolled in the course 'Functional Anatomy: Extremities and Trunk' during the first semester of academic year 2022–2023, and having given written informed consent to participate in the study. Participation in the study was entirely voluntary. No incentives were provided for participation, and no negative consequences applied for students not participating. Data were collected via an online questionnaire, drafted in Google forms (English translation in supplementary materials). Google forms was used, because it is easy to use, and it is a commonly used tool for surveys at Ghent University. The questions in the survey were designed to answer the research question and address the specific student population. Previous teaching experience, as well as data from similar previous studies[[<reflink idref="bib2" id="ref21">2</reflink>], [<reflink idref="bib9" id="ref22">9</reflink>], [<reflink idref="bib11" id="ref23">11</reflink>], [<reflink idref="bib13" id="ref24">13</reflink>]] were used to design the survey questions. The questionnaire took 5–10 min to complete, but no time limit for completion was imposed. The questionnaire was used to investigate if there was an association between the time Complete Anatomy was used and the grades on the final written exam (score out of 20), and to get more insight into how the app was used.</p> <p>The questionnaire was designed at the beginning of the semester. During a lecture in the third week of the semester, the study was announced to alert students that they could participate after finishing the final exam of the course. Students were informed about the aim of the study, the questionnaire, and their rights (see questionnaire in the supplementary material for full details provided to students). This first announcement informed students that they needed to keep track of the number of hours of Complete Anatomy usage if they wished to participate in the study, since data on app usage would be self‐reported. The course continued as usual with the final exam scheduled at the end of the semester. After the exam grades had been published, a second announcement about the study was made during a lecture. This time, students who wanted to participate in the study could do so immediately by scanning a QR code or following a link to the questionnaire. Both the number of hours of Complete Anatomy usage and the exam grades had to be self‐reported, based on the privacy criteria set by the ethical board.</p> <p>To accurately represent the voluntary use of Complete Anatomy and its effect on the exam scores, group sizes were based on the time spent using the app and the achieved grades, but only after the respondents filled out the questionnaire. This was the most reliable way to reflect actual learning conditions.</p> <hd id="AN0179320312-5">Course details</hd> <p>At Ghent University, the PT‐RS education spans 5 years, starting with 3 bachelor years, followed by 2 master years. In Belgium, students typically enter university after completing high school, around the age of 18. No entrance exam is required for students to start the first bachelor year of PT‐RS. This leads to the enrollment of large numbers of students, with 743 students in the 2022–2023 cohort. The students receive 37 lectures of 1.5 h each during a 20‐week semester. The course emphasizes knowledge of anatomical relations and good 3D understanding of the human body. This is crucial for performing correct palpations, the basis for assessment, and therapeutic techniques. A thorough anatomical basis is also of paramount importance for clinical reasoning. The syllabus, 2D atlases (Sobotta or Netter), the lecture slides (with recorded commentary and as separate uncommented files), and Complete Anatomy are the available study tools. The syllabus and the 2D atlas are the recommended materials to study for the exam. During the lectures, Complete Anatomy is mentioned as a freely available, non‐mandatory tool to improve 3D insight when studying for the exam.</p> <p>Apart from lectures, the course includes 4 mandatory osteology practical classes of 2 h each, for which dry human bones are used in the dissection facility. During these classes, students follow the part of the syllabus dedicated to the practical classes, and teaching assistants are available to answer questions. Whole‐body donor dissections follow in later years of the education program.</p> <p>At the end of the semester (week 18), the course concludes with a single exam. This multiple‐choice exam contains 64 questions that have to be answered in 3.5 h. The exam focuses on testing basic knowledge, the application of knowledge based on (3D) anatomical insight, and the relations between different anatomical structures that are important for physical therapists. To pass the exam, 62.5% of the questions needed to be answered correctly. This percentage is higher than 50% because students can guess the answer to a multiple choice question correctly, therefore, a correction for guessing is applied, and final scores are calculated out of 20 points. Because there is no entrance exam to enroll in the course and in‐depth knowledge of the human anatomy is required to pass the exam, only around 30% of the enrolled students obtain a passing grade at the end of the first semester.</p> <hd id="AN0179320312-6">Statistical analysis</hd> <p>To obtain sufficient observations in each class, students were grouped into four exam grade groups depending on their exam grades (score out of 20). Students who scored 0 to 4 were placed in the "low fail" group, from 5 to 9 in the "fail" group, from 10 to 14 in the "pass" group, and from 15 to 20 in the "high pass" group. Students were also divided into 6 categories depending on the time spent studying with Complete Anatomy. The categories were: no use of Complete anatomy, <4 h, 4–10 h, 10–25 h, 25–50 h, and >50 h. A Pearson's Chi‐squared test was used to check whether the distribution in grades differed significantly between these categories. Post‐hoc pairwise Fisher's Exact Tests were used to assess how grade distributions differed between the 6 study time categories. Finally, a Spearman's rank correlation test was performed to show if there was a correlation between hours of Complete Anatomy usage and number of students who passed the exam. Statistical analyses were performed in Rstudio.[<reflink idref="bib15" id="ref25">15</reflink>] The significance level for all tests was set to 0.05. The distribution in grades per group was further examined using pie charts to assess whether grades were positively associated with the number of hours that Complete Anatomy was used.</p> <hd id="AN0179320312-7">RESULTS</hd> <p></p> <hd id="AN0179320312-8">Relationship between final exam grade and time spent studying with Complete Anatomy</hd> <p>A total of 264 out of the 743 students enrolled in the course 'Functional Anatomy: Extremities and Trunk' gave written informed consent to participate and filled in the questionnaire, giving a response rate of 36%. None of the returned questionnaires contained missing data. In the questionnaire, the students were asked to indicate their exam score. Table 1 shows the exam scores, the corresponding exam score groups, and the number of students in each group. The first 2 groups failed the exam, while the latter two passed it. An overall success rate of 45.5% was recorded for the respondents of the questionnaire. Students were also asked to report the amount of time they spent using Complete Anatomy to prepare for the exam. Study times are displayed in Table 2, along with the corresponding study time categories, the number of students per category, and the percentage of students who passed the exam in each study time category. Almost half of the students (46.6%) reported that they used the app for >10 h.</p> <p>1 TABLE Overview of the reported grades, the corresponding exam grade groups, and the number of students in each exam grade group.</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left">Grades</th><th align="left">Exam grade group</th><th>Number of students</th></tr></thead><tbody valign="top"><tr><td align="left">0–4</td><td align="left">Low fail</td><td align="char" char=".">40</td></tr><tr><td align="left">5–9</td><td align="left">Fail</td><td align="char" char=".">104</td></tr><tr><td align="left">10–14</td><td align="left">Pass</td><td align="char" char=".">85</td></tr><tr><td align="left">15–20</td><td align="left">High pass</td><td align="char" char=".">35</td></tr></tbody></table> </ephtml> </p> <p>1 <emph>Note</emph>: Grades refer to achieved scores out of 20. 264 students responded to the questionnaire, only 1 answer was possible per student.</p> <p>2 TABLE Overview of the study time categories, the corresponding study times, and the number of students per study time category.</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left">Study time category</th><th align="left">Complete Anatomy usage (h)</th><th align="left">Number of students</th><th align="left">% of passing grades</th></tr></thead><tbody valign="top"><tr><td align="left">1</td><td align="left">0</td><td align="left">53</td><td align="left">29</td></tr><tr><td align="left">2</td><td align="left"><4</td><td align="left">31</td><td align="left">24</td></tr><tr><td align="left">3</td><td align="left">4–10</td><td align="left">57</td><td align="left">44</td></tr><tr><td align="left">4</td><td align="left">10–25</td><td align="left">60</td><td align="left">47</td></tr><tr><td align="left">5</td><td align="left">25–50</td><td align="left">44</td><td align="left">66</td></tr><tr><td align="left">6</td><td align="left">>50</td><td align="left">19</td><td align="left">90</td></tr></tbody></table> </ephtml> </p> <p>2 <emph>Note</emph>: The percentage of students that passed the exam is also indicated per category. 264 students responded to the questionnaire, only 1 answer was possible per student.</p> <p>To investigate the impact of the number of hours spent using Complete Anatomy on the exam grades, a Pearson's Chi squared test was performed. The distribution of grades differed significantly (<emph>χ</emph><subs>15</subs><sups>2</sups> = 49.34, <emph>p</emph> < 0.001) between different study time categories. A Fisher's Exact Test was used for a pairwise comparison between the study time categories. Students who used Complete Anatomy for >10 h (categories 4: '10–25 h', 5: '25–50 h' and 6: '>50 h') scored significantly better than those who did not use the tool (<emph>p</emph>‐values of 0.04; <0.001 and <0.001, respectively). The scores of study time category 5 differed significantly from those of study time category 4 (<emph>p</emph> = 0.02), while no statistically significant difference was found between study time categories 5 and 6 (<emph>p</emph> = 0.23).</p> <p>The percentage of students who passed the exam increased with the number of hours spent on Complete Anatomy (Figure 1, Table 2). This finding was confirmed by the Spearman's rank correlation test (<emph>r</emph><subs>s</subs> (<reflink idref="bib4" id="ref26">4</reflink>) = 0.94, <emph>p</emph> = 0.016). From the students who did not use Complete Anatomy, only 29% passed the exam, while 24% of the students who used the tool <4 h passed the exam. This percentage increased to about 44% when the tool was used for 4–10 h, and to 47% for 10–25 h of use. When using Complete Anatomy for 25–50 h, passing grades were achieved by 66% of the students. Interestingly, 90% of students who used Complete Anatomy for >50 h passed the exam, and no scores in the low fail group were recorded for this study time category. Overall, >10 h of Complete Anatomy usage had a positive effect on the passing grades, with more time spent using the app resulting in a higher percentage of students obtaining a passing grade.</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/8Z8K/01sep24/ase2491-fig-0001.jpg?ephost1=dGJyMMvl7ESepq84yOvsOLCmsE6epq5Srqa4SK6WxWXS" alt="ase2491-fig-0001.jpg" title="1 Relation between exam grades (4 groups) and hours spent studying with complete anatomy (6 categories)." /> </p> <p></p> <p>The relative number of students who used Complete Anatomy was higher in the groups with a passing grade (87.5%) compared to the groups with a failing grade (71%) (Figure 2). In the low fail group, 65% used Complete Anatomy, and no use of over 50 h was recorded. In the fail group, 77% used Complete Anatomy. In the pass group, Complete Anatomy was used by 88% of the students, and in the high pass group, 87% of the students used the app. It should also be noted that the decline of the number of non‐users in the higher scoring groups (pass and high pass) was accompanied by an increase in the number of users that spent more time using the app. Surprisingly, 25% of the students in the low fail group and 39% in the fail group used Complete Anatomy for >10 h. Of the 19 students who used Complete Anatomy >50 h, 2 failed the exam.</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/8Z8K/01sep24/ase2491-fig-0002.jpg?ephost1=dGJyMMvl7ESepq84yOvsOLCmsE6epq5Srqa4SK6WxWXS" alt="ase2491-fig-0002.jpg" title="2 Relation between hours spent studying with Complete Anatomy (6 categories) and exam grades (4 groups)." /> </p> <p></p> <hd id="AN0179320312-11">Findings related to how the app was used</hd> <p>Most students (93.9%) used more than one study tool for their final exam preparation, with a preference for the 2D atlas (89.8%). This was closely followed by 83% who used a digital 3D anatomy atlas (Table 3). The digital 3D anatomy atlas users strongly preferred Complete Anatomy over other 3D atlases. The PowerPoint presentations from the lectures were used by the majority of respondents (72.7%). Finally, roughly half of the students (48.1%) used the internet for additional information, and almost a third (29.5%) used memory cards/flash cards.</p> <p>3 TABLE Overview of the study tools used to prepare for the exam and the number of students that used them.</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left">Study tools</th><th>Number of students</th></tr></thead><tbody valign="top"><tr><td align="left">Multiple study tools</td><td align="char" char=".">248</td></tr><tr><td align="left">2D atlas</td><td align="char" char=".">237</td></tr><tr><td align="left">Digital 3D anatomy application</td><td align="char" char=".">219</td></tr><tr><td align="left">Complete Anatomy</td><td align="char" char=".">211</td></tr><tr><td align="left">Powerpoint from lectures</td><td align="char" char=".">192</td></tr><tr><td align="left">Internet sources</td><td align="char" char=".">127</td></tr><tr><td align="left">Flash cards/memory cards</td><td align="char" char=".">78</td></tr></tbody></table> </ephtml> </p> <p>3 <emph>Note</emph>: 264 students responded to the questionnaire; multiple answers were possible per student.</p> <p>Out of the 264 respondents, 211 used Complete Anatomy. Most students who used Complete Anatomy, believed it had an added value when studying anatomy, and it provided additional insights into the positioning of structures in the complex 3D framework of the human body (84%). The second argument for using the tool was its free availability through the Ghent University license (75.6%). When information was not clear from the 2D atlas or other study tools, 43.2% of students used Complete Anatomy to get a better insight. Some students (11.3%) were advised to use this tool by friends. Only five students exclusively used Complete Anatomy to prepare for the exam, all five failed the exam. Two of these students reported <4 h of Complete Anatomy usage time, 1 student reported 10–25 h, and the remaining 2 reported using the app for 25–50 h.</p> <p>Of the 264 participating students, 53 did not use Complete Anatomy. The reasons for this choice are summarized in Table 4. Almost half of the students (43.4%) did not use Complete Anatomy because they did not have time to learn how to work with it. About a quarter of the students (22.6%) did not feel the necessity to use the tool, while 18.9% stated that the tool contained too much information, making it difficult to find the right information. Almost a fifth of the students (17%) found the app was not user friendly/not clear in use, and 15.1% of the students stated they were already overloaded with information from other sources. A minority (13.2%) reported technical problems with the program or the license, while another 13.2% used other (partially) free digital 3D‐tools like Anatomy 3D Atlas, Zygote Body, and Netter3DAnatomy. Finally, 11.3% stated they did not know about the free Complete Anatomy license through Ghent University.</p> <p>4 TABLE Overview of the reasons not to use Complete Anatomy and the number of students that indicated these options.</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left">Reasons for not using Complete Anatomy</th><th>Number of students</th></tr></thead><tbody valign="top"><tr><td align="left">No time to learn how to work with the program</td><td align="char" char=".">23</td></tr><tr><td align="left">Use was deemed unneccesary</td><td align="char" char=".">12</td></tr><tr><td align="left">Tool contains too much information</td><td align="char" char=".">10</td></tr><tr><td align="left">Not user friendly</td><td align="char" char=".">9</td></tr><tr><td align="left">Already overloaded with information from other sources</td><td align="char" char=".">8</td></tr><tr><td align="left">Technical problems with application</td><td align="char" char=".">7</td></tr><tr><td align="left">Used another digital 3D app</td><td align="char" char=".">7</td></tr><tr><td align="left">Did not know it was free to use</td><td align="char" char=".">6</td></tr></tbody></table> </ephtml> </p> <p>4 <emph>Note</emph>: The number of students who did not use Complete Anatomy was 53; multiple answers were possible per student.</p> <p>Students were also asked whether they would change anything about Complete Anatomy. Most students (89.4%) did not think this was necessary. The most frequent comment was the load of the program on their devices, since many devices had problems with installing Complete Anatomy or with processing instructions. Students also noted that in the current version of Complete Anatomy the labels are in English, while they had to study the Latin terminology. Other suggested adaptations were more precise labelling and information about structures like origin, insertion, and anatomic variations. Students also suggested an option to save and have an overview of the user's study progress, a personal library with the option to save your own composed models for later use, and the option to visualize multiple models next to each other. Some students suggested a test/quiz function, so they could test themselves using the app.</p> <hd id="AN0179320312-12">DISCUSSION</hd> <p></p> <hd id="AN0179320312-13">Relationship between final exam grade and time spent studying with Complete Anatomy</hd> <p>The main objective of this study was to assess whether the time spent using the non‐mandatory study tool Complete Anatomy throughout the semester had an effect on the final exam scores.</p> <p>Usage of Complete Anatomy as a non‐mandatory study tool significantly improved exam grades, starting from study times above 10 h (category 4: '10–25 h', category 5: '25–50 h', and category 6: '>50 h'), compared to students who did not use the app. This effect was dose‐dependent, with more hours spent resulting in significantly better grades (category 5 scored significantly better than category 4), but a maximum was also observed (category 6 did not score significantly better than category 5). This suggests that there is an optimal number of hours for studying with this 3D app for maximum benefit in terms of the exam result. This optimum could be investigated for different study tools in a future study. This would allow teachers to give the students a more targeted study advice to prepare for the exam in an efficient manner, using the different study tools available.</p> <p>Figure 2 shows that the relative number of students who passed the exam was related to the number of students using Complete Anatomy. The groups with higher exam grades contained more students who used Complete Anatomy, and more hours were spent studying with the tool in these groups. Still, there were students who used Complete Anatomy for a decent amount of time (>10 h), but nevertheless failed the exam. This could be related to their visuo‐spatial abilities. Visuo‐spatial abilities of students have been discussed as a factor to estimate the benefit of using 3D applications as a study tool.[[<reflink idref="bib16" id="ref27">16</reflink>]] Other factors like the anatomical complexity of the region to be studied also play a role.[[<reflink idref="bib10" id="ref28">10</reflink>], [<reflink idref="bib16" id="ref29">16</reflink>]] This could mean that students with lower visuo‐spatial ability may simply benefit less from the 3D application than others. In fact, it has been described that the benefit of digital learning is impacted by learner characteristics like prior knowledge and spatial ability, and that students with lower spatial abilities may find it difficult to learn from complex and multi‐frame sources,[<reflink idref="bib14" id="ref30">14</reflink>] like, for instance, a 3D application.</p> <p>Most previous studies did not find an impact on exam grades as a result of using digital 3D applications for studying anatomy,[[<reflink idref="bib2" id="ref31">2</reflink>], [<reflink idref="bib7" id="ref32">7</reflink>], [<reflink idref="bib18" id="ref33">18</reflink>]] while for learning purposes, a neutral to positive effect from digital sources has been described in several review papers on the topic.[[<reflink idref="bib3" id="ref34">3</reflink>], [<reflink idref="bib5" id="ref35">5</reflink>], [<reflink idref="bib13" id="ref36">13</reflink>], [<reflink idref="bib19" id="ref37">19</reflink>]] The absence of an impact on the study grades in these studies could be related to the fact that students are likely equally distributed into groups of high and low visuo‐spatial abilities, and the positive effect that is expected from the group with high visuo‐spatial abilities could be canceled out by the negative effect that students with low visuo‐spatial ability might experience when studying with digital 3D atlases. The fact that this study did show a positive effect on grades from using a digital 3D application as an additional non‐mandatory study tool could be related to a bias in the type of participants who responded to the questionnaire (self‐selection bias), as discussed below in the limitations section.</p> <hd id="AN0179320312-14">Findings related to how the app was used</hd> <p>As a secondary goal, it was investigated how students used the app. In regard to the study tools that were used, it was not surprising that the 2D anatomical atlas was used by a large majority of students since it was repeatedly recommended during lectures as the best way to study for the exam. Irrespective of that, Complete Anatomy was a close runner‐up in student preferences, even though it was presented as additional non‐mandatory study material. The fact that Complete Anatomy was used slightly more often than the PowerPoint presentations from the lectures (even though these contain more targeted information for the exam) could be related to the fact that 'learning by doing',[<reflink idref="bib20" id="ref38">20</reflink>] could be more motivating for students, making them more engaged.[[<reflink idref="bib21" id="ref39">21</reflink>]] Indeed, many other studies indicate that students have a positive attitude toward using 3D applications as a study tool.[[<reflink idref="bib2" id="ref40">2</reflink>], [<reflink idref="bib7" id="ref41">7</reflink>], [<reflink idref="bib10" id="ref42">10</reflink>], [<reflink idref="bib18" id="ref43">18</reflink>], [<reflink idref="bib23" id="ref44">23</reflink>]] The percentage of use found in this study was comparable to the study of Park et al. that reported a 77.42% of the digital 3D application use to prepare for a final exam, but among medical students, instead of PT‐RS students.[<reflink idref="bib2" id="ref45">2</reflink>] This might mean that findings related to the amount of app usage are generalizable across different educational programs. The app was well‐used, as indicated by the fact that almost half of the students used it for at least 10 h.</p> <p>Reasons not to use Complete Anatomy were based on experienced information overload. Students found it difficult to recognize the correct information from the abundance of information in the app. Students who experienced information overload may have made the correct decision to not to use the app, since it did not coincide with their learning approach. If this information overload was also present among students who did continue using the app, despite being overloaded, this could explain why using Complete Anatomy was not beneficial for this specific group. Studying less complex anatomical regions in 3D does not impact learning as much as studying highly complex anatomical regions using a 3D visualization.[<reflink idref="bib10" id="ref46">10</reflink>] To avoid information overload, students with a low visuo‐spatial ability may only use the app to study less complex regions, possibly diminishing the app's learning impact in this group.</p> <p>This study showed that the majority of the participants found Complete Anatomy useful to improve their insight into the positioning and the complex 3D orientation of the human body. This was not unexpected, since this is the main purpose of this type of application. More interesting was the fact that almost half of the students indicated that they only used Complete Anatomy when something was not clear to them after using other study tools, like a 2D anatomical atlas. This stresses the value of digital 3D atlases as an additional study tool that was also described by several other studies.[[<reflink idref="bib3" id="ref47">3</reflink>], [<reflink idref="bib13" id="ref48">13</reflink>], [<reflink idref="bib19" id="ref49">19</reflink>]]</p> <p>Intriguingly, all students who studied for the exam using only Complete Anatomy failed the exam, even though some of them reported a very high number of hours spent with the application. This suggests that digital 3D atlases should not be used to replace traditional study tools,[<reflink idref="bib19" id="ref50">19</reflink>] but rather to complement them for the best study results. The final interesting finding for Complete Anatomy usage is that most of the students indicated they used the app because it was available free of charge. This shows that the Complete Anatomy license was at the very least not an unappreciated investment.</p> <p>Reasons not to use Complete Anatomy, included expected answers like finding it unnecessary to use the app, or experiencing technical difficulties with the app, or the license. The most important finding for this part of the study, however, was that almost half of the students who did not use the app felt that they did not have time to learn how to work with it. Another group already felt overloaded with other study material that was offered for the anatomy course. Add to this, the group who mentioned that the app contained too much information, making it difficult to find the right information and this study may have touched upon the biggest pitfall in the revolution of digital teaching: information overload. According to students, anatomy is already the course most overloaded with content.[<reflink idref="bib24" id="ref51">24</reflink>] Digital 3D applications could contribute considerably to this overloaded feeling, especially for students with a low visuo‐spatial ability. Additional information could help to explain more difficult parts of the course in a different way that might work better for certain students. If there is a group of students who learn better by doing, they may get more insights into specific anatomical regions from using a digital 3D app than from studying that specific part of the course text, or rewatching that specific part of the lecture. However, to a student who wants to work through all the material that is offered, this can easily become an unmanageable task if too much supporting material is available.</p> <p>Around 10% of the students suggested some practical changes to Complete Anatomy that could provide an added value for the application. Surprisingly, however, most of the suggested changes were already present in the application, but they were simply not identified by these students. The Latin terminology is provided below the English one, and additional information like origin and insertion of muscles is also available when clicking on the desired structure. Likewise, there is already a function to save previously created 3Ds and the program also contains a quiz function. These functions are unfortunately not always easy to find for new users. The most frequently mentioned complaint was the load of the program on the device that was running it. Technical issues were also reported concerning the installation of the program and the accessibility of the program via access link. Students with installation or accessibility issues were referred to the IT department during classes. 3D applications are inherently heavy to run due to the computing power needed to display the 3D graphics. Other than upgrading the device to a more powerful one, no solution is available for this issue. The suggestion to display multiple models next to each other would lead to an even bigger strain on the device. Even though this would be useful, it would therefore not be a realistic improvement.</p> <hd id="AN0179320312-15">Practical considerations from a teacher's perspective</hd> <p>After asking the students about their experience with the use of Complete Anatomy, it seems prudent to also give some input as a teacher with experience in using Complete Anatomy with a big group of students (<reflink idref="bib743" id="ref52">743</reflink>), to give some advice to fellow teachers. The reason not to make Complete Anatomy a mandatory study material was very much related to the technical implication. Even though most students had no issues installing the app and running it on their device, dozens of students reported technical issues throughout the semester. Teachers are the first point of contact and are, therefore, often expected to solve these issues, regardless of their IT skills. Due to a shortage of IT assistance during lectures, this would push the role of the teacher toward IT support, rather than answering anatomy‐related questions. Additionally, some students might not have the financial means to purchase a device powerful enough to run the software, while other students will have to deal with a lower visuo‐spatial ability. These students might be disadvantaged when the app becomes a mandatory study tool. The arguments above should therefore strongly be considered before making the use of a 3D digital atlas a mandatory requirement for a course. As an additional non‐mandatory study tool, however, especially for students who feel like they benefit from its use, Complete Anatomy can definitely be recommended.</p> <p>When considering the use of Complete Anatomy during lectures, a properly prepared video showing exactly the structures that will be discussed during the lecture is a necessity. Rotating the anatomical models in Complete Anatomy to show examples in real time should be avoided because most of the application's value lies in 'learning by doing'. If the teacher is doing the manipulations, this effect is lost, and with it likely the interest of the students. From experience with using other 3D programs among colleagues from the anatomy department, the same holds true. Looking at an anatomical 3D reconstruction that someone else is manipulating for you is very counter‐intuitive if you are not the one performing the manipulations, even if it is an anatomical region you are familiar with.</p> <p>To avoid information overload, it seems important to make a clear distinction between the non‐mandatory additional study material that is offered and the essential course material for passing the exam. From a teacher's perspective, it is therefore recommended to not be too enthusiastic with providing additional digital study material in the form of internet links or additional applications.</p> <p>Finally, something that could be considered as an additional way to avoid questions about the installation and use of Complete Anatomy would be a dedicated lecture, complete with an IT specialist, to make sure everyone who wants to install the app can do so without technical problems. A short introduction can be given about the most common functions and the best ways to use the application. The need for an introductory lesson about the program's functionalities was also highlighted by the responses to the questionnaire. The students who suggested changes to the program mostly requested functions that were available but that were apparently not found during self‐study.</p> <hd id="AN0179320312-16">Limitations</hd> <p>Even though our data suggest that an increased use (>10 h) of Complete Anatomy could result in higher grades, conclusions should be considered very carefully, as the cross‐sectional study design that was used for this study is not suitable for the assessment of causality. In other words, it is possible that the students that used Complete Anatomy for a lot of hours, also used the other study tools for a lot of hours, simply because they were motivated students with an interest in studying anatomy and were therefore more likely to score higher. This hypothesis will need to be tested in a future study, since the number of hours for other study tools was not recorded in the current pilot study. It should also be noted that filling out the questionnaire was on a voluntary basis, and motivated/higher scoring students may therefore be overrepresented in the study population, as they would be more likely to be interested in participating in this type of study. This self‐reflection bias is confirmed by the percentage of passing grades of the student population in the study (45.5%) compared to the percentage of passing grades of the entire class (33.4%). Self‐reflection bias cannot be prevented in a cross‐sectional study that focuses on studying the effects under actual learning conditions, at least not without introducing some other form of bias. For example, when equal groups for study time are desired, some students will be forced to spend an amount of hours studying using Complete Anatomy that they normally would not have invested. If participation remains completely voluntary and study group numbers are normalized to the study group with the lowest number of participants, study groups would likely be too small for meaningful statistical analysis. A final limitation of this study is the use of self‐reported data for parameters like the time of Complete Anatomy usage, this could have introduced some subjectivity into the study. Nevertheless, future studies can focus on proving the existence of a causal relationship between the study time using Complete Anatomy and the exam grades. The design of these future studies can be based on the additional results obtained from this study.</p> <hd id="AN0179320312-17">CONCLUSION</hd> <p>Complete Anatomy saw a lot of use during the semester to help students prepare for their final anatomy exam. Almost half of the students reported using the app for >10 h, suggesting that the app is very popular as an additional non‐mandatory study tool. Despite the cost for the software license, at least the application is well‐used/well‐appreciated by the students. A positive correlation was found between the proportion of students that passed the final exam and the number of hours of Complete Anatomy usage (<emph>r</emph><subs>s</subs> (<reflink idref="bib4" id="ref53">4</reflink>) = 0.94, <emph>p</emph> = 0.016), meaning that the more the app was used, the higher the chances of getting a passing grade on the exam were. This positive effect started from 10 or more hours of use compared to students who did not use Complete Anatomy (<emph>p</emph> = 0.04). Even though this positive correlation between hours of use and exam grades was identified, it is important that these results are not overinterpreted. The study design was focused on assessing the (amount of) use of Complete Anatomy under actual learning conditions, but this cross‐sectional study design was not suitable to prove causality. The results from this study gave a good overview of how the app was used by the students. Proving the existence of a positive correlation between hours of use and exam scores in this pilot study, definitely prompts a future study to prove the causality between these two factors. The findings from the current study will be useful to guide this future study.</p> <hd id="AN0179320312-18">ACKNOWLEDGMENTS</hd> <p>The authors wish to thank the students who filled out the questionnaire for making this study possible.</p> <hd id="AN0179320312-19">CONFLICT OF INTEREST STATEMENT</hd> <p>The authors have no conflicts of interest to report regarding this work.</p> <hd id="AN0179320312-20">ETHICS STATEMENT</hd> <p>This study was approved by the Ghent University Ethics Committee (2022‐148).</p> <p>GRAPH: Data S1.</p> <ref id="AN0179320312-21"> <title> REFERENCES </title> <blist> <bibl id="bib1" idref="ref2" type="bt">1</bibl> <bibtext> Singal A, Bansal A, Chaudhary P. Cadaverless anatomy: darkness in the times of pandemic Covid‐19. Morphologie. 2020 ; 104 (346): 147 – 150.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref7" type="bt">2</bibl> <bibtext> Park S, Kim Y, Park S, Shin JA. The impacts of three‐dimensional anatomical atlas on learning anatomy. 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His research interests are in anatomy education, medical imaging, 3D visualization and modelling and the lymphatic system.</p> <p>Lena Van Beek, MScEd, holds a master of teaching in health sciences with a broad interest in educational models and study tools and their implementation into practice. Her research interest is in anatomy education and the implementation of digital study tools in this context.</p> <p>Joris Van de Velde, PhD, is education coordinator for anatomical education at the Department of Human Structure and Repair of Ghent university, where he teaches gross anatomy. His research interests are in anatomy education, medical imaging, 3D visualization and modelling and radiotherapy.</p> <p>Carl Vangestel, PhD, is professor at the Department of Biology of Ghent University, where he teaches advanced biostatistics. He is also a research scientist at the Royal Belgian Institute of Natural Sciences. His research interests are in education, genomics, bioinformatics and biostatistics.</p> <p>Tom Van Hoof, PhD, is professor at the Department of Human Structure and Repair of Ghent University, where he teaches gross anatomy. His research interests include anatomy education, medical imaging, 3D visualization and modelling and biomechanics.</p> </aug> <nolink nlid="nl1" bibid="bib11" firstref="ref17"></nolink> <nolink nlid="nl2" bibid="bib12" firstref="ref18"></nolink> <nolink nlid="nl3" bibid="bib13" firstref="ref24"></nolink> <nolink nlid="nl4" bibid="bib15" firstref="ref25"></nolink> <nolink nlid="nl5" bibid="bib16" firstref="ref27"></nolink> <nolink nlid="nl6" bibid="bib10" firstref="ref28"></nolink> <nolink nlid="nl7" bibid="bib14" firstref="ref30"></nolink> <nolink nlid="nl8" bibid="bib18" firstref="ref33"></nolink> <nolink nlid="nl9" bibid="bib19" firstref="ref37"></nolink> <nolink nlid="nl10" bibid="bib20" firstref="ref38"></nolink> <nolink nlid="nl11" bibid="bib21" firstref="ref39"></nolink> <nolink nlid="nl12" bibid="bib23" firstref="ref44"></nolink> <nolink nlid="nl13" bibid="bib24" firstref="ref51"></nolink> <nolink nlid="nl14" bibid="bib743" firstref="ref52"></nolink>
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  Data: A Pilot Study for the Evaluation of 3D Anatomy Application 'Complete Anatomy' as an Additional Non-Mandatory Study Tool for the Functional Anatomy Classes of First Year Physical Therapy Students
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  Data: <searchLink fieldCode="AR" term="%22Michael+E%2E+J%2E+Stouthandel%22">Michael E. J. Stouthandel</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-4276-8926">0000-0003-4276-8926</externalLink>)<br /><searchLink fieldCode="AR" term="%22Lena+Van+Beek%22">Lena Van Beek</searchLink><br /><searchLink fieldCode="AR" term="%22Joris+Van+de+Velde%22">Joris Van de Velde</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-0003-1416">0000-0003-0003-1416</externalLink>)<br /><searchLink fieldCode="AR" term="%22Carl+Vangestel%22">Carl Vangestel</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-1024-8213">0000-0003-1024-8213</externalLink>)<br /><searchLink fieldCode="AR" term="%22Tom+Van+Hoof%22">Tom Van Hoof</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-9207-2217">0000-0002-9207-2217</externalLink>)
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  Data: <searchLink fieldCode="SO" term="%22Anatomical+Sciences+Education%22"><i>Anatomical Sciences Education</i></searchLink>. 2024 17(6):1336-1344.
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  Data: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
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  Data: <searchLink fieldCode="DE" term="%22College+Freshmen%22">College Freshmen</searchLink><br /><searchLink fieldCode="DE" term="%22Physical+Therapy%22">Physical Therapy</searchLink><br /><searchLink fieldCode="DE" term="%22Allied+Health+Occupations+Education%22">Allied Health Occupations Education</searchLink><br /><searchLink fieldCode="DE" term="%22Visual+Aids%22">Visual Aids</searchLink><br /><searchLink fieldCode="DE" term="%22Anatomy%22">Anatomy</searchLink><br /><searchLink fieldCode="DE" term="%22Computer+Assisted+Instruction%22">Computer Assisted Instruction</searchLink><br /><searchLink fieldCode="DE" term="%22Academic+Achievement%22">Academic Achievement</searchLink><br /><searchLink fieldCode="DE" term="%22Computer+Software+Evaluation%22">Computer Software Evaluation</searchLink><br /><searchLink fieldCode="DE" term="%22Time+on+Task%22">Time on Task</searchLink>
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  Data: 10.1002/ase.2491
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  Data: 1935-9772<br />1935-9780
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  Label: Abstract
  Group: Ab
  Data: For this pilot study, the use of the digital 3D anatomy application Complete Anatomy was evaluated as a non-mandatory additional study tool throughout the semester. The aim of the study was to investigate if the Complete Anatomy usage time had an effect on final exam grades and how the app was used post-COVID-19. This cross-sectional study asked first year bachelor/freshman university students of Physical Therapy and Rehabilitation Sciences to fill out a questionnaire to gauge Complete Anatomy usage time, the student's exam results, and how the app was used, for example, in relation to other study tools. A positive correlation was found between the proportion of students that passed the final exam and the number of hours of Complete Anatomy usage (r[subscript s] (4) = 0.94, p = 0.016). Compared to students who didn't use Complete Anatomy, these positive effects were observed when students used Complete Anatomy for at least 10 h (p = 0.04). The app was well-used with almost half of the respondents reporting >10 h of usage time. The results from this study provide a good overview of how and how often Complete Anatomy is used. Although a positive correlation between the hours of use and the number of passing grades was found in this pilot study, a future study to prove the causality between these two factors is warranted to further investigate the effect of Complete Anatomy as an additional non-mandatory study tool.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2024
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1437539
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1437539
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1002/ase.2491
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 9
        StartPage: 1336
    Subjects:
      – SubjectFull: College Freshmen
        Type: general
      – SubjectFull: Physical Therapy
        Type: general
      – SubjectFull: Allied Health Occupations Education
        Type: general
      – SubjectFull: Visual Aids
        Type: general
      – SubjectFull: Anatomy
        Type: general
      – SubjectFull: Computer Assisted Instruction
        Type: general
      – SubjectFull: Academic Achievement
        Type: general
      – SubjectFull: Computer Software Evaluation
        Type: general
      – SubjectFull: Time on Task
        Type: general
    Titles:
      – TitleFull: A Pilot Study for the Evaluation of 3D Anatomy Application 'Complete Anatomy' as an Additional Non-Mandatory Study Tool for the Functional Anatomy Classes of First Year Physical Therapy Students
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Michael E. J. Stouthandel
      – PersonEntity:
          Name:
            NameFull: Lena Van Beek
      – PersonEntity:
          Name:
            NameFull: Joris Van de Velde
      – PersonEntity:
          Name:
            NameFull: Carl Vangestel
      – PersonEntity:
          Name:
            NameFull: Tom Van Hoof
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      – BibEntity:
          Dates:
            – D: 01
              M: 09
              Type: published
              Y: 2024
          Identifiers:
            – Type: issn-print
              Value: 1935-9772
            – Type: issn-electronic
              Value: 1935-9780
          Numbering:
            – Type: volume
              Value: 17
            – Type: issue
              Value: 6
          Titles:
            – TitleFull: Anatomical Sciences Education
              Type: main
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