Abstract

Introduction: As medical education has progressed exponentially over the past decades, there are solid concerns regarding the refuse in students ‘ cognition of human body. Teaching anatomies is becoming increasingly challenging as students are becoming more technology-dependent and have to gain an understand of complex anatomic structures in a relatively curtly time.
Zygote Body® is a novel interface with potential to facilitate eruditeness of homo anatomy. This study investigates its relevance and appropriateness for use in anatomy department of education for checkup students.
Methods: After integration of the web-based application, questionnaires were used to gain feedback from beginning year medical students ( n=73 ).
Results : Data analysis revealed significant improvements in scholar ’ s comprehension ampere good as their exhilaration for such innovations.
Discussion: The software succeeds at engaging students and suggests that their inclusion of complex 3D structures was improved. however, because of its limitations, this web-based tool can not be used as a definite tool for learning anatomy. Although multimedia may compliment the memorize procedure, nothing can substitute living human body in a safe environment before handling patients.

Introduction

Anatomy education: Time for creativity and innovations
Because of the liberal evolution of student populations, aesculapian course of study and university teach mission, teaching human body is becoming increasingly challenging [ 1 ]. New aesculapian students besides face challenges in gaining an understand of the cubic shapes of anatomical reference components and the interconnections between them [ 2 ].
Functional anatomy is traditionally learned by reading books and by studying anatomical reference models, but because of the active nature of drift, many concepts of functional anatomy are not well portrayed in standard textbooks and figures [ 3 ]. This is why conventional human body department of education based on dissection has some shortcomings. besides, the quality of dissection and learning outcomes may depend on individual factors such as prior cognition, cognitive factors, visuospatial ability, motivation, and emotional concerns. second, many students encounter poor quality corporeal and sometimes non-preservation of substantive structures because of limitations in the number of cadavers, the phone number of teachers, time spent on dissection, and self-instruction time [ 4, 5 ].
Anatomy educators are expected to teach more students and more content as the practice of music requires an increasingly big, enriched, integrated, and applied cognition base [ 6 ] with fewer resources as budgets are cut and anatomy touch hours are reduced. Undergraduate anatomy educators are confronted with humble student accomplishment and memory rates, an academically divers cohort of students, and the preparation of students for admission into a huge array of competitive health science programs [ 7 ]. It is now more authoritative than ever to make anatomical reference instruction increasingly maximized, effective, and lifelong.
In hopes of coping with mod exercise, the conventional education of dissection is in the work of being revolutionized and enhanced if not replaced by more advanced modalities [ 8 ]. many institutions have officially deemed ceremonious cadaverous dissection disused in stead of model substitutes and technology [ 9, 10 ].
Innovative, multimodal approach in teaching anatomy
Multimodal methods to teach anatomy have gradually become the most democratic options among the majority of checkup institutions [ 11 ]. Regardless, dissection silent seems to be the darling method acting of teaching ampere well as providing optimum examples of pathology by students and teachers alike [ 12-14 ].
Computer-aided techniques have been proposed for teaching anatomy, including : hypertext entree to a large collection of data ; cross-section image ; animated 3D computer models ; interactional self-assessment ; and multimedia database systems [ 2 ].
many inquiry studies have compared the effectiveness of computer-assisted instruction for medical students with traditional lecture and/or casebook. Test scores repeatedly show that users perform evenly well, and sometimes slenderly better, if they have used computer-assisted direction rather that attended a lecture or viewed print materials [ 15, 16 ].
Zygote Body®: Interactive multimedia learning resource for medical education
Recently, we have decided to implement some modern technologies in the human body course at the Medical Faculty at the University of Maribor ( MF UM ). While considering versatile commercial options, the release of Zygote Body® was formally announced as Beta version in December 2010 and was upgraded at the goal of March 2011.
Zygote Body® is a web site ( zygotebody.com ) that allows users to navigate through a 3D anatomic model of the human consistency. It uses WebGL engineering, based on Open Graphics Library for Embedded Systems ( OpenGL ES ) 2.0, which provides a programmatic interface for 3D graphics. The engineering uses the Hypertext Markup Language 5 ( HTML5 ) canvas element and is accessed using Document Object Model interfaces. WebGL is a context of the sail HTML element that provides a 3D graphics Application Programming Interface ( API ) implemented in a web browser without the use of plug-ins. ( hypertext transfer protocol : //www.khronos.org/webgl/ ).
Zygote Body® as a determine joyride falls into the category of “ Open Educational Resources ” ( OER ) as has been introduced and promoted in the context of UNESCO ’ s aim to provide dislodge entree to educational resources on a ball-shaped scale. The term was inaugural adopted by UNESCO in 2002 to refer to “ the open planning of educational resources, enabled by information and communication technologies, for consultation, use and adaptation by a residential district of users for non-commercial purposes ”. [ 17 ]
Open generator and open standards are defined as the basis of the “ Open educational resource bowel movement ” that has been forming on a global level over the last ten [ 18 ]. We perceive Zygote Body® to be an crucial and valuable contribution to the theme of the OER.
Clearly open subject itself ( though a high-quality one individualized for the end drug user ) is not enough for effective learn. Before addressing utilitarian exposed content, tools and licenses, one must consider the pedagogical-didactical approaches in which these resources can make a dispute, i.e. by being used in advanced forms of education and memorize. [ 19 ]
From the didactic point of opinion, the independent principles of the Zygote Body® as a memorize tool are the principles of the “ Constructivist school of learning ”. Constructivists see learners as active preferably than passive voice. Knowledge is not received from the outside or from person else, but preferably, the individual learner interprets and processes what is received, through the senses, to create cognition. The apprentice is the center of the learn, with the teacher playing an propose and facilitate function. Learning is consequently moving away from one-way education towards construction and discovery of cognition [ 20 ]. Zygote Body® as a determine tool has the follow attributes of the Constructivist ’ s school views on Online learning :
Learning with Zygote Body® is a proactive work for the learner. He has no early option but to navigate and explore on his own.
The learner constructs his own cognition rather than accepting cognition produced by the teacher ( cognition construction in Zygote Body® on the other hand is not ( even ) facilitated by good synergistic on-line teaching ).
The learner is in dominance of the teach action. He autonomously decides on the memorize yard and direction.

Methods

After the spill of Zygote Body ® in January 2012, we decided to evaluate its potential relevance in teaching anatomy at MF UM. We wanted to confront students who recently passed the examination in osteology and muscle attachments with simulation of building complex 3D structures and spatial relations before working with cadavers. We use a state-of-art desktop computer and an LCD-projector, both located in the dissect room, allowing us to use Zygote Body® at the lapp time as we work with cadavers. After using Zygote Body® for 3 months, an promote adaptation with some extra features was released.
At MF UM, students must learn the entire human body along with histology and embryology in only two semesters. They attend traditional human body lectures followed by a practical naturally in the dissection room. Before working with cadavers, we again briefly repeat the theoretical frame relevant for virtual education. Working in groups of about 15 students, we try to use Zygote Body® to achieve better understand of some complicate anatomic structures and their sexual intercourse to each early in order to visually prepare students for the dissection work. Working in this room allows educators to examine scholar ‘s cognition deoxyadenosine monophosphate well as providing students with the ability to repeat previously learned subjects and gain relevant self-feedback.
first, we tested Zygote Body® in presenting the axillar, scapular and deltoid regions deoxyadenosine monophosphate well as all the upper limbs. We wanted to present anatomical reference walls of axillary pit adenine well as its content. In the deltoid region, we wanted to show anatomic structures according to layers. In the upper limb, we wanted to show the muscles, nerves and arteries.
Participants and data collection
After using Zygote Body® for more than 3 months and experiencing its first and upgrade version, we used questionnaires to gather information from the students about their military rank of the tool, acceptance, motivational and educational function. A set of six questions to be answered on a 5-level scale ranging from “ Agree completely ” to “ completely disagree ” was used. extra questions offered more options for students to provide their opinions about the best relevance of the joyride according to anatomic systems and relations between them.
The main focus of the trial was a group of inaugural year aesculapian students enrolled in the anatomy course. After we handed out 81 questionnaires, 73 of them were completed and returned. These were the subject of statistical analysis. mesa 1 shows classification of anatomic systems, offered as optional answers.

Results

Students accepted the virtual human model with enthusiasm. Their initial reaction was encouraging for the educators. It turned out to have a relevant motivational function as it meant something raw for students in the educational work adenine well as providing a better ocular, which gave the educators very positive feedback. Another sign of the student ’ s credence of the “ learning joyride ” was that they were besides matter to in trying it at home ( Figure 2 ). 90 % of students use Zygote Body at least occasionally when studying human body at dwelling, while more than 30 % practice it on a regular basis. The number could be even higher if it weren ’ thymine for the fact that is takes some effort to make the web-based lotion to work at home and all students are not capable of managing this themselves. however, we find this an important part of learning anatomy as it provides self-motivation for students to study during their release clock time.
The majority of students liked the lectures better after the implementation of Zygote Body®. This is due to the motivational role as mentioned above and better comprehension of building complex anatomical reference structures and their relations ( Figure 2, Table 2 ). 88 % of students are sealed to have better understanding of anatomy ( Figure 2 ) and graded this effect of Zygote Body® in learning anatomy at an average of 4.1 ( table 2 ). however, the situation is not the same when comparing the use of Zygote Body® with working with cadavers. These offer more realistic insight into the homo body and provide a stronger psychological effect. only 18 % of students prefer to use Zygote Body® over working with cadavers.
Zygote Body® is most efficient when learning about muscles and relations between anatomic structures according to the students ’ opinions ( Figure 3 ). Muscles are the most superficial structures, being equitable under the skin, which is why their form, origin and interpolation are well silent. With an option to select and isolate a individual brawn, Zygote Body® provides a nice sport for better visual image of the muscleman course. Bones, on the early bridge player, are besides well modeled, but contain besides small an amount of anatomical reference information that students have to learn. Inner organs are well presented, particularly ascribable to the officiate allowing the drug user to remove person structures. This allows users to observe relations between anatomic structures, which represents the second base most effective function according to the students ’ opinions ( Figure 3 ).
however, there are some concerns about Zygote Body® being a definite joyride for learning human body, tied since the release of the upgrade interpretation. In board 3, we evaluate the features of Zygote Body® according to the list of features described by Temkin et aluminum. [ 21 ], in which one can see that only the basic features are enabled, whereas the more twist ones are not. furthermore, there are some other issues with the tool chiefly noticed by educators while presenting anatomic structures to students angstrom well as by some students expressing their impression in the view.
first, educators had major problems while presenting peripheral lateral parts of the body, such as the wholly upper limb distal to elbow. This occurred because of the inability to rotate the homo model in all dimensions. What happens, for model, while zooming into the palmar vasculature, is that one can not center it on the screen. The model can be rotated merely on its sagittal axis and moved frontwards up and toss off and not besides left and mighty. By zooming in, lateral body parts move to the edge of the screen. By rotating the model on its sagittal bloc, these can be centered on the screen, but they are besides rotated along with the unharmed human model. The lack of the option to move the zoomed-in model left and right disables the observer to see the frontal layer of the anatomic structures, for case, the superficial and deep palmar arterial arch american samoa well as all other structures of the sleeve. The only choice to rotate the model in all directions is to select an person structure, which is insufficient for overall inclusion.
Another airy issue arises from a good feature of speech with which the drug user can pinpoint and highlight selected structures to visualize them individually from others, while it remains impossible to remove the name rag ( Figure 4a ). These are annoying, specially when there are lots of structures selected, as they are always in presence of the anatomic exemplary no matter what exploiter does to navigate away from them. There is, however, another way to present all relevant structures by deleting one structure at a clock time ( Figure 4b ). This method is more inconvenient and time consuming for educators during human body courses, but is more effective.
Structure survival, however, is critical in many ways. First, multiple-structure survival is not optional. This means that when the user wants to have a attend at the mouthpiece pit, for exemplar, he has to delete the outside structures individually, structure by structure ( e.g. tooth ), which is again clock consuming. We miss the option of group anatomical reference structures, which would facilitate the survival summons. Second, while individual structure deletion ( hiding ) is enabled, the exploiter can not reverse this carry through in the same manner, as the dominate mechanically un-hides all previously hidden structures at once. This means that by making a error or accidently clicking a adjacent structure, the exploiter has to start all complete again, hiding structure by structure. last, there is a problem with identifying anatomical reference structures ( specially bigger or longer ones ) while looking at an sphere at a high soar horizontal surface. By clicking on the desire anatomic depart, the screen moves towards the center of the selected part and moves the area of interest aside and thus distracts the drug user.
however, Zygote Body® has the potential to become more valuable as an educational instrument for human body students. This is dependable not entirely because it may be used for the human body course to better visualize some anatomical reference structures, but because it has a big benefit as a complimentary tool that students can launch at dwelling.

Discussions and Conclusion

The web site is easily to operate and, with an intuitive user interface, even inexperienced calculator users can make good practice of the platform [ 2 ]. This is why educators had no problems handling the virtual human 3D exemplary, rotating it in different directions and finding the relevant anatomic structures. Educators all appreciated the “ cock ”, as they were able to show what they wanted while attracting the students ’ focus towards the authoritative structures.
According to the previously mentioned sharpen of see ( Constructivist ’ randomness school of on-line learning – reference:22 ), Zygote Body®, in its future growth, has the likely to enhance the overall learn experience in the watch ways :
* When browsing specific details, learners can be directed to research on the Internet or link to online data and libraries to acquire further information ( reading textual materials, listening to sound recording materials, and viewing extra visuals or video materials ).
* Appropriate application exercises could be embedded throughout the on-line example to establish the relevance of the materials.
* Activities with feedback and assessment tools should be included to allow learners to monitor how they are performing.
* Clear memorize paths and scenarios could be defined. To promote higher-level action and to bring closure to the moral, a drumhead should be provided, or learners should be required to generate a lesson drumhead.
* Opportunities could be provided for learners to transfer what they learned to real-life applications, so that they can be creative and go beyond what was presented in the on-line lesson.
* Intelligent support with suggestions for personalize paths for specific learn goals.
But in order to achieve these enhancements, Zygote Body® would have to implement extra control features for educators that are common in modern e-learning environments ( use of assessment, group work tools, application of employing learning paths with outcomes, etc. ).
however, although multimedia may compliment the eruditeness work, nothing can substitute the hardheaded experience gained within peer-groups [ 23 ] along with familiarizing oneself with living anatomy in a condom environment before handling patients. however, function of boost computer graphics has been shown to provide substantial improvements for medical teaching in general [ 24, 25 ]. Students who entree web-based computer-aided instruction resources score significantly higher on examinations than those who never access the on-line content [ 8 ].
yet, the trial we performed has some limitations. First, we did not perform such a survey before the execution of Zygote Body®, therefore the definite rendition of results is restrict. besides, the fact that Zygote recently released an update translation of Zygote Body® with some of the disadvantages we found here having been eliminated could be another reason for limited results, but it is in our opinion of minor importance and does not influence the results.
As checkup education has progressed exponentially over the by decades, there are consentaneous concerns regarding the refuse in students ‘ cognition of anatomy, as discussed [ 26 ]. It is full of life to tackle this problem fountainhead on ; otherwise, the deconstruction of anatomy department of education and sabotage of crucial cognition and skills gained from the course will inescapably lead to under-qualified educators for future generations [ 27 ] vitamin a well as insecure and incompetent doctors.
The future of the anatomic sciences in checkup school course of study is presently being shaped. It is all-important that we think outside the boundaries of traditional educational modalities and be creative [ 28 ]. This is the reason for execution of such and further memorize tools in our course of study at MF UM.

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