Given the decline of cadavers as anatomy teaching tools, immersive virtual reality (VR) technology has gained popularity as a potential alternative. To better understand how to maximize the educational potential of VR, this scoping review aimed to identify potential determinants of learning anatomy in an immersive VR environment. A literature search yielded 4523 studies, 25 of which were included after screening. Six common factors were derived from secondary outcomes in these papers: cognitive load, cybersickness, student perceptions, stereopsis, spatial understanding, and interactivity. Further objective research investigating the impact of these factors on anatomy examination performance is required. Supplementary Information The online version contains supplementary material available at 10.1007/s40670-022-01701-y.

Three-dimensional (3D) scanning and printing technology has allowed for the production of anatomical replicas at virtually any size. But what size optimizes the educational potential of 3D printing models? This study systematically investigates the effect of model size on nominal anatomy learning. The study population of 380 undergraduate students, without prior anatomical knowledge, were randomized to learn from two of four bone models (either vertebra and pelvic bone [os coxae], or scapula and sphenoid bone), each model 3D printed at 50%, 100%, 200%, and either 300% or 400% of normal size. Participants were then tested on nominal anatomy recall on the respective bone specimens. Mental rotation ability and working memory were also assessed, and opinions regarding learning with the various models were solicited.The diameter of the rotational bounding sphere for the object ("longest diameter") had a small, but significant effect on test score (F(2,707) = 17.15, p < 0.05, R 2 = 0.046).Participants who studied from models with a longest diameter greater than 10 cm scored significantly better than those who used models less than 10 cm, with the exception of the scapula model, on which performance was equivalent across all sizes.These results suggest that models with a longest diameter beyond 10 cm are unlikely to incur a greater size-related benefit in learning nominal anatomy. Qualitative feedback suggests that there also appear to be inherent features of bones besides longest diameter that facilitate learning.

Introduction Cognitive load refers to the amount of working memory that is being used in a task, like memorizing the anatomical landmarks on distinct boney specimens. Critically, cognitive load may be compromised when the load imposed by the environment and the content to be learned together exceeds a student’s capacity. Previous research shows that stereoscopic materials delivered in virtual reality (VR) can be more mentally taxing compared to desktop (i.e., two dimensional) delivery but may be similar to that encountered in real life. There is no data on the cognitive load of autostereoscopic displays. Given the increased reliance upon digital media for teaching in learning in anatomy classrooms, it is prudent to better understand the cognitive load imposed on learners across a variety of modalities employed. Methods Cognitive load will be compared across three different learning modalities: immersive virtual reality (VR, displayed on the Oculus Quest 2TM), autostereoscopic (displayed on the AlioscopyTM screen), and an identical printed, physical model. During a four‐minute learning phase, undergraduate students, with no prior formal anatomy education, will learn 10 anatomical landmarks on a displayed bony model (calcaneus, zygomatic bone, or hemipelvis) in each of the three modalities. A Stroop test will be administered as a secondary task throughout the learning phase to evaluate cognitive load. Stroop test reaction time, and accuracy of the participants' responses to the Stroop test will be recorded. After the learning phase, an untimed, recognition‐based test will be administered wherein participants will be asked to recall the ten landmarks learned with the aid of a 3D‐printed bone identical to the one used in the learning phase. Performance will be evaluated based on landmarks correctly identified and the results will be correlated with cognitive load measured in each learning modality. Results We hypothesize that the cognitive load will be highest for VR when compared to the cognitive load on the AlioscopyTM and physical model modalities which would manifest as lower reaction times and/or accuracy on the Stroop test. Further, we hypothesize that cognitive load will inversely correlate with the recognition test performance. Conclusion The results of this study will allow educators and students to make informed decisions when deciding which learning modalities should be used for anatomy education or any other education that requires nominative learning on complex objects. Understanding which modalities minimize cognitive load and improve learning will help improve outcomes and allow for more efficient anatomical education.

Historically, learning anatomical specimens was limited to studying cadaveric materials, and by extension, specimens which are “life‐sized”. Recent technological advancements in 3D scanning and printing now allow for the production of inexpensive, durable anatomical replicas at virtually any size. This, however, creates a dilemma: what is the most effective model size to learn from? The goal of this project is to discover the appropriate size of an object to learn nominal anatomy and thus provide a critical step in improving anatomic education. We hypothesize that there is a curvilinear relationship between model size and learning, where a model too small or too big would not be the most conducive to learning and an ideal intermediate size can be determined. In this study, undergraduate students (n = 351) without prior anatomical training learned from four bones of varying normal anatomical size and features and were assessed on their ability to identify various landmarks. Thoracic vertebra (VE), hemipelvis (HE), sphenoid (SP), and scapula (SC) was 3D‐printed at four different scalar sizes. The VE and HE models were printed at 50%, 100%, 200%, and 400% scale, while SP and SC models were printed at 50%, 100%, 200%, and 300% scale. Each participant was randomly assigned to a group of two bone models (VE/HE or SP/SC) of a certain size, and randomized across the order in which they learned the models. They were then tested on the respective real bone specimens, followed by a qualitative survey reporting their experience with the 3D‐printed models, a Mental Rotations Test (MRT), and an Operation Span Test (OSPAN). Data collection for the 50% SP/SC group is still ongoing. Multiple regression suggested significant effects of Model Type, Model Size, MRT and OSPAN, (F(9, 596) = 17.96, p = 0.000, R2 = 0.2133). The most significant predictor of test score was MRT, which suggested a 10% increase in MRT score is associated with a ~3% increase in test score. The score variability independently accounted for by MRT and OSPAN was 14.6%, while the variability independently accounted for by model size and type was 7.8%. This means, that while test scores are primarily driven by participants’ mental rotation ability, model size remains an important feature that can be manipulated to improve learning. 3D printing allows for this in a cost‐effective way. Support or Funding Information This study was funded by the Education Program in Anatomy at McMaster University. Many thanks to the University of Buffalo for 3D printing the 400% VE and HE models.

Introduction Traditional anatomy learning relies on models and cadaveric specimens that are time and resource intensive to produce, which compromises their accessibility. To mitigate this, the use of three‐dimensional visualization technology (3DVT) to learn anatomy has substantially increased. Still, learning in an immersive virtual reality (VR) environment may pose new challenges, including increased self‐reported levels of cognitive load and cybersickness likely due to its immersive nature that isolates the learner from their surroundings. Autostereoscopy is a novel and potential solution, as it provides a headset‐free stereoscopic view of a three‐dimensional (3D) model. There is, however, a paucity of information about the use and educational efficacy of autostereoscopic 3DVT. The purpose of this study is to examine the strengths and limitations of implementing a non‐immersive autostereoscopic (AlioscopyTM) screen for learning anatomy. Methods A large‐scale study on the efficacy of VR, autostereoscopy, and 3D printed physical models for learning anatomy is currently underway. We suspect that cognitive load and cybersickness may compete with learning capacity. Based on the literature, we hypothesize the AlioscopyTM screen to represent a sort of middle‐of‐the‐road option, with moderate cognitive load and cybersickness levels (VR>AlioscopyTM>physical), that supports large‐group learning (as opposed to single‐user immersive VR) yet retains the accessibility associated with digital assets (as compared to physical specimens). As such, it is prudent to consider the feasibility of implementing an AlioscopyTM screen for anatomical teaching and summarize the strengths and limitations of the technology. Results According to the company’s website, 3D images on the 42” AlioscopyTM display we are using can be viewed from 2.5m to 9.0m away, with optimal results at 4.0m, by a theoretical maximum of “20 to 50 people spread over an area of 90°”. We suspect a practical limit of 14 people per display (2 people for each of the 7 viewing zones) and a comfortable limit of 7 (1 per zone). This allows viewers to comfortably situate themselves in a “sweet spot” where each of their eyes receives a clear, distinct image, which is required for the stereoscopic effect. The stereo‐3D effect is prominent, with objects allowed to both protrude from and recess into the display considerably. Display content was created using a plugin (provided by AlioscopyTM) for the videogame engine Unity, allowing existing Unity content to function on the modality easily. Conclusion The AlioscopyTMscreen represents a novel approach to promoting material accessibility and viewing 3D stereoscopic images in a group setting. The nature of this set up may both decrease the inherent issues most immersive 3DVT impose and offer an opportunity for collaborative learning not available with the use of single‐user headsets.