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.

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.

Introduction Cybersickness is an array of symptoms associated with exposure to three‐dimensional visualization technology (3DVT) environments, such as virtual reality (VR). It is thought that cybersickness is a type of motion sickness caused by a mismatch in sensory and vestibular input when using these modalities. Symptoms of cybersickness are often akin to those of traditional motion sickness, such as headache and nausea. In the literature, as many as 40‐60% of VR users report symptoms of cybersickness, though in our laboratory approximately 20% of users report symptoms of cybersickness. Our past research has shown that the physical environment is often preferred by students, and more effective for learning anatomy, compared to 3DVT environments. We hypothesize that the preference for, and effectiveness of, the physical environment over 3DVT may be a result of cybersickness due to the isolation of the learner from the physical environment. However, no direct measurements of cybersickness or comparisons between 3DVT environments in anatomy are available. Methods Our study involves comparisons of cybersickness during anatomy learning between three 3D modalities: a VR Oculus Quest 2TM headset, an autostereoscopic screen (AlioscopyTM), and a 3D‐printed physical model. Undergraduate students, with no formal anatomy training, will be randomized via a Latin square design to view one of three skeletal models (human hemipelvis, zygomatic bone, or calcaneus) in each of the modalities. Participants may not touch the model but may rotate it along the horizontal plane using an XboxTM controller. Participants will have four minutes to learn ten bony landmarks on the viewed model and will then take an untimed, recognition‐based test for landmarks learned before progressing onto the next modality. Cybersickness will be assessed following testing in each modality, via self‐reports on the simulation sickness questionnaire (SSQ). Results We hypothesise that reported cybersickness will be highest for the VR displayed on the head‐mounted display of the Oculus Quest 2TM which entirely covers the visual field, compared to learning through the AlioscopyTM screen or the physical model due to the relative lack of isolation of the learner from the physical environment in the last two treatment groups. Conclusion With the rapid development of 3DVT for use in anatomical education, cybersickness is an important issue in evaluating the quality of 3D modalities. The results of this study will allow educators and students to make informed decisions about the use of 3DVT in anatomy thus preventing uncomfortable physical symptoms associated with learning using 3DVT and improving learning as a result.

Introduction Traditional anatomical education relies on textbooks, physical models, and cadaveric specimens. Advances in technology have provided other display modalities including virtual reality (VR), and autostereoscopic displays. VR uses head‐mounted displays (HMDs) for an interactive experience and autostereoscopic screens, like AlioscopyTM, offer a stereoscopic but HMD‐free environment. Current research shows contradictory results on the efficacy of VR compared to physical models, and there appears to be no data on the efficacy of autostereoscopic displays in learning anatomy. The purpose of this study is to determine whether VR, AlioscopyTM, or physical models yield the best performance for anatomical education. Methods Students at McMaster University without prior anatomy training will learn nominal skeletal anatomy in three different modalities: VR (Oculus Quest 2TM), AlioscopyTM, or a physical 3D‐printed bone model. Each of the environments will be as identical as possible (i.e, the VR environment is a rendering of the exact room and set‐up used for testing the physical bone models). Participants will be randomized to one of three interventions where they will study ten bony landmarks on either the human hemipelvis, zygomatic bone, or calcaneus in a distinct modality. Participants will be seated and use an XboxTM controller to rotate the bone along the vertical axis of rotation. After four minutes, an untimed, recognition‐based test will be administered, where participants will be given a 3D‐printed bone identical to the one used in the learning phase, with randomized landmarks and word bank of landmarks learnt. Performance will be evaluated based on landmarks correctly identified on the recognition‐based test. Results Based on the current literature, we hypothesize that the physical models will be a superior learning environment compared to the VR environment. However, significant improvements in the HMD of the Oculus Quest 2 may have ameliorated previous issues with the VR environment. There is no data available on the efficacy of AlioscopyTM and while the absence of an HMD is appealing, its narrow viewing angle compared to the immersive VR environment may be problematic. Conclusion With the push to increase accessibility and decrease costs associated with anatomical education with the help of digital modalities, the findings from this study are critical to informing teaching practices, and technology use in anatomy education.