Diane-Michel.com

Diane E. Michel
Nova Southeastern University
M.S. Computing Technology in Education
Program Capstone Project
September 9, 2007

Abstract

Virtual reality is a tool for learning human anatomy in a cost efficient and convenient manner. It shows great promise as an answer to the many logistical and economic challenges occurring within anatomy programs today. The author will research and discuss best practices in virtual reality anatomy courses from collective case studies of medical schools. Those approaches will be documented and serve as a model for instructors who wish to create their own virtual anatomical research and study center. The virtual world of Second Life will be evaluated as to its potential for delivering anatomical instruction, either through visualization or collaboration. An instructional manual will provide direction on how to begin utilizing Second Life and how to use its tools for instructional use.

Designing Anatomical Medical Instruction within the Virtual Reality World of Second Life

Statement of Problem

The problem to be addressed in this project is the difficulty of creating engaging anatomical medical training that is highly realistic, while being cost efficient, and convenient for medical students. Second Life is an existing virtual reality space that is used by many pioneering universities around the world as a teaching environment. However it is still in its beginning stages. It is unclear if its technology is suitable for anatomical instruction. Anatomical study requires more than just static visual images in order to learn and accurately construct knowledge. Yang, Chen and Liu (2005) stated medical students must have the ability to visualize highly complex anatomical structures. Szekely and Satava (1999) reported that medical and surgical training requires “high fidelity visualization and realistic immersion into the virtual scene.” Hoffman, Murray, Curlee, and Fritchle (2001) explained traditional methods of teaching anatomy that involve lectures and dissection “fall short of instilling the requisite 3-D conceptualization, retention, and application of anatomic knowledge to clinical-problem solving.”

Virtual reality is an ideal environment for studying the anatomical structures of the human body in critical detail. Visualization is possible from numerous angles. Immersion in a three-dimensional space encourages students to actively participate in their own learning process. By making use of Second Life’s readily available technology, instructors can quickly create their own classrooms that can be scaled up or down as needed. As a virtual center of learning it frees participants from the barriers of distance, limited lab space, and problematic schedules. In addition it provides significant cost savings, as schools no longer need to create entire custom programmed environments from beginning to end.

Goal

The goal of the author in this project is to create a step-by-step manual introducing the essential elements and procedures necessary for creating successful medical virtual reality instruction. The manual will provide a realistic plan of action that instructors can follow in order to develop their own virtual research and study center. Second Life will be evaluated as to its potential of serving as an environment for anatomical coursework and how instructors can best utilize the platform for teaching either through collaboration or visualization.

Approach

1. The goal of the author in this project is to showcase best practices and methodologies currently being used for virtual reality medical instruction. The author will examine six courses or seminars taught within Second Life.

2. The author will present detailed information and valuable reference on professional resources, relevant communities of practice, and specific third party tools.

Review of the Literature

Introduction: Complexities of Teaching Anatomy

Virtual reality used as a tool to teach human anatomy can potentially solve many of the practical problems associated with this complex subject. Inwood and Ahmad, (2005) have reported studying by dissection is “an unparalleled means of teaching gross anatomy.” However with it comes a “significant logistical and financial investment.” Fundamental issues include a scarcity of qualified instructors (Reeves, Sheedlo & Roque, 2005). Berube, Murray, and Schultze (1999) have reported the availability of donated human specimens for laboratory study has been steadily declining over the years, while their cost of being stored properly has increased significantly. In addition, Warner and Rizzolo (2006) discussed that increasing competition from other required curricula, affects gross anatomy programs, with the end result being that some courses must be eliminated altogether. Haase (2000) stated that medical students must traditionally spend extraordinary amounts of time performing detailed dissections of the human body. But, at the same time, medical student’s schedules are increasingly demanding; causing numerous time constraints, and financial pressures (Terrell, 2006). Such complications can make attending regularly scheduled courses difficult even if the school is able to offer them.

Benefits of Virtual Reality

Spitzer and Scherzinger (2006) reported that virtual anatomy has many benefits over traditional dissection. Those benefits include: visualization of body structures through a variety of perspectives and angles that would normally be impossible, freeing students from the barriers of time and distance, and a chance to standardize instruction and evaluation techniques. Virtual reality also provides the opportunity to study a diverse number of “living persons” as opposed to only the deceased. Nieder, Scott, and Anderson (2000) stated that QTVR “can provide a more realistic presentation of anatomic structure than two-dimensional atlas pictures and facilitate study of specimens outside the dissection lab.” Jasthrow and Vollrath, (2003) discussed how the Visible Human project is a pioneering breakthrough for anatomical study. For example, Temkin, Acosta, Malvankar, and Vaidyanath, (2006) have successfully used the Visible Human digital datasets to create a Web based anatomical training system that students can use to interactively explore the human body. Students are able to take a self-guided tour in real time throughout the entire body. Students have the advantage of actively discovering complex anatomical structures, constructing new knowledge, and selecting areas of interest, by “extracting, highlighting and then labeling 2D and 3D structures.” Nieder, Nagy and Wagner (2004) have reported the value of embedding photographic quality QTVR of specimens into Websites. Their work has centered on showing anomalies that most students would never otherwise have the opportunity to study.

How can Second Life’s Virtual Reality Environment be Utilized?

At this time there are definite limits in Second Life’s visualization capabilities. Incorporating aspects of the Visible Human project, along with audio lecture, and collaborative chat would potentially be the most practical approach. Presently there are no discernable anatomy courses offered within Second Life. However, Second Life does currently host a virtual hospital, medical lab, and neurological study center at the time of this writing.

Methodology, Procedures and Approach

Methodology

Case-based reasoning takes on solving new problems based on the historical solutions of similar problems. Since Second Life is an entirely new paradigm for teaching anatomy, the author first approached the subject via collective case research of other virtual reality teaching environments. The author has researched, analyzed and reported on the elements and procedures that are common across learning institutions for creating successful medical virtual reality instruction. Through inductive and qualitative methodology, the author worked at creating new hypotheses based on observing patterns or themes within the case studies (Johnson & Christensen, 2004). Information discovered via research was scored as to its relevancy, and then synthesized into a narrative of best practices for teaching anatomy using virtual reality. The author has examined six courses or seminars currently being taught within Second Life. Findings for best practices have then been placed into the environmental and technical context of Second Life. Research validity was safeguarded through reflexivity, and pattern matching.

Procedures and Approach

1. First, the author researched twenty six relevant collective case studies from top tier medical schools. The case studies were published in professional medical, education, or virtual reality journals. The researcher looked for authentication of potential best practices via replicated themes, elements and procedures that existed across multiple case studies. The researcher examined: how technology was being specifically used to successfully reach teaching objectives, and particular methods or techniques that had tangible, positive effects on learning. Relevant patterns and techniques that were repeated across various case studies were of particular interest. Each identified element or technique that was repeated in a separate case study was scored an additional point. Those approaches rated with the highest scores were considered an indicator of potential best practice. Best practices were then compiled in the final narrative as key points for designing one’s own anatomical training environment.

2. The author reviewed six Second Life educational courses which demonstrated instructional design expertise. Five courses were medically related, and one was from Harvard Law School. The courses encouraged the successful construction of knowledge, followed a pedagogically sound instructional design based on accepted learning theories, or produced authentic, meaningful learning within realistic simulations. The courses engaged students and created memorable, relevant knowledge without becoming lost in superficial delivery mechanisms.

3. Best practices for virtual reality anatomy classes and the realities of delivering such instruction in the Second Life platform are examined in the final narrative. The author presents information on how instructors can best utilize the platform for teaching, either through collaboration or visualization. The author also presents detailed resources, relevant communities of practice, and third party tools gathered from: Second Life, medical schools, professional educators who were currently teaching within the environment, anatomical institutes, and virtual reality experts.

Results

Criterion Selection, Sampling, Data Collection Methods

The author performed inductive qualitative research over a period of four weeks. Criterion-based selection included published peer reviewed case studies of medical schools who utilized virtual reality as part of their instructional programs for gross anatomy. By using typical-case study sampling, a sample size of n=26 medical school anatomy programs was reached. It is unclear how many medical schools worldwide utilize virtual reality technology for anatomical study, therefore the figure for N= total population size was not attainable through any source referenced. However, given the sample size, and the respected professional level of the universities within the given sample size, one can reasonably assume that their chosen instructional designs were an indication of merit. Primary data collection method was produced by scoring one point for each identified instructional pattern found within the documents. Replicated patterns, i.e. methods found repeated in other case studies were of primary interest. Information was triangulated and cross checked. As for Second Life, criterion based selection included medical educational experiences developed by established university medical departments or practicing physicians and one pioneering law program from Harvard. A sample size of n=6 was obtained with an estimated total population size of around N=10.

Best Practice Patterns Within Medical School Anatomy Programs Using Virtual Reality

Blended approaches to instruction that combined lecture, actual dissection and virtual reality for reinforcement and practice were effective. As for VR, multiple views of key structures were preferred. Increased levels of interactivity led to more active engagement and positive learning outcomes. Students who were given an option to actively zoom in and out, pan, rotate on all three planes: x, y, and z were found to reach a better understanding of the complex spatial interrelationships of bodily structures. Courses that accommodated students with both high and low spatial abilities had better overall learner success. Supplementary documentation for VR that included printed image/text documents, or linked 2 dimensional images anchored into their respective 3D model counterparts were deemed effective. Clear labels using internationally standardized medical terms aided in identification and orientation. Rote memorization of numerous structures was considered secondary to demonstrating higher levels of synthesized and holistic understanding of the structures of the body. Self-testing for knowledge and review within each unit or lesson was considered critical to successful learning.

Current Second Life Best Teaching Practices Within Medical Facilities

Learning occurred as a result of situated practice and learner-centered exploration within authentic medical simulations. Emphasis was on engaging students through relevant contextual simulations, introducing new pieces of knowledge, and then allowing them to immediately experiment and practice. Students were empowered to assess the situation, think and work independently or collaboratively to solve medical problems and/or diagnose patient symptoms.

Conclusions

Can Second Life’s platform accommodate engaging anatomical medical training in a cost efficient and convenient manner?

Research has shown Second Life is a conveniently accessible environment which can be accessed on any day, at any time, by anyone in the world who is technically capable of running the Second Life viewer on their computer. It is also highly cost effective, as users may access the environment free of charge. The cost of renting or purchasing virtual plots of land is minimal. The platform hosts numerous learner-centered engaging instructional experiences which encourage active involvement and self-directed exploration. Discovery and experimentation occurs within authentic contextual environments. Learning is made relevant to the medical student, through skillful instructional design which encourages discovery, testing and analysis, diagnosis and immediate practice of newly learned knowledge. Peer and mentor collaboration is easily facilitated through a variety of means including audio, instant messaging, and virtual conferencing. Students are empowered to take an active role in their learning, and can direct their own learning experience according to their specific interests. In addition, Second Life’s environment is conducive to building collaborative communities of practice. Individuals can develop their own social presence; communicate freely, and seek out others of like mind for collaboration or support.

Is the rendering technology sophisticated enough for gross anatomy training?

Despite numerous attempts, the author did not uncover any totally realistic immersive modeling or VR animations that successfully simulated the organic structures of the body in a 3D space. Available model building technology within Second Life has yet to reach the level of sophistication necessary for creating high fidelity organic structures. The toolkit for building primarily focuses on geometric objects or creating objects that serve for media delivery.

Implications

Second Life is certainly a cost effective and convenient solution for creating engaging medical training. However, research has shown the teaching of gross anatomy within virtual reality should use highly realistic rendering, rich in detail and be fully traversable within a 3D space. This appears not to be technically feasible as of yet within the existing tools of Second Life. Currently rendering organic objects based on external data sets is only in its beginning stages. Once this is functionality is added, organic modeling will become a distinct reality.

Recommendations

Instructors could initially start with 2 dimensional models using hyper links to fully rendered 3D immersion experiences using QTVR. Graphics from the Visible Human project incorporated into streaming video animations, or slides delivered inside SL could answer current rendering limitations. Instructors could focus on creating supportive virtual campuses that host collaborative communities of practice, situated authentic simulations built within the context of anatomical subjects, virtual sharing of expertise knowledge, and strong peer mentor support.

References

Berube, D., Murray, C., & Schultze, K. (1999). Cadaver and computer use in the teaching of gross anatomy in physical therapy education. Journal of Physical Therapy Education, 13(2), 41-46.

Haase, P. (2000, February). How will we get there: The challenges of teaching an old subject in a new world €“ a personal perspective. Clinical Investigative Medicine, 23(1), 81-83.

Hoffman, H., Murray, M., Curlee, R., & Fritchle A. (2001). Anatomic VisualizeR: Teaching and learning anatomy with virtual reality. In M. Akay , & A. Marsh (Eds.), Information technologies in medicine (Vol 1, pp. 205-218) New York: Wiley & Sons.

Inwood, M.J. & Ahmad, J. (2005, November). Development of instructional, interactive,multimedia anatomy dissection software: A student-led initiative. Clinical Anatomy, 18(8), 613-617.

Jasthrow, H. & Vollrath, L. (2003, January). Teaching and learning gross anatomy using modern electronic media based on the visible human project. Clinical Anatomy, 16(1), 44-54.

Johnson, B. & Christensen, L. (2004). Educational research: Quantitative, qualitative, and mixed approaches. New York: Pearson.

Neider, G.L., Scott, J.N. & Anderson, M.D. (2000, June 23). Using Quick Time? virtual realityobjects in computer-assisted instruction of gross anatomy: Yorkick €“ the VR skull. Clinical Anatomy, 13(4), 287-293.

Neider, G.L., Nagy, F., & Wagner L.A. (2004, January 22). Preserving and sharing examples of anatomical variation and developmental anomalies via photorealistic virtual reality. The Anatomical Record Part B: The New Anatomist, 276B(1), 15-18.

Reeves, R.E., Sheedlo, H.J. & Roque, R.S. (2005, May). Promoting graduate student interest and participation in human gross anatomy. The Anatomical Record Part B: the New Anatomist, 284 (1), 12-16.

Spitzer, V.M., & Scherzinger A.L. (2006, March 24). Virtual anatomy: An anatomist’splayground. Clinical Anatomy, 19, 192-203.

Szekely, G., & Satava, R. (1999, November 13). Where are we going: Virtual reality in medicine. British Medical Journal, 319, 1305.

Temkin, B., Acosta, E., Malvanka, A., & Vaidyanath, S. (2006, February 27). An interactive three-dimensional virtual body structures system for anatomical study. Clinical Anatomy, 19(3), 267-274.

Terrell, M. (2006, November 15). Anatomy of learning: instructional design principles for the anatomical sciences. The Anatomical Record Part B: The New Anatomist, 289B(6), 252-260.

Yang, L., Chen, J. & Liu, Y. (2005, September). Virtual human anatomy. Computing in Science and Engineering, 7(5), 71-73.

Warner, J.H., & Rizzolo, L.J. (2006, April). Anatomical instruction and training for professionalism from the 19th to the 21st centuries. Clinical Anatomy, 19(5) 403-414.

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Appendix A

Virtual reality
Virtual reality is the simulation of a real or imagined environment that is created by computers,software and hardware. It provides a rich sensory experience, in which a person interacts and
experiences the artificial environment utilizing the 3 dimensions of width, height and depth. Sound, and tactile feedback may also be used to enhance the experience. Virtual reality is created using VRML, or virtual reality modeling language.

QTVR

QVTR is an acronym for Quick Time? VR, a standard developed by Apple. Quick Time? allows one to create immersive virtual environments and virtual objects that can be viewed by any computer that has the Quicktime player installed. QVTR is able to create a full multimedia experience through animation, audio or video. Quick Time? VR is an enhanced version of Quick Time? and it allows the ability to display and rotate objects in three dimensions, and view an environment in 360 degrees.

Second Life

Second Life is an Internet based virtual reality world. It made its debut on the World Wide Web in 2003, and was created by Linden Research of San Francisco. Second Life is accessible by anyone running the free downloadable Second Life client onto a personal computer. Residents exist as virtual “avatars” that move throughout the world known as the grid.

Each region of the grid is controlled and created by a network of servers. Communication among “residents” is primarily achieved through text, and instant messaging. Currently speech capabilities are within reach and are undergoing beta testing.

Users may utilize the downloadable client in order to access the grid for free. However premium members can own virtual land from $5.00 per month to $195 for a region. Avatars move about the virtual world by teleporting via landmarks, or using Slurl.com which indexes regional links

Visible Human Project

The Visible Human Project is operated under the auspices of the United States National Library Of Medicine (NLM). The project consists of extremely detailed data sets of two humans, one female and one male who donated their bodies to science. The data set consists of MRI, CT and anatomical images, that are detailed three-dimensional represent-ations of normal bodies. The male is sectioned at one millimeter intervals, while the female was produced at one-third of a millimeter intervals.

Copyright: Diane Michel 2007. All rights reserved.