Investigation of the efficacy of three-dimensional printed models in anatomy teaching and learning using a design-based research paradigm

Abstract

Anatomy has been one of the fundamental pillars in medical education and is considered to be integral in clinical examinations and surgical procedures. Nevertheless, a pervasive perception exists in the literature that medical graduates possess an insufficient level of anatomical knowledge for safe practice. To understand the issues surrounding the learning of the subject and what educators can do to address these issues, a design-based research methodology was used to identify the learning difficulties and evaluate an intervention, in the form of three-dimensional (3D) printed model, that was developed to tackle these difficulties. A mixed-methods design involving semi-structured interviews and questionnaire was utilised in identifying the learning difficulties. A total of 28 interviews were conducted and it was theorised that the perceived lack of anatomical knowledge was derived from a combination of insufficient surface knowledge and impeded “near” transfer resulting in impeded deep and “far” transfer of learning. Results from the questionnaire highlighted the cause of the insufficiency was due to the failure to visualise structures. A 3D printed model depicting the arterial supply to the head and neck region was developed and evaluated using a randomised controlled trial experiment. Its efficacy was investigated by a pre- and post-test study and other common learning modalities such as wet specimen, digital model and textbook image were chosen for comparison. A total of 184 participants took part in the study and each modality group had an n=46. Wet specimen group showed statistically significant differences in the post-test scores and the pre/post-test score differences compared to other three modality groups. However, 3D printed model showed no significant differences when compared to wet specimen in terms of the learning experience and participants were equally likely to recommend wet specimens and 3D printed models to other students for learning anatomy. Focus-group interviews with participants suggested that the 3D printed model in its current form were unable to help them correctly identify anatomical structures in the post-test because they lacked the adjacent structures hence were very dissimilar to the wet specimens. Therefore, refinements were made to the 3D printed model including the addition of adjacent structures, the use of semi-transparent and pliable material and the use of colour printing. Implementation of the refined 3D printed models in a dental practical showed that students were more likely to transfer their learning using 3D printed models compared to students without access to 3D printed models. Students were more likely to record a demonstration video using wet specimens having learned with 3D printed models. Taken together, findings from this series of studies demonstrated that 3D printed models were able to induce learning in learners despite not being as effective as wet specimens. However, 3D printed models were shown to promote transfer of learning, which could be the springboard for increasing the level of anatomical knowledge in graduates.