Document Type : Original Article

Authors

1 Department of Anaesthesiology, All India Institute of Medical Sciences, Patna, Bihar, India

2 Department of Anatomy, All India Institute of Medical Sciences, Bathinda, Punjab, India

3 Department of Anatomy, All India Institute of Medical Sciences Rishikesh, Uttarakhand, India

4 Department of Anatomy, BP Koirala Institute of Health Sciences, Nepal

Abstract

BACKGROUND: Many academicians suggested the supplementary use of 3D‑printed models
reconstructed from radiological images for optimal anatomy education. 3D‑printed model is newer
technology available to us. The purpose of this systematic review was to capture the usefulness or
effectiveness of this newer technology in anatomy education.
MATERIALS AND METHODS: Twenty‑two studies met the inclusion and exclusion criteria for
quantitative synthesis. The included studies were sub‑grouped according to the interventions and
participants. No restrictions were applied based on geographical location, language and publication
years. Randomized, controlled trial, cross‑sectional and cross‑over designs were included. The effect
size of each intervention in both participants was computed as a standardized mean difference (SMD).
RESULTS: Twenty‑two randomized, controlled trials were included for quantitative estimation of effect
size of knowledge acquisition as standardized mean difference in 1435 participants. The pooled effect
size for 3D‑printed model was 0.77 (0.45–1.09, 95% CI, P < 0.0001) with 86% heterogeneity. The
accuracy score was measured in only three studies and estimated effect size was 2.81 (1.08–4.54,
95% CI, P = 0.001) with 92% heterogeneity. The satisfaction score was examined by questionnaire in 6
studies. The estimated effect size was 2.00 (0.69–3.32, 95% CI, P= 0.003) with significant heterogeneity.
CONCLUSION: The participants exposed to the 3D‑printed model performed better than participants
who used traditional methodologies. Thus, the 3D‑printed model is a potential tool for anatomy
education.


Keywords

  1. Sugand K, Abrahams P, Khurana A. The anatomy of anatomy:
    A review for its modernization. Anat Sci Educ 2010;3:83‑93.
    2. Yammine K, Violato C. A meta‑analysis of the educational
    effectiveness of three‑dimensional visualization technologies in
    teaching anatomy. Anat Sci Educ 2015;8:525‑38.
    3. Biasutto SN, Ignacio Caussa L, Esteban Criado del Río L. Teaching
    anatomy: Cadavers vs. computers? Ann Anat 2006;188:187‑90.
    4. Chytas D, Piagkou M, Salmas M, Johnson EO. Is cadaveric
    dissection the “gold standard” for neuroanatomy education?
    Anat Sci Educ 2020;13:804‑5.
    5. Fruhstorfer BH, Palmer J, Brydges S, Abrahams PH. The use
    of plastinated prosections for teaching anatomy‑The view of
    medical students on the value of this learning resource. Clin Anat
    2011;24:246‑52.
    6. McMenamin PG, Quayle MR, McHenry CR, Adams JW.
    The production of anatomical teaching resources using
    three‑dimensional (3D) printing technology: 3D printing in
    anatomy education. Anat Sci Educ 2014;7:479‑86.
    7. Mogali SR, Yeong WY, Tan HKJ, Tan GJS, Abrahams PH, Zary N,
    et al. Evaluation by medical students of the educational value
    of multi‑material and multi‑colored three‑dimensional printed
    models of the upper limb for anatomical education: 3D printed
    upper limb in anatomical education. Anat Sci Educ 2018;11:54‑64.
    8. Radzi S, Tan HKJ, Tan GJS, Yeong WY, Ferenczi MA, Low‑Beer N,
    et al. Development of a three‑dimensional printed heart from
    computed tomography images of a plastinated specimen for
    learning anatomy. Anat Cell Biol 2020;53:48‑57.
    9. Ye Z, Dun A, Jiang H, Nie C, Zhao S, Wang T, et al. The role of 3D
    printed models in the teaching of human anatomy: A systematic
    review and meta‑analysis. BMC Med Educ 2020;20:335.
    10. Garas M, Vaccarezza M, Newland G, McVay‑Doornbusch K,
    Hasani J. 3D‑Printed specimens as a valuable tool in anatomy
    education: A pilot study. Ann Anat 2018;219:57‑64.
    11. Fleming C, Sadaghiani MS, Stellon MA, Javan R. Effectiveness
    of three‑dimensionally printed models in anatomy education for
    medical students and resident physicians: Systematic review and
    meta‑analysis. J Am Coll Radiol 2020;17:1220‑9.
    12. Chen Y, Qian C, Shen R, Wu D, Bian L, Qu H, et al. 3D printing
    technology improves medical interns’ understanding of anatomy
    of gastrocolic trunk. J Surg Educ 2020;77:1279‑84.
    13. Chen S, Pan Z, Wu Y, Gu Z, Li M, Liang Z, et al. The role of
    three‑dimensional printed models of skull in anatomy education:
    A randomized controlled trail. Sci Rep 2017;7:575.
    14. Smith CF, Tollemache N, Covill D, Johnston M. Take away body
    parts! An investigation into the use of 3D‑printed anatomical
    models in undergraduate anatomy education. Anat Sci Educ
    2018;11:44‑53.
    15. Tanner JA, Jethwa B, Jackson J, Bartanuszova M, King TS,
    Bhattacharya A, et al. A three‐dimensional print model of
    the pterygopalatine fossa significantly enhances the learning
    experience. Anat Sci Educ 2020;13:568‑80.
    16. Li Z, Li Z, Xu R, Li M, Li J, Liu Y, et al. Three‑dimensional printing
    models improve understanding of spinal fracture—A randomized
    controlled study in China. Sci Rep 2015;5:11570. doi: 10.1038/
    srep11570.
    17. YiX, Ding C, Xu H, Huang T, Kang D, Wang D. Three‑dimensional
    printed models in anatomy education of the ventricular
    system: A randomized controlled study. World Neurosurg
    2019;125:e891‑901.
    18. Kirkpatrick JD, Kirkpatrick WK. Kirkpatrick’s Four Levels
    of Training Evaluation. Association for Talent Development;
    Alexandria, Virginia: ATD publisher 2016.
    19. Williams BW, Byrne PD, Welindt D, Williams MV. Miller’s
    pyramid and core competency assessment: A study in relationship
    construct validity. J Contin Educ Health Prof 2016;36:295‑9.
    20. Smith RP, Learman LA. A plea for MERSQI: The medical
    education research study quality instrument. Obstet Gynecol
    2017;130:686‑90.
    21. AlAli AB, Griffin MF, Calonge WM, Butler PE. Evaluating the use
    of cleft lip and palate 3D‑printed models as a teaching aid. J Surg
    Educ 2018;75:200‑8.
    22. Awan O, Dako F, Akhter T, Hava S, Shaikh F, Ali S, et al. Utilizing
    audience response to foster evidence‑based learning in a pilot
    study: Does It really work? Cureus; 10:e3799. doi: 10.7759/cureus.
    3799.
    23. Bangeas P, Drevelegas K, Agorastou C, Tzounis Lazaros, Chorti A,
    Paramythiotis D. Three‑dimensional printing as an educational
    tool in colorectal surgery. Front Biosci (Elite Ed) 2019;11:29‑37.
    24. Bohl MA, Zhou JJ, Mooney MA, Repp GJ, Cavallo C, Nakaji P, et al.
    The barrow biomimetic spine: Effect of a 3‑dimensional‑printed
    spinal osteotomy model on performance of spinal osteotomies
    by medical students and interns. J Spine Surg 2019;5:58‑65.
  2. 25. Cai B, Rajendran K, Bay BH, Lee J, Yen C‑C. The effects of a
    functional three‑dimensional (3D) printed knee joint simulator
    in improving anatomical spatial knowledge. Anat Sci Educ
    2019;12:610‑8.
    26. Chedid VG, Kamath AA, Knudsen JM, Frimannsdottir K, Yost KJ,
    Geske JR, et al. Three‑dimensional‑printed liver model helps
    learners identify hepatic subsegments: A randomized‑controlled
    cross‑over trial. Am J Gastroenterol 2020;115:1906‑10.
    27. Guitarte Vidaurre A, Hadeed K, Dulac Y, Karsenty C, Acar P.
    Usefulness of 3D printed models of congenital heart diseases
    as educational tools for medical students. Arch Cardiovasc Dis
    Suppl 2019;11:e329.
    28. Jones TW, Seckeler MD. Use of 3D models of vascular rings
    and slings to improve resident education. Congenit Heart Dis
    2017;12:578‑82.
    29. Hojo D, Murono K, Nozawa H, Kawai K, Hata K, Tanaka T, et al.
    Utility of a three‑dimensional printed pelvic model for lateral
    pelvic lymph node dissection. Int J Colorectal Dis 2020;35:905‑10.
    30. Loke Y‑H, Harahsheh AS, Krieger A, Olivieri LJ. Usage of 3D
    models of tetralogy of Fallot for medical education: Impact on
    learning congenital heart disease. BMC Med Educ 2017;17:54.
    31. Low CM, Morris JM, Matsumoto JS, Stokken JK, O’Brien EK,
    Choby G. Use of 3D‑printed and 2D‑illustrated international
    frontal sinus anatomy classification anatomic models for resident
    education. Otolaryngol Head Neck Surg 2019;161:705‑13.
    32. Wang C, Daniel BK, Asil M, Khwaounjoo P, Cakmak YO.
    A randomised control trial and comparative analysis of
    multi‑dimensional learning tools in anatomy. Sci Rep 2020;10:6120.
    33. White SC, Sedler J, Jones TW, Seckeler M. Utility of
    three‑dimensional models in resident education on simple and
    complex intracardiac congenital heart defects. Congenit Heart
    Dis 2018;13:1045‑9.
    34. Wu A‑M, Wang K, Wang J‑S, Chen C‑H, Yang X‑D, Ni W‑F, et al.
    The addition of 3D printed models to enhance the teaching and
    learning of bone spatial anatomy and fractures for undergraduate
    students: A randomized controlled study. Ann Transl Med
    2018;6:403. doi: 10.21037/atm. 2018.09.59.
    35. Lin Q‑S, Lin Y‑X, Wu X‑Y, Yao P‑S, Chen P, Kang D‑Z. Utility of
    3‑dimensional‑printed models in enhancing the learning curve
    of surgery of tuberculum sellae meningioma. World Neurosurg
    2018;113:e222‑31.
    36. Su W, Xiao Y, He S, Huang P, Deng X. Three‑dimensional printing
    models in congenital heart disease education for medical students:
    A controlled comparative study. BMC Med Educ 2018;18:178.
    37. Jansen Y, Dragicevic P, Fekete J‑D. Evaluating the efficiency of
    physical visualizations. In: Proceedings of the SIGCHI Conference
    on Human Factors in Computing Systems. Paris France:
    ACM; 2013. p. 2593‑602.Available from: https://dl.acm.org/
    doi/10.1145/24706540.2481359. [Last accessed on 2021 Dec 04].
    38. Khot RA. Exploring material representations of physical activity.
    In: Proceedings of the 2014 Companion Publication on Designing
    Interactive Systems‑DIS Companion ’14. Vancouver, BC, Canada:
    ACM Press; 2014. p. 177‑80. Available from: http://dl.acm.
    org/citation.cfm?doid=2598784.2598792. [Last accessed on
    2021 Dec 04].
    39. Jago R, Page AS, Cooper AR. Friends and physical activity during
    the transition from primary to secondary school. Med Sci Sports
    Exer 2012;44:111‑7.
    40. Salvy S‑J, de la Haye K, Bowker JC, Hermans RCJ. Influence
    of peers and friends on children’s and adolescents’ eating and
    activity behaviors. Physiol Behav 2012;106:369‑78.
    41. Salvy S‑J, Roemmich JN, Bowker JC, Romero ND, Stadler PJ,
    Epstein LH. Effect of peers and friends on youth physical
    activity and motivation to be physically active. J Pediatr Psychol
    2008;34:217‑25.
    42. Barkley JE, Salvy S‑J, Sanders GJ, Dey S, Von Carlowitz K‑P,
    Williamson ML. Peer influence and physical activity behavior in
    young children: An experimental study. J Phys Activity Health
    2014;11:404‑9.
    43. Pearce M, Page AS, Griffin TP, Cooper AR. Who children spend
    time with after school: Associations with objectively recorded
    indoor and outdoor physical activity. Int J Behav Nutr Phys Act
    2014;11:45. doi: 10.1186/1479‑5868‑11‑45.
    44. Chatterjee HJ, Hannan L. Engaging the Senses: Object‑Based
    Learning in Higher Education. London; New York: Routledge;
    2016. Available from: https://www.taylorfrancis.com/
    books/e/9781315579641. [Last accessed on 2021 Dec 04].
    45. Romanek D, Lynch B. Touch in Museums: Policy and
    Practice in Object Handling. first. Routledge: Taylor Francis;
    2008. Available from: https://www.taylorfrancis.com/
    books/9781003135616. [Last accessed on 2021 Dec 04].
    46. Biggs JB, Tang CS. Teaching for Quality Learning at University:
    What the Student Does. 4th ed. Maidenhead, England New York,
    NY: McGraw‑Hill, Society for Research into Higher Education &
    Open University Press; 2011.
    47. Bonwell CC, Eison JA. Active Learning: Creating Excitement in
    the Classroom. Washington, DC: School of Education and Human
    Development, George Washington University; 1991.
    48. Kolb DA, Rubin IM, McIntyre JM. Organizational Psychology:
    Readings on Human Behavior in Organizations. Prentice Hall;
    1984.
    49. Bai J, Wang Y, Zhang P, Liu M, Wang P, Wang J, et al. Efficacy
    and safety of 3D print‑assisted surgery for the treatment of
    pilon fractures: A meta‑analysis of randomized controlled trials.
    J Orthop Surg Res 2018;13:283.
    50. Kong X, Nie L, Zhang H, Wang Z, Ye Q, Tang L, et al. Do
    Three‑dimensional visualization and three‑dimensional printing
    improve hepatic segment anatomy teaching? A randomized
    controlled study. J Surg Educ 2016;73:264‑9.
    51. Langridge B, Momin S, Coumbe B, Woin E, Griffin M, Butler P.
    Systematic review of the use of 3‑dimensional printing in surgical
    teaching and assessment. J Surg Educ 2018;75:209‑21.
    52. Ratka A. Empathy and the development of affective skills. AJPE
    2018;82:7192. doi: 10.5688/ajpe7192.
    53. Khot Z, Quinlan K, Norman GR, Wainman B. The relative
    effectiveness of computer-based and traditional resources for
    education in anatomy. Anat Sci Educ 2013;6:211‑5.
    54. Fried CB. In‑class laptop use and its effects on student learning.
    Comput Educ 2008;50:906‑14.
    55. Abarghouie MH, Omid A, Ghadami A. Effects of virtual and
    lecture‑based instruction on learning, content retention, and
    satisfaction from these instruction methods among surgical
    technology students: A comparative study. J Educ Health Promot
    2020;9:296. doi: 10.4103/jehp.jehp_634_19.
    56. Rajprasath R, Kumar VD, Murugan M, Goriparthi BP, Devi R.
    Evaluating the effectiveness of integrating radiological and
    cross‑sectional anatomy in first‑year medical students–A
    randomized, crossover study. J Educ Health Promot 2020;9:16.
    doi: 10.4103/jehp.jehp_325_19.