Virtual dissection applications in learning human anatomy: international medical students’ perspectives
Across all medical schools, preclinical knowledge is taught through the basic medical sciences, with a strong focus on anatomical sciences. The rationale behind this is that to perform precise and skilled physical examinations, interpret radiologic tests, perform surgical procedures, and carry out different medical interventions, medical practitioners need to possess a solid understanding of the anatomy of the human body . The vertical integration of anatomical sciences and clinical training was spurred by the importance of anatomy education for medical and paramedical students’ clinical training . The basic subject of human anatomy in medical school is crucial in forming the minds of future medical professionals. Cadaveric dissection has long been a part of anatomy education, providing students with a practical way to learn about the intricacies of the human body. A new age of medical education has been brought about by the development of technology, which has led to the inclusion of virtual dissection software in the anatomy curriculum . The significant challenges raised by this paradigm change are how medical students view new digital tools and how they affect traditional instructional approaches . There are several factors to consider while moving from cadaveric dissection to virtual platforms, from student involvement to instructional efficacy . As medical students navigate this revolutionary change, the current study aims to explore their attitudes and perceptions. If instructors and curriculum designers want to combine cutting-edge technologies with traditional approaches in anatomy education, they must understand how students see virtual dissection applications. Cadavers have long been used in traditional medicine because of their exceptional capacity to provide a concrete, three-dimensional understanding of human anatomy . Nonetheless, difficulties like restricted access to cadavers, moral dilemmas, and the rising expense of cadaveric dissection have forced educators to reconsider their tactics. In addition to being appropriate, the investigation of virtual dissection applications fits with how medical education is changing and the general trend toward technology-enhanced teaching resources . Virtual anatomy dissection is a cutting-edge educational technology that involves students manipulating a digital cadaver through an electronic table screen. An advanced educational tool for studying and teaching anatomy is the Anatomage Tables . Students can study anatomical structures and deepen their comprehension of human anatomy using this cutting-edge technology . The study’s primary objective is to examine medical students’ preferences for virtual dissection procedures in comparison to traditional cadaveric dissection methods. Specifically, the research aims to delve into the attitudes and perceptions of medical students from Saudi Arabia and Egypt regarding adopting virtual dissection technology in their education. The anticipated study conclusion will provide enlightening advice that anatomists can utilize to properly include virtual dissection into their teaching methodologies, maximizing student enjoyment and educational benefits.   This multinational cross-sectional study was conducted to assess medical students’ perceptions of the use of free virtual applications in learning human anatomy. Medical students who were enrolled in the academic year 2023–2024 from different governmental universities in the Kingdom of Saudi Arabia (Al-Qassim, Bisha, and Jazan) and Egypt (Al-Azhar, Zagazig, and South Valley) were invited to complete the survey. An online self-administered questionnaire was designed and validated. Cronbach’s alpha to measure internal consistency (0.817), Kaiser-Meyer-Olkin Measure of Sampling Adequacy (0.848), and Bartlett’s Test of Sphericity (< 0.001) were calculated. The first section of the questionnaire covered the sociodemographic characteristics of the students, such as age, gender, academic level, school of medicine, type of program, types of interactive anatomy teaching methods and materials being adopted in the program, and history of use of virtual dissection applications like (3D Anatomy, Anatomage, Real Anatomy or any other free applications) in human anatomy learning. The second section of the survey (3 questions) touched on students’ perception of the advantageous characteristics of these applications, such as easiness of use, realism, and usefulness in learning human anatomy. The third Sect. (3 questions) addressed students’ satisfaction with the efficiency of virtual applications in memorization, understanding, and perfectness in learning anatomy. The last question handled students’ recommendation to use virtual dissection applications routinely, even without potential obstacles to traditional training. Students were motivated to express their concepts by choosing among a Lickert scale ranging from 1 (strongly disagree) to 5 (strongly agree). The questionnaire was built on a Google form and distributed online through respected article authors in different universities. In the beginning, the study’s goal was explored, and the authors pledged to keep all data anonymous, and confidential and use it for research purposes only. Also, optional participation was disclosed, and the students were requested to answer the questions based on their own experience which was considered consent to participate. Answers were collected, summarized, and analyzed using Excel and the Statistical Package for the Social Sciences (SPSS) software version 23. Sociodemographic characteristics were described in frequencies country-wise and university-wise. Selective questions in each section of the questionnaire were analyzed separately and in sum. When the student scored a certain question with 3 or more, it was considered high and below this was considered low. Moreover, a summation of scores in each section was performed to estimate the score of the whole addressed theme in the section. Total scores in sections two and three (3 questions per each) ranged from 3 to 15, and in the last Sect. (1 question) from 1 to 5. Good perception and high satisfaction were considered when the student’s score sum was equal to or more than 9 in the first 2 sections, and positive recommendation was considered when the score was 3 or more in the last section. The independent sample t-test and ANOVA test were used to analyze the numerical data, and the Chi-square test was used to assess the categorical data according to sociodemographic characteristics. A P-value less than 0.05 was considered significant.   Description of the sample Responses from 401 international medical students with a mean age of 20 ± 1.6 were retrieved in the study. Participants from Saudi universities comprised 178 (47%) and the remaining 214 (53%) responses were received from Egyptian universities. More than half of the sample were female 254 (63%), and the males were 147 (37%). Various academic levels (first to sixth grades) were included, and participation rates were 3%, 23%, 40%, 14%, 15%, and 4%, respectively. Students from the six selected universities (Al Qasim, Bisha, and Jazan universities from the Kingdom of Saudi Arabia and Al Azhar, Zagazig, and South Valley universities from Egypt) shared in the study with different rates (14%, 13%, 19%, 20%, 15%, and 19% respectively of the whole sample). Regarding the program, 25% of the students declared they were enrolled in a traditional and 75% in an integrated programs. Moreover, 43%, 38%, 5%, and 14% of the participants disclosed that flipped classrooms, group discussions, small group teaching, and team-based learning methods were adopted in their programs. Also, 41%, 34%, 15%, 7%, and 4% of the students revealed that they use Anatomage, dissection videos, cadavers, plastinated specimens, and plastic models, respectively. The use of virtual dissection applications was recorded by 84% of the sample, while the remaining 16% reported that they did not use virtual dissection applications. All the previous frequencies were calculated for the whole sample of participants (a total of 401). Country-wise analysis The data’s country-wise handling (178 from the Kingdom of Saudi Arabia and 214 from Egypt) showed variable distribution of sociodemographic characteristics. A significant difference ( P = 0.02) in the age of the two groups (20.66 ± 1.57 and 20.29 ± 1.57 for Saudis and Egyptians, respectively) was elaborated by the student’s t-test. The frequency distribution of the gender, academic levels, university, program type, teaching methods, teaching materials, and use of virtual dissection applications of the participants were calculated and presented in Fig. . There were no significant differences between participants from the Kingdom of Saudi Arabia and those from Egypt in terms of the teaching methods adopted in their programs and the accustomed use of virtual dissection applications in learning anatomy. The remaining sociodemographic characteristics showed significant differences between the two groups using the Chi-square test (P values are summarized in Fig. ). Analysis of the mean scores submitted for each selective question revealed no significant differences between participants from Saudi universities and those from Egyptian universities using a student’s t-test, as presented in Table . Considering the coding of the scores provided in each selective question (3 or more is considered high, and below this is considered low), there were significant differences in considering the virtual applications that are easy to use and their perfectness in anatomy lectures. Other than the previous two points, there were no significant differences between participants from the Kingdom of Saudi Arabia and their peers from Egypt by the Chi-square test (Frequencies and P values are presented in Table ). Moreover, the questionnaire scores were treated as section-dependent sums and were coded with good perception or high satisfaction if equal to or more than 9 in Sects. 2 and 3 and positive recommendation when the score was 3 or more in Sect. 4. Frequencies of different grades of perception, satisfaction, and recommendation were summarized in Fig. . The Chi-square test showed a significant difference between Saudi participants and their colleagues from Egypt in their perception of virtual dissection applications ( P = 0.034). No significant difference was detected in their satisfaction ( P = 0.154). The degree of recommendation for virtual dissection applications used in learning anatomy differed significantly between the two groups of participants ( P = 0.034). University-wise analysis The distribution of the participants in different universities was considered in the analysis. Al Qasim University showed a total participation of 58 students, whereas Bisha University 53 and Jazan University participated with 76 students. In addition, Al Azhar University shared with 79 students, Zagazig University with 60 students, and South Valley University with 75 students. ANOVA test revealed a significant difference ( P < 0.001) in the age between students at different universities (Mean ± SD is shown in Table ). Distribution of the gender, academic levels, program type, teaching methods, teaching materials, and use of virtual dissection applications among different groups and the P value calculated by the Chi-square test are presented in Fig. . A comparison between the mean scores submitted for each selected question by ANOVA test showed variable degrees of significance between participants from different universities, as presented in Table . The Chi-square test assessed the relationship between the coded scores for each selective question. Significant differences between participants from different universities were elaborated regarding the feasibility, reality, and usefulness of the virtual dissection applications. Also, the preference for virtual dissection applications in memorizing and understanding anatomy and its perfectness in lecturing showed significant differences. All the frequencies and P values are presented in Table . Section-dependent analysis of the results elaborated significant differences in the perception, satisfaction, and degree of recommendation between students from different universities. Variable frequencies and P values calculated by the Chi-square test are presented in Fig. .   Responses from 401 international medical students with a mean age of 20 ± 1.6 were retrieved in the study. Participants from Saudi universities comprised 178 (47%) and the remaining 214 (53%) responses were received from Egyptian universities. More than half of the sample were female 254 (63%), and the males were 147 (37%). Various academic levels (first to sixth grades) were included, and participation rates were 3%, 23%, 40%, 14%, 15%, and 4%, respectively. Students from the six selected universities (Al Qasim, Bisha, and Jazan universities from the Kingdom of Saudi Arabia and Al Azhar, Zagazig, and South Valley universities from Egypt) shared in the study with different rates (14%, 13%, 19%, 20%, 15%, and 19% respectively of the whole sample). Regarding the program, 25% of the students declared they were enrolled in a traditional and 75% in an integrated programs. Moreover, 43%, 38%, 5%, and 14% of the participants disclosed that flipped classrooms, group discussions, small group teaching, and team-based learning methods were adopted in their programs. Also, 41%, 34%, 15%, 7%, and 4% of the students revealed that they use Anatomage, dissection videos, cadavers, plastinated specimens, and plastic models, respectively. The use of virtual dissection applications was recorded by 84% of the sample, while the remaining 16% reported that they did not use virtual dissection applications. All the previous frequencies were calculated for the whole sample of participants (a total of 401).   The data’s country-wise handling (178 from the Kingdom of Saudi Arabia and 214 from Egypt) showed variable distribution of sociodemographic characteristics. A significant difference ( P = 0.02) in the age of the two groups (20.66 ± 1.57 and 20.29 ± 1.57 for Saudis and Egyptians, respectively) was elaborated by the student’s t-test. The frequency distribution of the gender, academic levels, university, program type, teaching methods, teaching materials, and use of virtual dissection applications of the participants were calculated and presented in Fig. . There were no significant differences between participants from the Kingdom of Saudi Arabia and those from Egypt in terms of the teaching methods adopted in their programs and the accustomed use of virtual dissection applications in learning anatomy. The remaining sociodemographic characteristics showed significant differences between the two groups using the Chi-square test (P values are summarized in Fig. ). Analysis of the mean scores submitted for each selective question revealed no significant differences between participants from Saudi universities and those from Egyptian universities using a student’s t-test, as presented in Table . Considering the coding of the scores provided in each selective question (3 or more is considered high, and below this is considered low), there were significant differences in considering the virtual applications that are easy to use and their perfectness in anatomy lectures. Other than the previous two points, there were no significant differences between participants from the Kingdom of Saudi Arabia and their peers from Egypt by the Chi-square test (Frequencies and P values are presented in Table ). Moreover, the questionnaire scores were treated as section-dependent sums and were coded with good perception or high satisfaction if equal to or more than 9 in Sects. 2 and 3 and positive recommendation when the score was 3 or more in Sect. 4. Frequencies of different grades of perception, satisfaction, and recommendation were summarized in Fig. . The Chi-square test showed a significant difference between Saudi participants and their colleagues from Egypt in their perception of virtual dissection applications ( P = 0.034). No significant difference was detected in their satisfaction ( P = 0.154). The degree of recommendation for virtual dissection applications used in learning anatomy differed significantly between the two groups of participants ( P = 0.034).   The distribution of the participants in different universities was considered in the analysis. Al Qasim University showed a total participation of 58 students, whereas Bisha University 53 and Jazan University participated with 76 students. In addition, Al Azhar University shared with 79 students, Zagazig University with 60 students, and South Valley University with 75 students. ANOVA test revealed a significant difference ( P < 0.001) in the age between students at different universities (Mean ± SD is shown in Table ). Distribution of the gender, academic levels, program type, teaching methods, teaching materials, and use of virtual dissection applications among different groups and the P value calculated by the Chi-square test are presented in Fig. . A comparison between the mean scores submitted for each selected question by ANOVA test showed variable degrees of significance between participants from different universities, as presented in Table . The Chi-square test assessed the relationship between the coded scores for each selective question. Significant differences between participants from different universities were elaborated regarding the feasibility, reality, and usefulness of the virtual dissection applications. Also, the preference for virtual dissection applications in memorizing and understanding anatomy and its perfectness in lecturing showed significant differences. All the frequencies and P values are presented in Table . Section-dependent analysis of the results elaborated significant differences in the perception, satisfaction, and degree of recommendation between students from different universities. Variable frequencies and P values calculated by the Chi-square test are presented in Fig. .   In the field of basic medical sciences, using complementary educational tools such as virtual technology can help enhance the quality of learning, clinical skills, and long-term retention of information by students . However, the effectiveness of such tools depends on various factors, including the integration of technology into the curriculum and the ability to bridge the gap between theoretical knowledge and practical applications . An ongoing debate surrounds the significance of cadaveric dissection in anatomy education, considering factors such as cost, ethical considerations, shortage of cadavers, and the management of the dissection lab facilities. With an increasing number of students in anatomy classes, the availability of cadavers might be insufficient to meet the requirements of all students . Health education institutions encounter a myriad of obstacles and complexities when it comes to acquiring cadavers for educational use. Legal, administrative, cultural, religious, social, economic, and educational factors are among the most significant challenges they face . Understanding student perspectives is crucial for evaluating the effectiveness and adoption of new educational resources. This understanding is essential given technology’s escalating prominence in medical education . The authors endeavor to gain insight into students’ perceptions of emerging digital tools, specifically virtual dissection, and their influence on conventional teaching methodologies. The study focuses on exploring medical students’ perceptions regarding virtual dissection applications. By comparing traditional cadaveric dissection with virtual dissection, the study offers valuable insights into the advantages and limitations of each approach. Including viewpoints from Saudi Arabian and Egyptian medical students provides a regional perspective that may offer unique insights not found in studies conducted in Western countries. Governmental Saudi and Egyptian universities were included in this multinational cross-sectional study using a four-section questionnaire. Although 401 participants shared in this study (178 from Saudia universities and 214 from Egyptian universities; more than half of the sample were females. This gender difference might be attributed to the fact that women are in the majority in terms of entry to medical schools worldwide and will soon represent the majority of working doctors . The teaching methods adopted by these different university programs showed no significant differences in using virtual dissection in learning anatomy. Similar results were reported in a comprehensive national survey undertaken to evaluate the status of anatomy education across various academic and professional fields in France. The authors reviewed other teaching methods adopted by anatomy instructors, specifically those based on digital technology, such as virtual reality, three-dimensional printing, augmented reality, online programs, and games . However, significant differences were recorded between Saudi and Egyptian participants considering the virtual applications as easy to use and their perfectness in anatomy lectures. Cadaver dissection has long been the traditional method of teaching anatomy, but this practice is no longer as widespread as it once was. The significant differences based on country preferences can be attributed to several valid reasons, including financial considerations and ethical issues. Each institution tries to explore alternative methods of teaching anatomy that are both cost-effective and ethically sound . Furthermore, in the current study, no significant difference was detected in students’ satisfaction; while the degree of recommendation for virtual dissection applications used in learning anatomy differed significantly between the two groups of participants. Student satisfaction is a valuable tool that educational institutions use to channel their resources toward areas that require improvement. As students are the primary stakeholders in any educational system, it is vital to prioritize their satisfaction with their academic experience. This approach helps ensure that students’ opinions and feedback are considered, allowing the institution to better meet their needs and expectations. By focusing on the areas that matter most to students, educational institutions can foster a positive learning environment that promotes academic success and personal growth . Significant differences between participants from different universities were elaborated in this research, regarding the feasibility, reality, and usefulness of virtual dissection applications. A study was conducted to determine the effectiveness of implementing Virtual Reality (VR) training in an Ear, Nose, and Throat residents’ course that involved temporal bone dissection. The study concluded that even short VR sessions, guided by experts, are beneficial for the trainees. Furthermore, VR training before the actual dissections helped reduce the time required to perform surgical tasks while maintaining the same level of performance scores . Also, the preference for virtual dissection applications in memorizing and understanding anatomy and its perfectness in lecturing showed significant differences. Incorporating various tools as a means of educational support can enhance the current anatomy curriculum and counteract the difficulties associated with cadaveric dissection. However, the expense and maintenance fees of virtual tools may prevent their widespread use in developing countries . The widespread Anatomage table is a valuable tool that can enhance the understanding of anatomy for medical and paramedical students and residents. It offers an opportunity to improve radiological knowledge and enables pre-planning for surgical procedures. Additionally, its significance is amplified during critical situations such as pandemics, where it can be pivotal in facilitating medical education and practice . This study offers an intricate insight into effectively integrating virtual dissection technology in anatomy education, harmonizing conventional approaches with contemporary innovations. Section-dependent analysis of the results elaborated significant differences in the perception, satisfaction, and degree of recommendation between students from different universities which could be attributed to the type of virtual reality tools available in each university. Numerous research studies have identified that incorporating plastinated specimens as a teaching method for anatomy enhances the quality of knowledge and comprehension of anatomy among medical students. This method of learning provides a more hands-on and practical approach, allowing students to visualize and interact with anatomical structures in a detailed and immersive manner. As a result, it has become increasingly popular among medical schools and institutions as an effective means of teaching anatomy although it might be expensive to buy in some universities .   It is evident that while some students may prefer traditional teaching methods for anatomy, technology has been proven to enhance medical education. The study findings suggest that rather than replacing traditional methods, technology should be utilized as a supplementary resource to support the educational process as the benefits of incorporating technology in medical education far outweigh any limitations it may have. Continuously gauging students’ perceptions to inform curriculum design is essential in designing their curricula and approving the learning facilities and tools, which might vary based on different considerations. Study limitations and future perspectives The limited number of the sample was considered the first limitation. Also, the study was centered on perceptions rather than objective indicators of learning outcomes, such as exam performance or practical skills assessment depending on the limited resources available. Variable social and cultural barriers formed an obstacle to integrating qualitative data into the study. In future research endeavors, the authors are encouraged to enhance the methodological rigor of this study by considering several critical improvements and additional control measures. First, including a larger and more diverse sample size is recommended to bolster the generalizability of the findings. It may be achieved by enlisting students from different universities and varied geographical regions to gain a more comprehensive perspective. Second, integrating qualitative data through interviews or focus groups is suggested to acquire more profound insights into students’ experiences and perceptions. Third, collecting detailed data on the frequency and duration of virtual dissection application usage could prove instrumental in correlating the extent of usage with students’ perceptions and satisfaction levels, offering valuable insights. Fourth, incorporating a control group utilizing only traditional cadaveric dissection methods is proposed to enable a more precise evaluation of the effectiveness of each technique through comparative analysis. Fifth: Investigating the cost-effectiveness of virtual dissection applications compared to traditional methods, especially in the context of developing countries. Lastly: Examine the potential of virtual dissection applications to address the shortage of cadavers and ethical concerns associated with cadaveric dissection.   The limited number of the sample was considered the first limitation. Also, the study was centered on perceptions rather than objective indicators of learning outcomes, such as exam performance or practical skills assessment depending on the limited resources available. Variable social and cultural barriers formed an obstacle to integrating qualitative data into the study. In future research endeavors, the authors are encouraged to enhance the methodological rigor of this study by considering several critical improvements and additional control measures. First, including a larger and more diverse sample size is recommended to bolster the generalizability of the findings. It may be achieved by enlisting students from different universities and varied geographical regions to gain a more comprehensive perspective. Second, integrating qualitative data through interviews or focus groups is suggested to acquire more profound insights into students’ experiences and perceptions. Third, collecting detailed data on the frequency and duration of virtual dissection application usage could prove instrumental in correlating the extent of usage with students’ perceptions and satisfaction levels, offering valuable insights. Fourth, incorporating a control group utilizing only traditional cadaveric dissection methods is proposed to enable a more precise evaluation of the effectiveness of each technique through comparative analysis. Fifth: Investigating the cost-effectiveness of virtual dissection applications compared to traditional methods, especially in the context of developing countries. Lastly: Examine the potential of virtual dissection applications to address the shortage of cadavers and ethical concerns associated with cadaveric dissection.   