Evaluation of virtual reality versus plastinated specimens in musculoskeletal anatomy education for second year medical students

Abstract

There are diversified methods for human anatomy teaching lined with curricular matrices of the biomedical field. This research identified the effect of human anatomy resources teaching on cognitive performance, motivation in medical undergraduate. Students were allocated in a virtual reality group and a plastinated specimens’ group. Cognitive performance and motivation were measured before and after training of human anatomy skills focused on musculoskeletal system. No statistically significant differences were observed between the groups in cognitive performance scores or confidence in assigning responses to test items (p > 0.05). However, intra-group analysis revealed notable improvements in both metrics after the intervention. These findings demonstrate that both plastinated specimens and immersive technologies are effective tools for enhancing learning in anatomy education. The results highlight the value of methodological diversity and support the integration of innovative, ethically grounded approaches in the context of teaching human anatomy focused on musculoskeletal muscles.

Supplementary Information

The online version contains supplementary material available at 10.1038/s41598-025-34832-4.

Introduction

In Brazil, the use of human cadavers for educational and research purposes is regulated by Law 8501/92, which permits unclaimed bodies to be allocated to medical institutions after a 30-day period in the custody of public authorities. Despite this provision, many medical schools in Brazil face difficulties in acquiring sufficient cadaveric material for anatomy education, leading to the adoption of alternative methods for body preservation and anatomical study¹.

Compounding this issue is a national and global trend toward reduced curricular hours allocated to basic sciences, including human anatomy, in undergraduate medical education². Additionally, the logistical, ethical, and financial constraints associated with cadaver acquisition and maintenance further limit access in many institutions.

To address these challenges, modern educational technologies such as plastinated anatomical specimens and virtual reality (VR) tools have gained prominence as complementary or substitute teaching resources. VR platforms, including 3D visualization tables, allow dynamic reconstruction of anatomical structures and their spatial relationships, enhancing learners’ understanding from both morphological and surgical perspectives^3,4. However, the pedagogical effectiveness of such technologies depends on several factors, including their realism, user interaction, and integration into broader instructional strategies⁵.

The differential impact of VR and plastinated specimens on cognition, confidence, and motivation can be explained through established learning theories. According to Cognitive Load Theory⁶, the way information is presented influences cognitive processing; plastinated specimens may reduce extraneous cognitive load through direct, tactile engagement with physical structures, while VR, if not optimally designed, risks increasing this load due to interface complexity and additional visual stimuli. In contrast, Mayer’s Multimedia Learning Theory⁷ supports the use of multimodal inputs, such as VR’s integration of visual and interactive elements, to facilitate deeper understanding when effectively implemented.

From a motivational perspective, Self-Determination Theory⁸ highlights the role of autonomy, competence, and relatedness in fostering intrinsic motivation. VR’s immersive and interactive nature can enhance these elements by promoting active learner engagement and perceived control over the learning process. Meanwhile, Embodied Cognition theory⁹ emphasizes learning through bodily interactions with the environment; thus, plastinated specimens provide crucial sensorimotor experiences that support spatial reasoning and anatomical comprehension.

Effective anatomy teaching environments should support interactive, student-centered learning through a combination of teacher facilitation, peer collaboration, and self-directed study¹⁰. Exposure to three-dimensional structures, whether through physical or virtual means, is critical for preparing students for clinical reasoning and practice¹¹.

Furthermore, student motivation is a pivotal factor in learning outcomes and should be fostered through well-designed educational interventions that align with clear learning objectives^12,13. However, motivating students remains a challenge, and the influence of instructional methods on motivation requires further investigation.

Integrating innovative resources like VR and plastination requires careful consideration of their pedagogical impact. VR technologies, including those incorporating elements of serious games, offer interactive and engaging platforms for exploring complex anatomical structures, potentially enhancing student motivation and satisfaction¹⁴. While traditional methods rely on lectures and physical specimens, VR allows for dynamic visualization and manipulation that can cater to different learning styles. However, understanding the relative effectiveness of different resource types is crucial. Comparative studies are needed to evaluate how newer modalities like VR measure up against established alternatives, such as plastinated specimens or traditional lectures, not just in terms of knowledge gain (e.g., exam scores) but also considering factors like learning time and efficiency¹⁵. Furthermore, the potential for these technologies to support collaborative learning and ensure long-term knowledge retention are key areas requiring investigation¹⁶.

Given these considerations, it is essential to evaluate the educational impact of different anatomy teaching tools not only in terms of cognitive performance but also student motivation. Among the most promising alternatives are plastinated anatomical specimens, which offer high structural fidelity, and VR-based platforms, which provide interactive and immersive learning experiences.

Therefore, this study hypothesizes that the use of plastinated specimens and virtual reality platforms for anatomy teaching will produce similar effects on cognitive performance in medical students. However, virtual reality is expected to promote greater motivation due to its interactivity and immersive qualities, whereas plastinated specimens are hypothesized to favor traditional tactile and visual comprehension.

Materials and methods

Type of study, research location, population and sample

This is a pre-and post-test experimental study. It was done at a Federal Public University in Northeastern Brazil. The initial sample was 43 students in the second year of the undergraduate course in Medicine of the institution studied. It was a non-probabilistic type for convenience samples. It is noteworthy that the orientation of the pedagogical model of the course uses student-centered teaching-learning strategies, allowing the student to experience the applicability of theoretical knowledge in their professional and social perspective, establishing a link between classroom and work situation.

Inclusion and exclusion criteria

All students who were enrolled in the curricular component entitled Locomotion, who participated in all stages of the study, and who responded to all research instruments were included.

Exclusion criteria include previous exposure to a subject of human anatomy and/or topography in a previous undergraduate degree course or in other teaching experiences, as well as failure in some curricular component offered in previous semesters and partial completion in some data collection instrument.

Data collection instruments

A Cognitive Performance Assessment (CPA) - was developed by the researchers. Composed of 15 questions of multiple school type, with 4 alternatives, with only one correct answer. The evaluation was structured from the theoretical framework exposed on the page of the curricular component and bibliographically available to students through the Sectorial Library.

The questions contemplate 3 difficulty levels: five questions of low difficulty, five questions of intermediate difficulty and five questions of high difficulty. For each question of the evaluation, there is a space below the alternatives containing an aspect of attributing a level of certainty in assigning an answer to the item. For this assignment of certainty, it uses a scale type Likert of 5 items, namely: 1 (no certainty) 2 (little certainty) 3 (medium certainty) 4 (much certainty) 5 (total certainty).

The CPA development was made according to the Locomotion module’s learning objectives: recognize the role of the upper limb acromioclavicular joint; identify the structures that make up the upper limb acromioclavicular joint; identify the main bone accidents of the upper limb acromioclavicular joint; identify the muscle groups of the upper limb; identify the main bone accidents of the upper limb; identify radial, median and ulnar nerves; identify the main bony landmarks of the pelvic girdle and lower limbs; recognize the key ligaments of the pelvic girdle and lower limbs; describe the muscle groups involved in the hip, knee, and ankle joints; understand the topographic organization of the muscular compartments of the lower limbs; analyze the gluteal muscles and their anatomical relationship with the sciatic nerve; relate movement axes to the main trauma mechanisms affecting the hip, knee, and ankle joints.

Difficulty tiers (low/medium/high) were determined using Item Response Theory (IRT)¹⁷. Reliability was acceptable (Cronbach’s α = 0.82). Item difficulty and discrimination were estimated via a 2-PL IRT model (a = 0.45–1.32; b = − 1.1–1.4), supporting the low/medium/high tiers.

The Instructional Materials Motivation Survey (IMMS)¹⁸ is an instrument based on a motivational learning model that assesses four key dimensions of student motivation in educational contexts: Attention, Relevance, Confidence, and Satisfaction. The survey includes both positive and negatively worded statements, with responses recorded on a 5-point Likert scale ranging from 0 (“strongly disagree”) to 4 (“strongly agree”). The Attention dimension (items Q2 to Q8) evaluates the extent to which the instructional material captures and maintains the learner’s interest and focus. Relevance (items Q9 to Q16) measures the perceived usefulness of the content and its connection to the learner’s goals, interests, or prior experiences. Confidence (items Q17 to Q23) assesses the learner’s self-perception regarding their ability to master the presented content. Satisfaction (items Q1 and Q24 to Q29) reflects the learner’s pleasure and fulfillment in using the material, including feelings of reward and quality of feedback. The IMMS is widely used to explore motivational aspects in learning, providing valuable insights for optimizing instructional design.

Randomization, control and manipulation

Initially, the research was explained to the students. All 43 students volunteered to participate and agreed to the terms of the survey. They completed a sociodemographic characterization form containing the following variables: sex, age and Academic Performance Index (API). After completing the questionnaire, we performed electronic randomization stratified by age and cumulative API. The students were randomized by an independent statistician and allocated to an Experimental Group (EG) and a Control Group (CG). In possession of the identification numbers drawn by group, the T-test was performed for independent samples (significance level: 5%).

Initially, the students of both groups participated in 02 classes related to the contents of upper limb and lower limb. They then responded to a cognitive performance assessment (pretest). To achieve the objectives, the students received three clinical cases and were accommodated in rooms containing the resources for the skills class.

EG students used Virtual Reality (VR) and CG students used anatomical parts that underwent the plastination process. To obtain a more favorable teaching environment in the skill, each group (EG and CG) was subdivided into two subgroups, with an equal number of students, so that they came to occupy 4 different rooms and followed two routes of theoretical and practical activities. Both groups followed an identical, checklist-based roadmap; activities occurred in teams of 3/4 with 1 facilitator per 10 students, restricted to procedural guidance.

EG students worked with a virtual reality feature, the SECTRA Table^®. The CG students worked with the plastinated anatomical pieces. EG students performed structure identification activities, exploring all components of the program using the “Rotate”, “Zoom in/out”, “dissect” functions to remove structures, and “isolate” to isolate elements to be studied. The students who were part of the CG used three plastinated specimens of upper and lower limbs. In both groups, a roadmap containing the objectives and clinical cases was made available.

Then, after an hour and a half of practical studies of each subgroup, the same cognitive assessment used in the pre-test phase of the research was reapplied, concluding the post-test phase. Fourteen days after the application of the pretest questionnaire, the questionnaire of the IMMS was applied. The flowchart with the description of the steps is arranged in Fig. 1.

Fig. 1.

Flowchart with the description of the steps. Caicó/RN, 2025.

Ethical aspects

The project was submitted and approved by the Trairi College of Health Sciences Research Ethics Committee (CEP) Ethics under nº 55,501,322. All methods were performed in accordance with the relevant guidelines and regulations according to Resolution of the National Health Council number 466/12, which provides for Guidelines and regulatory standards for research related to human beings in Brazil After approval by the committee, a statement confirming that informed consent was obtained from all subjects. After data collection, the students were able to experiment with anatomy resources that were not previously used at the time of the research.

Data analysis

After the database cleaning routine, univariate analysis of the variables was performed. For this purpose, tables with absolute and relative values were constructed. The motivation scores, confidence and performance values of the knowledge tests were compared between the groups. T-test to independent samples or paired T-test were used. There were significant P values ≤ 0.05. SPSS software version 20.0 was used for data analysis.

Results

When comparing the means ± SD (Standard Deviation) of cognitive performance and confidence in assigning a response to the item, between the groups, regardless of pre or posttest, there weren´t significant differences observed (Table 1).

Table 1.

Confidence indices in assigning response to the item and cognitive performance between the experimental and control Groups. Caicó/RN, 2025.

Item:	Mean	SD	t	p value
Pre-trial performance	7.05	1.84	0.28	0.77
Pre control performance	6.88	1.56
Pre-trial confidence	30.75	7.43	0.93	0.35
Pre control confidence	28.66	6.07
Post experimental confidence	42.75	7.69	0.37	0.70
Post control confidence	41.83	7.17
Post experimental performance	8.10	1.51	− 0.68	0.49
Post control performance	8.44	1.58

In intra group analysis, it was possible to identify that the means of cognitive performance and confidence in assigning a response to the item were significantly better in the post-test in the CG compared to the pre-test (p < 0.001). In addition, the means of confidence in assigning response to the item were significantly higher in the post-test in the EG compared to the previous moment (p < 0.001) (Table 2).

Table 2.

Confidence and performance indices in the experimental and control groups during the two observation moments. Caicó/RN, 2025.

Item:	Mean	SD	t	p value
Pre-experimental performance	7.22	1.66	− 1.60	0.12
Post experimental performance	8.11	1.56
Pre-trial confidence	30.05	7.51	− 10.61	< 0.001
Post experimental confidence	42.33	8.02
Pre control confidence	28.66	6.07	− 10.66	< 0.001
Post control confidence	41.83	7.17
Performance pre control	6.88	1.56	− 4.27	< 0.001
Post control performance	8.44	1.58

For the motivation instrument questionnaire (IMMS), performed at the time of completion of the Locomotion module, the EG scores were significantly higher in items 12, 27, 30 and 31 (Table 3). There was no significant difference when comparing the scores of the dimension’s attentions, relevance, confidence, satisfaction between control and experimental groups (Table 4).

Table 3.

Confidence indices of the IMMS instrument obtained through the questionnaire responses of the experimental and control Groups. Caicó/RN, 2025.

Variables	Mean ± SD (Experimental)	Mean ± SD (control)	t	p value
01. When I initially saw the content, I had the impression that (learning) would be easy for me.	1.85 ± 1.08	2.17 ± 1.07	− 0.914	0.367
02. There was something interesting at the beginning of the content that caught my eye.	3.10 ± 0.85	3.26 ± 0.83	− 0.487	0.630
03. The content was more complicated to understand than I would like it to be.	2.50 ± 1.23	2.58 ± 1.06	− 0.231	0.819
04. After reading the introductory information, I felt confident of what I should learn from the content.	2.45 ± 1.05	2.47 ± 0.94	− 0.062	0.951
05. Completing the exercises on the content caused a satisfying sense of accomplishment.	3.30 ± 0.80	3.00 ± 0.86	1.094	0.282
06. It is clear to me how the content of the discipline is related to knowledge that I already have.	2.55 ± 0.99	2.76 ± 1.03	− 0.642	0.525
07. Many of the pages had so much information that it was difficult to choose and remember the important points.	2.50 ± 1.14	3.05 ± 1.02	− 1.547	0.131
08. The content is interesting.	3.35 ± 0.58	3.58 ± 0.61	− 1.200	0.238
09. There were examples that showed me how important content could be to some people.	3.50 ± 0.51	3.52 ± 0.71	− 0.145	0.886
10. Successfully completing the content activities was important to me.	3.45 ± 0.51	3.29 ± 0.84	0.689	0.496
11. The way the content was written helped keep my attention.	2.25 ± 0.96	2.11 ± 0.99	0.410	0.684
12. The content is so abstract that it was hard to keep my attention.	1.80 ± 0.95	1.05 ± 0.89	2.421	0.021
13. As I worked/learned the content activities, I was confident that I could learn the content.	2.55 ± 0.94	2.82 ± 0.72	− 0.973	0.337
14. I liked the content so much that I would like to learn more about it.	2.65 ± 0.98	3.05 ± 0.82	− 1.350	0.186
15. The way the content was presented seems to be uninteresting.	1.40 ± 1.18	1.29 ± 1.04	0.285	0.777
16. The content of the course is relevant to my interests.	3.20 ± 0.69	3.35 ± 0.86	− 0.597	0.554
17. The way the information is organized in the content helped keep my attention.	2.20 ± 1.05	2.23 ± 0.75	− 0.115	0.909
18. There are explanations or examples of how people use the knowledge of this content.	2.90 ± 0.64	3.00 ± 0.85	− 0.403	0.689
19. The exercises of this content were very difficult.	2.10 ± 1.02	2.11 ± 0.85	− 0.056	0.955
20. The content has elements that pique my curiosity.	3.05 ± 0.51	3.11 ± 0.60	− 0.371	0.713
21. I really enjoyed studying this content.	2.40 ± 0.94	2.88 ± 0.69	− 1.745	0.090
22. The amount of repetition of this content made me eventually bored.	1.35 ± 0.96	1.29 ± 0.84	0.172	0.865
23. The content and style of activities in this material make it seem worth knowing about it.	2.90 ± 0.96	3.00 ± 0.86	− 0.329	0.744
24. I learned some things that were surprising or unexpected.	2.90 ± 0.96	3.05 ± 0.74	− 0.551	0.585
25. After working on the content activities for some time, I was confident that I would be able to pass a test on it.	2.55 ± 0.99	2.17 ± 0.63	1.329	0.193
26. These content activities were not relevant to my needs because I already knew most of them.	0.45 ± 0.51	0.47 ± 0.51	− 0.122	0.904
27. The way the feedback was given, after the activities, or other comments on the activity helped me feel rewarded for my effort.	2.20 ± 1.10	1.47 ± 1.06	2.032	0.050
28. The variety of reading excerpts, exercises, illustrations etc. helped keep my attention on the activity.	2.65 ± 0.93	2.58 ± 1.06	0.188	0.852
29. The way the content and its activities are written is boring.	1.70 ± 0.92	1.41 ± 0.71	1.048	0.302
30. I was able to relate the content to things I had already seen, done or thought about in my own life.	3.30 ± 0.65	2.82 ± 0.63	2.231	0.032
31. There were so many words on each slide that it was annoying.	1.95 ± 1.09	1.17 ± 0.95	2.268	0.030
32. I felt good about doing the content activities.	2.75 ± 0.91	3.00 ± 0.70	− 0.920	0.364
33. The content of the discipline will be useful to me.	3.60 ± 0.59	3.76 ± 0.43	− 0.941	0.353
34. I could not understand even a little of the content material.	1.00 ± 0.97	0.58 ± 0.87	1.346	0.187
35. The organization of the content helped me to be confident that I could learn this material.	2.30 ± 1.03	2.05 ± 1.02	0.710	0.483
36. It was a pleasure working with such a well-planned tutorial.	2.25 ± 1.20	2.58 ± 1.17	− 0.859	0.396

Table 4.

Motivation dimension scores between experimental and control Groups. Caicó/RN, 2025.

Item:	Mean	SD	t	p value
Experimental attention	2.30	0.31	1.29	0.20
Control attention	2.18	0.28
Experimental relevance	2.87	0.36	− 0.13	0.89
Control relevance	2.88	0.37
Experimental confidence	2.20	0.30	− 0.23	0.81
Control Confidence	2.22	0.44
Experimental Satisfaction	2.59	0.67	− 0.39	0.69
Control Satisfaction	2.66	0.44

Discussion

The results presented in Table 1 indicate that both the resources used in the experimental group (virtual reality) and in the control group (plastinated specimens) were effective in promoting improvements in cognitive performance and self-confidence among medical students. The absence of a statistically significant difference between the groups suggests that both methods are comparable in terms of educational impact, reinforcing the idea that multiple approaches can be equally valid when integrated into the teaching-learning process.

The study’s results support existing literature indicating cognitive performance equivalence between non-cadaveric modalities such as plastinated specimens and virtual reality^19,20. Nevertheless, the different methodologies appear to stimulate learning and motivation through distinct pathways.

However, the analysis of Table 2 revealed that, although both groups showed a significant increase in confidence levels after the intervention, only the control group demonstrated a significant improvement in cognitive performance. This finding may indicate greater effectiveness of traditional methods in developing the specific cognitive performance evaluated, or it may reflect methodological limitations that hindered the detection of gains in the experimental group.

The greater sense of reward and personal connection reported by the experimental group may be attributed to the immersion and interactivity provided by virtual reality, which fosters multimodal learning, as advocated by Mayer⁷. Furthermore, Embodied Cognition suggests that active manipulation of three-dimensional models can enhance understanding and engagement. On the other hand, the reported difficulties with maintaining attention suggest that, if poorly designed, virtual reality can increase extraneous cognitive load, thereby limiting learning efficiency. Therefore, it is essential that the development of digital materials incorporate instructional design principles that minimize overload and maximize clarity and focus⁶.

McMenamin et al.²¹ demonstrated that resources like plastinated models and interactive virtual environments promote equivalent cognitive gains, even though they engage different perceptual pathways. Similarly, Khot et al.²² and Moro et al.²³ observed that the use of digital resources, although not necessarily superior to traditional methods in terms of factual learning, fosters greater engagement and perceived usefulness among students.

A study by Wang et al.²⁴ using immersive virtual reality showed that, despite the absence of statistical differences in test scores compared to conventional methods, students reported better three-dimensional visualization and considered the tool highly motivating. Similar results were reported by Bölek et al.²⁵, who used the IMMS instrument to assess motivation in augmented reality activities, demonstrating positive effects on the attention and satisfaction dimensions.

The diversification of approaches and adoption of interactive technologies, such as the one evaluated in this study, comprises an extensive list of possibilities and attitudes capable of promoting greater engagement on the part of students. In this research, there wasn´t any differences in performance and motivation dimensions were observed between the experimental and control groups. However, when comparing the same group in the two moments of observation, the performance and confidence scores were better in the group that used the plastinated pieces.

A multicenter study evaluated motivation and investigated performance among cohorts students. It was observed that the association of performance and motivation controlling by gender and self-efficacy. Moreover, task value and intrinsic goal orientation were important variables of student performance in anatomy¹².

An England study evaluated the motivation of students after their human anatomy dissection sections. The evaluation of students’ motivation was high for the anatomy dissection experience at the end of the Human Anatomy course. Attention, relevance, confidence and satisfaction were rated above 4/5. Additionally, the motivational scores were greater in males and in greater anatomical knowledge levels¹¹.

Although various studies^26–28 point out that the use of VR resources and digital media used in the human anatomy discipline are not able to promote significantly greater learning, when compared to the traditional model; students often report that the experience of having experienced the application of these technologies in teaching-learning practice was more stimulating, pleasant and useful, in addition to achieving a significantly higher result in the motivation tests²⁵. Other studies^29–32 evaluated the impact of the use of these 3D reconstruction programs for anatomical teaching purposes and pointed out significantly higher differences than the groups that did not use them in their proposed tests.

The IMMS is a measurement tool that is based on the motivation model in learning. To overcome this weakness in the motivation indicated by the instrument, both groups that achieved lower scores in these items of the axes of Confidence and Relevance can adopt strategic activities to recover the motivation of students in these points. According to the authors Meguid & Khalil¹¹, clear communication should be established aimed at students of how important the assimilation of content will be for the future profession.

The assessment of motivational indices using the Instructional Materials Motivation Survey (IMMS) showed that, for most items, students’ perceptions were similar across groups, indicating comparable motivational effectiveness between the methods¹⁸. However, some differences are worth highlighting. The experimental group reported a greater sense of reward from completing the activities (item 27, p = 0.050) and a higher ability to relate the content to their own experiences (item 30, p = 0.032). These aspects align with Self-Determination Theory⁸ (Deci & Ryan, 1985) and Embodied Cognition⁹, which emphasize the importance of personal relevance and active engagement for intrinsic motivation.

On the other hand, students in the experimental group reported greater difficulty maintaining attention, attributed to the abstract nature of the content (item 12, p = 0.021) and textual overload (item 31, p = 0.030). According to Cognitive Load Theory⁶, this overload—classified as extraneous load—can impair the efficiency of cognitive processing and learning, suggesting that the instructional design of virtual materials should be carefully optimized to avoid these adverse effects.

From this previous analysis, the positive highlights of the responses of the IMMS of the SECTRA^® group orbited more in the field/axis of confidence and satisfaction. It is possible to deduce that the students were able to relate the theme to their life as well as having adequate feedback. Although they found the content material very extensive information, making it difficult to list the important points worked.

Despite these differences in results, the benefits of better spatial understanding related to anatomical structures³³ and more significant understanding of complex vascular networks³⁴. These are desirable goals for students to consolidate in order to develop a better future professional clinical practice. Interactive technologies are interesting within the wide range of possibilities that currently exist to diversify the teaching of Human Anatomy, although they require a large amount of time to develop the competence to use these²⁹.

Certainly, the use of cadaveric specimens is costly, time-consuming, and requires specific facilities, and may involve various risks. However, educators should continue to trust this modality, as a targeted and methodical use of dissection can maximize its potential. Prosections are a valuable alternative. While they cannot replace dissection, their use can address issues like cadaver shortages and limited teaching time. Their contribution to teaching gross anatomy is well-proven. Three-dimensional anatomy software is an emerging teaching modality.

Anatomy education must be grounded in rigorous ethical principles. Continued support for body donation programs and the conscientious use of alternative methods are essential to maintaining educational integrity. In accordance with Article 14 of Law No. 10,406/2002 of the Brazilian Civil Code, “it is valid, for scientific or altruistic purposes, to freely dispose of one’s own body, in whole or in part, after death. The act of disposition may be freely revoked at any time”³⁵. This legal framework made possible the establishment of the Donor Bank, thereby creating the Body Donation Program, which institutionalized and regulated voluntary body donation for scientific and educational purposes within the Federal University of Rio Grande do Norte.

Furthermore, Law No. 8,501, enacted on December 30, 1992, regulates the use of unclaimed cadavers for study or scientific research purposes and establishes additional provisions³⁶. In addition to these regulations, Provision No. 093/12-CGJ/RN, issued on July 12, 2012, governs the registration of deaths of cadavers destined for medical schools in the State of Rio Grande do Norte, specifically for teaching and scientific research purposes, and provides further measures to ensure compliance³⁷.

Cadaver availability is subject to legal and ethical constraints, with the use of unclaimed bodies governed by jurisdiction-specific regulations and institutional oversight. Consequently, access to cadaveric material may vary significantly across regions and institutions, underscoring the need for equitable and ethically sound resource allocation in anatomical training. All procedures related to the plastination technique performed at this research are highly professional, ethical, and respectful regarding the cadaveric anatomical specimens³⁸.

In contrast to the traditional teaching system, which is more commonly applied in the disciplines of human anatomy in other universities, the students of the researched institution initially used resin macromodels as physical educational instruments and digital media with three-dimensional reconstruction of anatomical structures, worked in didactics software for use in computers. The first contact with real anatomical specimens, preserved through the plastination process, in this case, occurred only from the development of this research³⁹.

Small group discussions are undoubtedly an effective method for learning human anatomy. Their success, however, depends not only on the content addressed but also on the dynamics within the group. In this context, the tutor plays a crucial role in ensuring that discussions are productive⁴⁰. Our study revealed that the quality of learning was influenced as much by the interactions among participants as by the material itself. The chosen group size (ten students) proved sufficient to encourage diverse perspectives and experiences, though it also presented challenges in maintaining focus and guaranteeing equal participation. At times, the risk of dispersion or the emergence of subgroups demanded greater skill from the tutor to guide the conversation and foster collaboration.

The teaching of human anatomy still requires the face-to-face and active guidance of university professors, along with cadaveric dissection, to convey the significant knowledge and visualization of body structures and their functional relationship. In addition, different kinds of educational innovation interventions may be useful to help with the integration of knowledge, the motivation of students and the development of transversal skills required to acquire higher education competencies⁴¹.

The integration of cadaveric dissection and virtual reality (VR) technologies can be achieved in a complementary way, where initial exposure to digital models prepares students for laboratory practice, optimizing the use of cadaveric material and reducing operational costs. Future directions include evaluation of long-term retention and skill transfer in relation to clinical tasks. Use of Augmented reality may further learning. Implementation in resource limited settings through collaborations may improve cost effectiveness⁴². Besides, virtual dissection has the potential to supplement or replace donor dissection in anatomy education⁴³.

Limitations

A key limitation of this study is the relatively short intervention period and the focus solely on immediate post-test cognitive scores and motivation. While we observed significant pre-post gains in confidence for both groups and in cognitive performance for the plastinated group, we did not assess the long-term retention of this knowledge, which is crucial for clinical practice. Future longitudinal studies are needed to track retention over time¹⁶.

Furthermore, although this study focused on individual learning, the potential for collaborative learning within both VR and plastinated specimen environments warrants exploration¹⁶. Additionally, our cognitive assessment relied on MCQs. While studies like Kadri et al.¹⁵ found VR superior based on exam scores and learning time, our study did not show a significant cognitive advantage for VR over plastination using MCQs alone.

Future research should incorporate diverse assessments, potentially including objective skill tests and measures of learning efficiency, and investigate technology acceptance to provide a more comprehensive comparison^15,16. Finally, exploring different VR modalities, perhaps incorporating more immersive serious game elements, might yield different motivational and cognitive outcomes compared to the visualization table used here¹⁴.”

Conclusion

No differences were observed in cognitive performance scores and confidence in assigning a response to the item between the experimental and control groups (p > 0.05.). In intra group analysis, it was possible to identify that the means of cognitive performance and confidence in assigning a response to the item were better in the post-test in the groups. Thus, the training skills with plastinated anatomical parts and with virtual reality resources promoted learning in the context of teaching human anatomy focused on musculoskeletal anatomy. The benefits of this include improvement in the execution and planning of theoretical/practical activities and the evaluation methods of the components of Human Anatomy.

In summary, the use of technologies such as virtual reality and plastinated specimens appears promising for anatomy education, promoting meaningful motivational and cognitive gains. However, the impact of these resources depends on the quality of their pedagogical implementation.

The findings highlight the importance of adopting multimodal approaches that integrate the sensory richness and interactivity of digital environments with the physical and tangible contact of traditional methods, in order to enhance both cognitive performance and student motivation. Future studies should further investigate the affective and motivational aspects related to these technologies, to improve instructional design and ensure effective learning.

Supplementary Information

Below is the link to the electronic supplementary material.

Author contributions

E.A.M. original draft, review, editing, conceptualization, data curation, formal analysis.A.F.S. original draft, review, editing, conceptualization, data curation, formal analysis.I.L.O.N. original draft, review, editing, conceptualization, data curation, formal analysis.C.A.C. original draft, review, editing, conceptualization, data curation, formal analysis.E.S.N.J. - original draft, review, editing, conceptualization, data curation, formal analysis.G.D.A. - original draft, review, editing, conceptualization, data curation, formal analysis.J.R.L.P.C. - original draft, review, editing, conceptualization, data curation, formal analysis. S.P.D.N. - original draft, review, editing, conceptualization, data curation, formal analysis.R.R.O.C. - original draft, review, editing, conceptualization, data curation, formal analysis.E.E.S.L. - original draft, review, editing, conceptualization, data curation, formal analysis.

Funding

This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES) – Finance Code 001.

Data availability

The datasets used and/or analysed during the current study is available like supplementary material.

Declarations

Competing interests

The authors declare no competing interests.