Abstract
Objective
This study aimed to evaluate the feasibility and efficacy of a virtual reality (VR) platform for understanding head and neck anatomy in medical education.
Study Design
Prospective trial using a pretest/posttest design to assess understanding of head and neck anatomy.
Setting
Single academic institution.
Methods
21 medical students performed a standardized, guided VR experience. Students had completed formal education in cadaveric anatomy and reported varying levels of VR and video game exposure. Baseline knowledge was assessed with a multiple‐choice quiz (MCQ) (T1). Students then engaged in an educational experience using the Meta Quest platform, followed by a post‐VR MCQ (T2). Outcomes included performance metrics, self‐reported confidence, user satisfaction, and potential influence of prior technologic exposure on these outcomes.
Results
Post‐VR, the average MCQ score increased from 4.33 ± 1.53 (T1) to 6.67 ± 1.52 (T2) (P < .001). This improvement was consistent across all technological backgrounds, with no significant influence of prior VR (P = .18) or gaming (P = .14) on performance. Subjects found the VR intervention effective for understanding head and neck anatomy, with 90.48% reporting increased confidence in their knowledge. Students rated the VR educational experience highly for control, sensory immersion, and realism, with minimal distraction or frustration.
Conclusions
Anatomic VR experiences are a valuable adjunct in medical education, enhancing student confidence and understanding of complex head and neck anatomy, independent of technological background.
Keywords: head and neck anatomy, medical education, virtual reality
The anatomy of the head and neck region is notorious for its complexity and intricate interworking of bones, muscles, vessels, and nerves. Acquiring a comprehensive understanding of these spatial anatomic relationships is a challenge and prompts the need for exploration of innovative educational modalities to optimize learning.
Virtual reality (VR) technology has emerged as a promising tool in various educational and professional settings, including medical training. In medical residency programs, particularly in specialties such as otolaryngology (ENT) and neurosurgery, VR has been increasingly adopted for preoperative guidance and preparation. 1 , 2 VR simulations allow residents to practice and refine their surgical skills in a controlled, risk‐free environment. 3 This immersive, three dimensional visualization of complex anatomical structures enhances spatial awareness and anatomical understanding, which are critical for surgical performance.
In addition to residency training, VR has shown potential in enhancing medical student education, particularly in anatomy courses. Studies have demonstrated that the use of VR can increase confidence among students and is highly rated as a learning tool. 4 The interactive nature of VR allows dynamic exploration of anatomical structures, which may be more effective than traditional methods such as textbooks and cadaver dissections. However, the literature is less definitive regarding the impact of VR on actual performance outcomes, 5 and its specific application to the head and neck region remains underexplored.
When evaluating the feasibility of an educational tool, one must consider the possible difficulties associated and possible individuals that may excel with the utilization of the tool. A known challenge is the learning curve associated with becoming proficient with VR headsets. 6 This proficiency includes the technical skills to navigate the VR environment and the ability to interpret and manipulate the anatomical structures accurately. 7 Prior gaming experience may aid in the transition and adaptation, as both VR and gaming demand strong hand‐eye coordination 8 This is particularly relevant in surgical fields like otolaryngology, where such coordination is vital and studies have shown potential for gaming experience to influence surgical skill. 9
Despite the growing use of VR in medical education, there has been little research examining the influence of prior VR and gaming experience on medical student performance in VR‐based anatomy learning. Exploring this relationship could inform the development of tailored training for varying levels of familiarity with VR technology, ultimately enhancing complex anatomical education and improving both educational outcomes and surgical preparedness.
In this study, the feasibility of using an emerging, commercially available VR headset and anatomy software to adjunct traditional medical anatomy training was evaluated. Subjects were guided through an immersive educational head and neck curriculum and were assessed on their knowledge of complex anatomy. Objective and subjective measures were obtained from each subject during and after the VR intervention.
Materials and Methods
Twenty‐one medical students from a single institution were enrolled in a prospective trial. This study utilized a within‐subjects pretest/posttest design whereby each participant served as their own control via a control pretest and an experimental posttest. Subjects were informed of the study goals and design and consented to participation prior to enrollment. All participants had completed formal, cadaveric head and neck education at the same institution. Approval from Louisiana State University Health Shreveport (LSUHS) Office of Medical Education and the LSUHS Institutional Review Board (IRB) was obtained prior to beginning recruitment of participants.
Before the intervention began, subject‐specific information was collected, including year in medical school, age, prior experience with VR, prior experience with video games, and confidence in head and neck anatomy. Experience with VR was rated on a scale from 1 to 3, with 1 being no experience, 2 being 1 to 4 prior VR interactions, and 3 being more than 4 interactions with VR. Experience with video gaming was also rated on a scale from 1 to 3, with 1 being no experience, 2 being some experience, and 3 being proficient at gaming. Participants rated their confidence in head and neck anatomy on a scale from 1 to 3, with 1 being not confident and 3 being extremely confident.
The application (app) “Human Anatomy VR for Institutions” on a single Meta Quest 3 was purchased and used as the educational VR platform. Images of the application platform can be visualized in Figure 1. Using the app, the authors constructed a standardized educational script for each participant's encounter with the VR device. The intervention began with a brief tutorial to familiarize students with the VR controls. The educational portion consisted of several sections that allowed the student to interact with and learn from the VR anatomy platform. The series of consecutive educational sections is outlined in Table 1.
Figure 1.
Images of the standardized, immersive experience on the Meta Quest VR platform.
Table 1.
4 Sections of the Educational Experience
| Section | Main topic | Task |
|---|---|---|
| 1 | Mandible and Sphenoid Bones | Manipulate both bones and review pertinent (highlighted) structures. Review all the foramina of the sphenoid bone. |
| 2 | Muscles of Anterior Neck, Submandibular Region, and Lateral Face | Review the orientation, relationships, innervation, and origin of the deep and superficial muscles of the cheek and all the muscles attaching to the hyoid bone (with the sternocleidomastoid removed). |
| 3 | Internal and External Carotid Arteries | Review the major branches of the external carotid. Follow the internal carotid through the skull and into the cranium, making note of the direction and orientation at the different portions. |
| 4 | Middle and Inner Ear | Review the ossicles and semicircular canals, making note of their orientation. |
Specific topics covered by the standardized VR anatomy intervention in sequential order.
The first section led participants to manipulate the mandible and sphenoid bones, noting specific landmarks and foramina. The second section involved reviewing the muscles attached to the hyoid bone, including their associated innervation and origin, and dissecting the lateral face to view the deep muscles and nerves of the cheek. The third section guided students to review the major segments of the external carotid artery and follow the internal carotid artery from its origin at the common carotid into the cranium until the middle cerebral artery originated, noting the general direction of each segment of the internal carotid. The fourth and final section led students to review the orientation of the semicircular canals and ossicles of the ear. Figure 1 demonstrates examples of the variety of features offered by the VR interface. The VR model allows for visualization of blood vessel, muscles, bones, and other major anatomical landmarks at different levels. Objects can be isolated and examined in detail. Using the “Infopanel” feature, the user can read information about a specific structure when the curser is placed over that structure. With the controls, the user can also follow the track of different blood vessels and muscle attachments to understand orientation and spatial relationships.
After enrolling and completing the initial survey, subjects scheduled a time to complete the intervention, with all participants finishing the education within one week. Immediately before the VR educational session, each subject completed a 10‐question multiple‐choice quiz in under 10 minutes to assess their baseline spatial head and neck anatomy knowledge (Supplemental Document S1, available online). All subjects were informed that they would complete a second 10‐question multiple‐choice quiz after the intervention. The proctor then read the script to guide each participant through the same educational session, providing additional guidance on controls as needed. The time it took each subject to finish each section was recorded. After the participant finished the last section and felt confident about the information they had interacted with, they immediately took a 10‐question multiple‐choice quiz identical to the first.
A post‐intervention survey was filled out by each subject after finishing the second quiz. This survey assessed the perceived helpfulness and ease of the VR intervention, the self‐reported change in confidence in head and neck anatomy, and any complications the participant had during the session. Helpfulness, ease, and usefulness of the VR intervention were determined on a scale of 1 to 3, with 1 being not helpful/easy/useful at all and 3 being very helpful/easy/useful. The self‐reported change in confidence was provided on a scale from 1 to 4, with 1 being decreased confidence, 2 being confidence unchanged, 3 being confidence slightly increased, and 4 being confidence extremely increased. This survey also included the NASA Task Load Index and the Presence Index to validate the “Human Anatomy VR” app on the Meta Quest 3 for use in an academic setting. 10 , 11
Descriptive statistics were performed to describe participant characteristics. Univariate analysis with Pearson correlation tests, along with single‐factor ANOVA and paired t‐tests, were used to evaluate subjective and objective measures before and after the VR intervention. A paired t‐test was employed for the primary outcome of interest (change in quiz performance after interacting with the VR session), with a p‐value of 0.05 used as the threshold for significance. Pearson correlation and single‐factor ANOVA tests were performed for secondary outcome metrics to assess the relationship between prior VR and video gaming exposure on performance.
Results
Subjects included 21 medical students ranging from first‐ through third‐year students. Table 2 showcases descriptive statistics of the 21 students who participated in the VR experience and the respective outcomes of interest. The majority of the cohort was first‐year medical students (66.7%), 52% of the cohort were male, and the average age of the cohort was 24.6 years old. Regarding self‐reported prior video gaming experience, 57% of participants stated proficiency in gaming. On the other hand, only 5% of students reported proficiency in VR experience (using more than 4 times), while 57% stated that they had never used a VR device. With 100% of the students having participated in the same traditional head and neck cadaveric anatomy course prior to this study, most of the cohort (81%) reported average confidence in head and neck anatomy (on a Likert scale of 1‐3).
Table 2.
Participant Demographics
| Participant | M/F | Class | VR Exp | Gaming Exp | T1 Score | T2 Score | Total time (s) |
|---|---|---|---|---|---|---|---|
| 1 | F | 1 | None | None | 6 | 6 | 1009 |
| 2 | F | 1 | None | None | 4 | 8 | 1448 |
| 3 | F | 3 | Some | Proficient | 4 | 3 | 1304 |
| 4 | M | 1 | Some | Proficient | 5 | 6 | 1188 |
| 5 | F | 3 | None | Some | 4 | 7 | 1339 |
| 6 | F | 3 | Some | None | 2 | 8 | 1450 |
| 7 | F | 1 | None | None | 5 | 6 | 1130 |
| 8 | M | 3 | None | Proficient | 7 | 9 | 1166 |
| 9 | M | 1 | Some | Proficient | 5 | 8 | 1300 |
| 10 | M | 3 | Some | Proficient | 3 | 8 | 1226 |
| 11 | F | 1 | Some | Some | 1 | 7 | 1075 |
| 12 | M | 1 | Some | Proficient | 5 | 5 | 955 |
| 13 | M | 1 | Some | Proficient | 6 | 5 | 1123 |
| 14 | M | 2 | None | Proficient | 5 | 8 | 1351 |
| 15 | M | 3 | Proficient | Proficient | 1 | 7 | 1185 |
| 16 | M | 1 | None | Proficient | 5 | 7 | 1301 |
| 17 | F | 1 | None | Some | 5 | 5 | 1104 |
| 18 | M | 1 | None | Proficient | 4 | 6 | 1222 |
| 19 | F | 1 | None | None | 4 | 7 | 969 |
| 20 | M | 1 | None | Proficient | 5 | 5 | 934 |
| 21 | F | 1 | None | None | 5 | 9 | 1088 |
Pertinent demographics of all participants.
Abbreviations: Class, Medical School Class; Gaming Exp, Prior Gaming Experience; M/F, male/female; sec, seconds; T1 Score, Pre‐Intervention Quiz Score (out of 10); T2 Score, Post‐Intervention Quiz Score (out of 10); VR Exp, Prior VR Experience.
The primary outcome of interest, the change in quiz performance after interacting with the VR session, is indicated via Figure 2. Mean initial T1 quiz score was 4.33 ± 1.53 and improved by 54% to an average of 6.67 ± 1.52 on the T2 postintervention quiz (P < .001). Respective level of experience (medical school class) did not significantly affect the change in scores (P = .07). Additionally, prior gaming experience and prior experience with VR did not significantly correlate with performance (F = 2.11, P = .14 and F = 1.89, P = .18, respectively). The average time to complete the intervention was 19 minutes and 43 seconds. The time to complete the educational experience did not significantly affect the change in quiz scores (P = .39). Likewise, prior gaming experience and prior experience with VR did not significantly affect the time to complete the intervention (P = .88, 95% CI: −151‐116 and P = .78, 95% CI: −173‐150, respectively).
Figure 2.
Mean participant quiz scores before and after VR learning experience. T1 Score, Pre‐Intervention Quiz Score (out of 10); T2 Score, Post‐Intervention Quiz Score (out of 10).
During a postintervention survey, 100% of participants stated that this VR platform, along with the standardized activity, was an effective way of understanding complex head and neck anatomy. 90.1% of subjects reported increased confidence in head and neck anatomy after the VR intervention. 90.1% of subjects also stated that they would use this VR platform again to learn anatomy. Two participants that stated they would not use the VR platform again reported dizziness after finishing the intervention.
The NASA Task Load Index and presence questionnaire results are shown in Table 3 and Table 4, respectively. The Meta Quest educational experience on the “Human Anatomy VR for Institutions” app was rated highly for control, sensory immersion, and realism, with minimal distraction, frustration, or delay. Participants also found the adjustment to the VR environment to be quick and easy, regardless of prior gaming and VR experience. Relating to the VR system and environment, 4 students said that the images were blurry at times and another 4 students stated that they were getting dizzy toward the end of the educational experience.
Table 3.
NASA Task Load Index
| Average | SD | Conclusion | |
|---|---|---|---|
| How mentally demanding was the task? | 4.8 | 2.06 | Medium mental effort |
| How physically demanding was the task? | 2.4 | 1.83 | Low physical effort |
| How hurried or rushed was the pace of the task? | 2.4 | 1.36 | Slow, leisurely rate |
| How successful were you in the task? | 7.7 | 1.39 | High success |
| How hard did you have to work to accomplish your level of performance? | 4.2 | 1.94 | Medium effort |
| How insecure, discouraged, irritated, stressed, and annoying were you? | 1.9 | 1.37 | Very low frustration |
NASA Task Load Index determined by postintervention survey. 11
Scale: 1‐10:0‐2 = very low, 8‐10 = very high.
Abbreviation: SD, standard deviation
Table 4.
Presence Questionnaire
| Average | SD | ||
|---|---|---|---|
| How much were you able to control events? | 8.8 | 1.04 | CF |
| How responsive was the environment to actions that you initiated? | 8.8 | 1.21 | CF |
| How natural did your interactions with the environment seem? | 8.6 | 1.40 | CF |
| How much did the visual aspects of the environment involve you? | 8.0 | 2.22 | SF |
| How natural was the mechanism, which controlled movement through the environment? | 7.7 | 2.20 | CF |
| How aware were you of events occurring in the real world around you? | 4.1 | 2.14 | DF |
| How aware were you of your display and control devices? | 8.1 | 1.84 | DF |
| How compelling was your sense of objects moving through space? | 8.6 | 1.08 | SF |
| How much did your experiences in the virtual environment seem consistent with your real‐world experiences? | 7.0 | 1.88 | RF, CF |
| Were you able to anticipate what would happen next in response to the actions that you performed? | 8.3 | 1.56 | CF |
| How completely were you able to actively survey or search the environment using vision? | 8.0 | 2.52 | RF, CF, SF |
| How compelling was your sense of moving around inside the virtual environment? | 8.5 | 2.32 | SF |
| How closely were you able to examine objects? | 9.5 | 0.87 | SF |
| How well could you examine objects from multiple viewpoints? | 8.8 | 1.87 | SF |
| How well could you move or manipulate objects in the virtual environment? | 8.8 | 1.64 | CF |
| To what degree did you feel confused or disoriented at the beginning of breaks or at the end of the experimental session? | 3.6 | 2.27 | RF |
| How involved were you in the virtual environment experience? | 9.0 | 0.97 | CF |
| How distracting was the control mechanism? | 3.0 | 2.00 | DF |
| How much delay did you experience between your actions and expected outcomes? | 1.9 | 1.35 | CF |
| How quickly did you adjust to the virtual environment experience? | 8.5 | 1.33 | CF |
| How proficient in moving and interacting with the virtual environment did you feel at the end of the experience? | 8.8 | 1.14 | CF |
| How much did the visual display quality interfere or distract you from performing assigned tasks or required activities? | 3.3 | 1.79 | DF |
| Did you learn new techniques that enabled you to improve your performance? | 8.0 | 1.75 | CF |
Presence Questionnaire determined by post‐intervention survey. 10
Scale: 0‐10:0 = not at all, 10 = completely.
Abbreviations: Factors for presence = (CF, control; DF, distraction; RF, realism; SF, sensory). SD, standard deviation.
Discussion
This study involved 21 medical students, primarily in the first year of medical school, and all having completed a traditional cadaveric head and neck anatomy course during the first year. While most participants reported proficiency in video gaming prior to beginning the study, the majority had never used VR. Following the standardized VR educational intervention, quiz scores improved significantly by 54%, with no significant impact from level of training, gaming experience, prior VR familiarity, or time spent in the VR session. Post‐intervention, all students found the VR platform effective, and the large majority reported increased confidence in their anatomical knowledge as well as an interest in using the platform for future educational endeavors. The VR system received high ratings for immersion and user‐friendliness using standardized quality indices. Additionally, participants noted minimal lag in software response, low distraction, and a sense of control and presence in the virtual environment, contributing to effective knowledge transfer. 7 , 10 , 11
Human anatomy, especially the head and neck region, is a vital component of medical education. To our knowledge, there are no existing studies evaluating a VR adjunct for head and neck anatomy education. Prior VR research in medical training overall has yielded inconsistent and variably measured improvements in knowledge acquisition when compared to traditional teaching methods. 5 , 12 , 13 This study addresses both subjective and objective improvements in student understanding using immersive VR.
The Meta Quest 3 was the VR platform used in this study due to its availability, high consumer ratings, and reasonable price point. Similar VR headsets have been utilized in recent studies, all of which have shown promise and potential benefit in an academic setting. 14 , 15 While other studies have engineered software to be used during their studies, 16 , 17 , 18 this study used a commercially available VR application software in conjunction with the Meta Quest 3 called “Human Anatomy VR for Institutions.” This application allows for viewing and manipulating complex 3D images with fidelity, color, and texture. There are several features within the application that were used in this study, for example “Ant Mode,” the “Information Panel,” and the “Hand Menu.” These features, along with the high‐definition anatomical images, allow for exploration of intricate detail and orientation of head and neck structures. When compared to software and applications used by other studies, this application provides thorough and realistic imaging and a plethora of application‐specific functions that medical education institutions could customize according to their curriculum.
In order for a VR platform to be effective, it must maintain resolution and quality, rapid response of the user's input, and the feeling of presence within the virtual environment. 7 , 14 The NASA Task Load Index and the presence questionnaire were used as validated subjective assessments of workload and presence, respectively. 10 , 11 Participants experienced high levels of control, sensory immersion, and realism while using the Meta Quest 3 and the educational intervention, with rapid response times and low levels of distraction, allowing them to complete the required sections of manipulating various structures and identifying the necessary anatomical landmarks. Subjects gave the highest ratings for sensory and control factors in the presence questionnaire. Regarding the NASA Task Load Index, students reported that they could successfully accomplish each required task with moderate mental and physical effort, with very low frustration and stress, and at an unpressured, leisure pace. These findings are supported by prior studies which have shown VR to increase learner immersion and engagement, creating a salient and motivating environment. 12 , 13 , 14 While most of our subjects did not report side effects while using the headset, other studies have noted a significant limitation of using VR long‐term due to the possible adverse effects. 13 , 18 Cybersickness can present as headache, blurry vision, dizziness, and nausea and is a well‐documented side effect of prolonged VR use. 19 , 20 This supports the notion of VR use in anatomy education as an adjunct, rather than in isolation.
Because of the high levels of sensory and control when utilizing this VR platform, there may be improved transfer of knowledge and skills via contextualization of the learning environment. 7 The learning possibilities are demonstrated by evaluating the objective multiple‐choice quiz test scores along with the subjective opinions of the participants. The participants' performance and ability to correctly identify complex relationships of the head and neck region improved significantly after the VR educational intervention. Gender differences, differences between classes (ie, first‐year medical students vs. third‐year medical students), and differences in prior confidence in head and neck anatomy did not affect student performance.
The objective benefit of VR increasing students' fund of anatomical knowledge is mixed throughout previous literature. Using a systematic review, Barteit et al showed that VR was at least non‐inferior when compared to traditional cadaveric and textbook teaching methods. 12 Similarly, a recent prospective study examining the educational capacity of VR against tablet‐based image viewing found no differences in knowledge acquisition between groups. 18 A more recent meta‐analysis found that VR allowed a significant improvement of knowledge score when compared to other methods (textbook images, 2D images, lectures, plastic models, etc.). 13 Multiple independent studies have shown significant objective potential for utilizing VR in medical education of temporal bone anatomy, head and neck vascular anatomy, and general head and neck anatomy instead of, or in adjunct with, traditional modalities. 14 , 17 , 21 Although some studies have shown no difference when utilizing VR interventions in anatomy education, this study shows promising results when VR anatomy intervention is used as an adjunct to prior cadaveric education.
Analysis of subjective opinions of the students, apart from the NASA Task Load Index and presence questionnaire, showed that all participants found the VR platform and software effective for learning head and neck anatomy. The majority of students also reported increased confidence in head and neck anatomy after completing the VR educational intervention. This subjective information taken with the objective improvement in anatomical knowledge support VR‐based learning as a constructive, student‐centered method. 13 , 22
An important consideration when determining the utility of new technology‐based educational intervention is the ability for those without familiarity or exposure to the intervention to adapt and reap benefits. Prior studies have suggested a steep learning curve that must be overcome when learning to use the VR environment, leading to more time and mental strain to become proficient using the controls. 23 , 24 In our study, despite minimal prior exposure with VR, all students were able to quickly adjust to the VR environment and controls without significant stress or frustration. This adaptability reinforces the platform's potential as an inclusive educational tool that does not require prior technological expertise when used as a supplement to traditional modalities.
This study is not without limitations. The sample size was small and derived from a single institution, limiting generalizability. The average VR educational intervention time was less than 20 minutes; therefore, longer sessions or additional sessions at periodic intervals may improve knowledge transfer and recall. 25 Although a standardized process was employed, some participants may have engaged more deeply with embedded informational text, causing differences in visual and spatial associations. The pre‐/posttest method implemented could inherently fail to control for extensive prior knowledge of head and neck anatomy and improvement of knowledge post‐intervention. Additionally, without a true standard education group to compare our intervention to and because identical tests were utilized as the pre‐/posttests, the association between improvement and the VR intervention could be confounded by educational exposure. Further studies could include a true standard education group to compare the exposure group. Albeit minimally expressed, the most common complaint provided by the participants regarding the intervention was that the images were often blurry. This could be due to the intercanthal distance not being adjusted to eliminate blurriness prior to the intervention. Lastly, although the VR platform utilized during this study was used because of its relative reliability, cost efficiency, and availability, multiple headsets would be needed for a larger study or to implement VR intervention into medical school curriculum. Due to this, the utilization of this platform could be cost‐prohibitive for some institutions.
In conclusion, anatomic VR experiences are a feasible adjunct in medical education, with potential to enhance student confidence and understanding of complex head and neck anatomy, independent of prior technological experience. Modern VR platforms that are widely commercially available could be a valuable educational resource for medical institutions interested in implementing innovative adjuncts to the anatomy curriculum.
Author Contributions
Ivan Alvarez, design, conduct, analysis, presentation, writing, statistics, reviewing; Emily Johnson, conduct, reviewing; Mackenzie Latour, analysis, statistics, writing, reviewing; Michael Yim, design, analysis, reviewing.
Disclosures
Competing interests
None.
Funding source
None.
Supporting information
Supplementary Document 1: Multiple choice quiz used to evaluate subjects on spatial head and neck anatomy.
This article was presented at the AAO‐HNSF 2024 Annual Meeting & OTO EXPO, September 28‐October 1, 2024, Miami Beach, Florida
References
- 1. Carlstrom LP, Graffeo CS, Perry A, et al. Three‐dimensional modeling for augmented and virtual reality‐based posterior fossa approach selection training: technical overview of novel open‐source materials. Oper Neurosurg. 2022;22(6):409‐424. 10.1227/ons.0000000000000154 [DOI] [PubMed] [Google Scholar]
- 2. Mishra R, Narayanan MDK, Umana GE, Montemurro N, Chaurasia B, Deora H. Virtual reality in neurosurgery: beyond neurosurgical planning. Int J Environ Res Public Health. 2022;19(3):1719. 10.3390/ijerph19031719 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3. Feinmesser G, Yogev D, Goldberg T, et al. Virtual reality‐based training and pre‐operative planning for head and neck sentinel lymph node biopsy. Am J Otolaryngol. 2023;44(6):103976. 10.1016/j.amjoto.2023.103976 [DOI] [PubMed] [Google Scholar]
- 4. Kim‐Berman H, Bui D, Lee K, et al. Student learning of head and neck anatomy using cone beam computed tomography and immersive virtual reality. AADS Proceedings. 2023;87(8):1180‐1187. 10.1002/jdd.13224 [DOI] [PubMed] [Google Scholar]
- 5. Wang J, Li W, Dun A, Zhong N, Ye Z. 3D visualization technology for Learning human anatomy among medical students and residents: a meta‐ and regression analysis. BMC Med Educ. 2024;24(1):461. 10.1186/s12909-024-05403-4 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6. Al Fartoussi H, Sølvsten Sørensen M, Arild Wuyts Andersen S. Learning curves in directed self‐regulated virtual reality training of mastoidectomy and the role of repetition and motivation. J Int Adv Otol. 2023;19(2):99‐104. 10.5152/iao.2023.22753 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7. Dalgarno B, Lee MJW. What are the learning affordances of 3‐D virtual environments? Br J Educ Technol. 2010;41(1):10‐32. 10.1111/j.1467-8535.2009.01038.x [DOI] [Google Scholar]
- 8. Richardson AE, Collaer ML. Virtual navigation performance: the relationship to field of view and prior video gaming experience. Percept Mot Skills. 2011;112(2):477‐498. 10.2466/22.24.PMS.112.2.477-498 [DOI] [PubMed] [Google Scholar]
- 9. Westenhaver ZK, Africa RE, Zimmerer RE, McKinnon BJ. Gamification in otolaryngology: a narrative review. Laryngoscope Investig Otolaryngol. 2022;7(1):291‐298. 10.1002/lio2.707 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10. Witmer BG, Singer MJ. Measuring presence in virtual environments: a presence questionnaire. Presence: Teleop Virt Environ. 1998;7(3):225‐240. 10.1162/105474698565686 [DOI] [Google Scholar]
- 11. Hart SG, Staveland LE. Development of NASA‐TLX (Task Load Index): results of empirical and theoretical research. Adv Psychol. 1988;52:139‐183. 10.1016/S0166-4115(08)62386-9 [DOI] [Google Scholar]
- 12. Barteit S, Lanfermann L, Bärnighausen T, Neuhann F, Beiersmann C. Augmented, mixed, and virtual reality‐based head‐mounted devices for medical education: systematic review. JMIR Serious Games. 2021;9(3):e29080. 10.2196/29080 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13. Salimi S, Asgari Z, Mohammadnejad A, Teimazi A, Bakhtiari M. Efficacy of virtual reality and augmented reality in anatomy education: a systematic review and meta‐analysis. Anat Sci Edu. 2024;17(9):1668‐1685. 10.1002/ase.2501 [DOI] [PubMed] [Google Scholar]
- 14. Kurul R, Ögün MN, Neriman Narin A, Avci Ş, Yazgan B. An alternative method for anatomy training: immersive virtual reality. Anat Sci Educ. 2020;13(5):648‐656. 10.1002/ase.1959 [DOI] [PubMed] [Google Scholar]
- 15. Duncan‐Vaidya EA, Stevenson EL. The effectiveness of an augmented reality head‐mounted display in learning skull anatomy at a community college. Anat Sci Educ. 2021;14(2):221‐231. 10.1002/ase.1998 [DOI] [PubMed] [Google Scholar]
- 16. Ekstrand C, Jamal A, Nguyen R, Kudryk A, Mann J, Mendez I. Immersive and interactive virtual reality to improve learning and retention of neuroanatomy in medical students: a randomized controlled study. CMAJ Open. 2018;6(1):E103‐E109. 10.9778/cmajo.20170110 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17. Copson B, Wijewickrema S, Sorace L, Jones R, O'Leary S. Development of a virtual reality clinically oriented temporal bone anatomy module with randomised control study of three‐dimensional display technology. BMJ Simul Technol Enhanc Learn. 2020;7(5). 10.1136/bmjstel-2020-000592 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18. Moro C, Štromberga Z, Raikos A, Stirling A. The effectiveness of virtual and augmented reality in health sciences and medical anatomy. Anat Sci Educ. 2017;10(6):549‐559. 10.1002/ase.1696 [DOI] [PubMed] [Google Scholar]
- 19. Kim H, Kim DJ, Chung WH, et al. Clinical predictors of cybersickness in virtual reality (VR) among highly stressed people. Sci Rep. 2021;11(1):12139. 10.1038/s41598-021-91573-w [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20. Caserman P, Garcia‐Agundez A, Gámez Zerban A, Göbel S. Cybersickness in current‐generation virtual reality head‐mounted displays: systematic review and outlook. Virtual Reality. 2021;25(4):1153‐1170. 10.1007/s10055-021-00513-6 [DOI] [Google Scholar]
- 21. Cui D, Wilson TD, Rockhold RW, Lehman MN, Lynch JC. Evaluation of the effectiveness of 3D vascular stereoscopic models in anatomy instruction for first year medical students. Anat Sci Educ. 2017;10(1):34‐45. 10.1002/ase.1626 [DOI] [PubMed] [Google Scholar]
- 22. Uruthiralingam U, Rea PM. Augmented and virtual reality in anatomical education—a systematic review. Adv Exp Med Biol. 2020;1235:89‐101. 10.1007/978-3-030-37639-0_5 [DOI] [PubMed] [Google Scholar]
- 23. Mulders M, Buchner J, Kerres M. A framework for the use of immersive virtual reality in learning environments. Int J Emerg Technol Learn. 2020;15(24):208. 10.3991/ijet.v15i24.16615 [DOI] [Google Scholar]
- 24. Sweller J, Van Merriënboer JJG, Paas F. Cognitive architecture and instructional design: 20 years later. Educ Psychol Rev. 2019;31(2):261‐292. 10.1007/s10648-019-09465-5 [DOI] [Google Scholar]
- 25. Taveira‐Gomes T, Prado‐Costa R, Severo M, Ferreira MA. Characterization of medical students recall of factual knowledge using learning objects and repeated testing in a novel e‐learning system. BMC Med Educ. 2015;15:4. 10.1186/s12909-014-0275-0 [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Supplementary Document 1: Multiple choice quiz used to evaluate subjects on spatial head and neck anatomy.