Veterinary Students and Faculty Partner in Developing a Virtual Three-Dimensional (3D) Interactive Touch Screen Canine Anatomy Table

Abstract

As educational technology advances, it is imperative that universities responsibly and appropriately adapt new approaches to enhance teaching and learning. Over a 6-month period, veterinary students at Ross University School of Veterinary Medicine (RUSVM) spearheaded the improvement of a proprietary prototype virtual interactive three-dimensional (3D), touch screen, canine anatomy table (APEX). Eight veterinary students with a grade of 80% or higher in their anatomy courses were hired as research assistants to identify and characterize 306 virtual anatomical structures. Descriptive statistics were used to assess students’ (1) accuracy in reviewing assigned anatomical structures, and (2) perceptions surrounding the use of APEX as an educational anatomical tool. The overall accuracy rating was 3.73 on a 4-point scale, and students reported their experience as enjoyable (median 4 on a 5-point Likert scale) and beneficial to their knowledge of veterinary anatomy (median 4). In addition, 29 RUSVM faculty were surveyed on both the prototype APEX table as well as the student-improved version. Faculty agreement with utilization of APEX in RUSVM curriculum increased from Likert mean = 2.0 to a mean of 3.9 (p = < 0.001) between the two versions. Study results support the use of veterinary students to critically assess the development of anatomical educational tools for veterinary anatomy. Furthermore, students and faculty supported acceptance of technology in teaching and learning veterinary anatomy, and reported enjoyment and benefit of its use.

Introduction

Anatomical proficiency is a demanding task, which requires students to gather, understand, and remember a significant amount of information [1]. This process is often accomplished through detailed cadaveric dissection that supports conceptualizing the inter-system and inter-structural relationships of complex three-dimensional structures [2, 3]. Anatomical learning is further complicated by a student’s limited ability to grasp three-dimensional (3D) relationships between anatomic structures [4, 5]. As the practice of human and veterinary medicine advances, and requires an increasingly extensive and integrated knowledge base, anatomy educators are required to teach additional content [6] to a larger class size while the faculty to student ratio is increasing [7]. These obstacles of anatomy education illustrate the responsibility on universities to continuously evaluate their curriculum and teaching methods, as consequences for patient care are at stake [8].

Although cadaveric dissection has been the mainstay of anatomy learning since the renaissance [9], some of the more traditional methods of anatomy education are being improved, or even replaced, by more innovative techniques [8]. Aspiration for reduced dependence upon cadaveric dissection for anatomy education stems from the challenges surrounding moral judgements, practical and financial implications, and safety and environmental concerns associated with chemical preservation of tissue [10]. Additionally, veterinary students may suffer the same emotional effects associated with human cadaveric dissection including anxiety, [11] revulsion, [12], and stress [2]. Consequently, animal used in veterinary education and research has decreased significantly in recent years [13, 14] as more universities explore alternate techniques of teaching anatomy [15, 16].

Each student employs their own unique study method to learn most effectively [17], and traditional teaching via dissection and lecture may be enhanced by supplementation of novel learning mechanisms [18, 19]. Therefore, the most powerful and effective way to utilize computer-assisted learning (CAL) resources is to apply them in concert with other educational methods [20]. In these circumstances, students have shown significantly improved conceptual and spatial understanding of anatomy via CAL interventions [21].

There is increasing evidence that simulation-based healthcare education tools lead to superior outcomes compared with traditional clinical education alone [22]. Computer-assisted learning in anatomy courses tend to receive favorable responses from students [20]. Student enjoyment, enthusiasm, and engagement contribute to the efficiency of student learning [23], so it is logical to understand why CAL is a rapidly growing field and many universities are already supplementing their anatomy courses with CAL software [18, 24, 25].

Technology is advancing quickly within medical education with anticipation for continued production of three-dimensional virtual dissection programs in the future [7]. For example, using QuickTime to view anatomic specimens in virtual reality [18] and utilizing virtual reality to practice surgical skills [26]. Given its virtues of novel perspectives, increased portability, longevity, and standardization between students, previous studies support utilization of CAL in anatomy education [27]; however, development of these learning tools may require a significant investment of time, financial venture and expertise [28]. Regardless, anatomy instructors should take advantage of the latest technological advances in imaging and visualization methods to enhance their teaching [7]. One area of this subject that has remained relatively unexplored is the potential benefit of engaging students toward the development of their own CAL learning tool.

This study assessed the use of student assistance in the development of a virtual interactive three-dimensional (3D) touch screen anatomy table. Specifically, it involved third semester veterinary students in identifying and describing anatomical structure inaccuracies of the prototype APEX program for incorporation into an updated version of the software. It was hypothesized that students’ engagement in identifying anatomic inaccuracies of the rudimentary prototype virtual anatomy program and their perceptions of the APEX table would be beneficial and positive. Furthermore, it was hypothesized that the RUSVM faculty would recognize the enhancement in accuracy and fidelity of APEX anatomy after student-assisted development and that their perceptions of the APEX table would improve.

Materials and Methods

Anatomy Curriculum

The RUSVM anatomy curriculum is divided between two courses, taught over the first and second semesters. Each anatomy course is worth 4-credits administered over a 15-week semester. First semester anatomy consists of 85 student contact hours (21 h lecture and 64 h laboratory), while the second semester course consists of 76 student contact hours (28 h lecture and 48 h laboratory). The student to instructor ratio during each two-hour laboratory session is approximately 28:1. Students take advantage of textbooks, lecture materials, prosections, faculty assistance, and a proprietary lab guide to help direct their dissection and understanding of each anatomic structure. The canine specimen is dissected over the two semesters of gross anatomy in a regional and organ system approach. Two text books are utilized: Textbook of Veterinary Anatomy [29] and Guide to the Dissection of the Dog [30].

APEX Table

APEX is the name given to a proprietary prototype educational tool created specifically for use at RUSVM, and is not currently commercially available. The table was built on a 55-in. pedestal frame incorporating a TablerTV™ touch overlay supporting more than 100 simultaneous touch points (Fig. 1). It is powered by a custom Windows™ computer with high speed simulation capability and graphic fidelity. The APEX table allows integration to audio-visual systems through externally routed HDMI, audio, and USB ports. The program allows students to virtually dissect a 3D virtual canine model through touch responsive sliding of volumized anatomic structures as well as removal and/or replacement of individual organs, organ systems, or specific anatomic structures (Fig. 2). Interaction with the table is through finger touch gestures on the surface of the screen. Each unique anatomic structure may be selected to bring up an identification label and a concise text description of the structure.

Fig. 1.

A proprietary prototype educational tool

Fig. 2.

A 3D virtual canine model

The preliminary virtual canine cadaver images were produced by computer artists with no veterinary or anatomical expertise. All images were created by free-hand graphic design artists and without diagnostic imaging techniques to use as a template. Consequently, many structural representations were anatomically inaccurate and/or inappropriately labeled, while other structures were completely missing. The development of the APEX prototype-engaged computer animators in creating rudimentary anatomy structures with anticipation of future refinement by anatomists. The images for the 3D assets of the APEX table (virtual dog) were created with Autodesk 3DS Max© and/or Autodesk Maya© to develop the shape, and Adobe Photoshop© to create the texture and color. All of the 2D assets (buttons and other flat user interface items) were created in Adobe Photoshop© and/or Adobe Illustrator©.

Participants

All participants were asked to read and sign an informed consent form prior to the start of the study. Standards, guidelines, and approval for the use of student cohorts relative to this research were administered by the RUSVM institutional review board (IRB).

Student Participants

During the summer semester at RUSVM (May 9–August 18, 2016), eight third-semester students were hired as research assistants from a volunteer applicant pool who had successfully completed both of the RUSVM gross anatomy courses with a grade of 80% or higher. Success in RUSVM anatomy curriculum was used as selection criteria.

Faculty Surveyed

All RUSVM Faculty with a DVM or VMD degree, as well as those with a PhD that routinely apply veterinary anatomy were invited via email to provide survey perceptions of the APEX table. Thirty-two faculty members initially volunteered but only 29 completed both surveys.

Assessment of Student Critique

At the start of this study, students were informed that the anatomic accuracy of the virtual canine was not dependable. The students were asked to critique the APEX program by providing the following: (1) identification of an assigned anatomic structure, (2) description of the structure as found in their provided texts, and (3) a critique of the virtual structure’s anatomic accuracy in relation to size, shape, location, and association to other surrounding anatomic features. Structures which students were tasked to label were from a list of required learning objectives for the musculoskeletal system of the fore and hind limbs for the first semester RUSVM veterinary anatomy course. Each student was randomly allocated 50 structures to label as time permitted in the study. Each student devoted a minimum of 15 total hours to the labeling process. The number of labels produced per student, time spent on each label, and accuracy of the 3D representation and description were evaluated. Student-submitted corrections of anatomic structures were incorporated into an improved version of APEX by computer programmers, digital artists, and one the authors (WBL).

Survey Tools

Faculty were asked to complete a survey following each of their interactions with APEX, where their opinions of the prototype and the student-improved version were assessed. Faculty surveys collected perceptions via Likert style statements regarding the following: (1) general attitude and experience surrounding CAL tools, (2) perceived educational value of CAL tools compared to cadaver dissection, and (3) accuracy, fidelity and content of APEX table.

Students were asked to complete pre and post APEX interaction survey. The surveys consisted of Likert style statements about their opinion and interaction with the APEX table in four categories of interest: (1) general attitude and experience surrounding CAL tools, (2) perceived educational value of CAL compared to other learning resources, (3) consequences of the APEX prototype’s lack of accuracy, and (4) educational benefits associated with the APEX table.

All surveys were adapted from those developed to evaluate another computerized anatomy education tool by Linton et al. [31]. Surveys were administered online over a secure RUSVM website using E*Value™ software [32]. Although our student cohort critiqued APEX as editors rather than utilization for anatomic education, the authors shared the objective with Linton et al. to quantify student perceptions.

Statistical Analysis

Quantitative data entry of Likert responses and label scores were composed using Microsoft Excel™ in which descriptive results such as means, median, and standard deviations were calculated for each question amongst the cohort. Due to the small sample size (eight students), the median Likert response was utilized for aggregate answers. Likert scale responses were considered to be in disagreement with the statement if the median score was 2 or less, neutral if the median score was 3 and in agreement with the statement if the median score was 4 or more. To compare faculty perceptions of the initial prototype versus the student-improved APEX table, a Paired Wilcoxon test was performed on Likert survey responses. A value of p < 0.05 was considered to be statistically significant.

Each student-derived label was graded by one researcher (WBL) using a four-point scale where 4 was excellent. The scale reflected the accuracy of the student’s textual description of each specific anatomic structure, as well as the student’s critique of its 3D anatomic location, size, and shape. The grading rubric is shown in Table 1.

Table 1.

Student label evaluation rubric

	Description of student label
Score	Structure identification is anatomically accurate	Text description of structure is thorough and correct
4.0	Yes	Yes
3.0	Student label needs minor modification to identification or text description to be complete and accurate.
2.0	Either Identification or text description is wrong (but not both)
1.0	No	No

Results

Student Labels

Students evaluated 306 structures on the prototype APEX table. The ability of students to correctly critique the accuracy of the prototype virtual cadaver anatomy was excellent with an average score of 3.7 out of 4.0 (Table 2).

Table 2.

Student average time required for each label produced and mean score

	Number of structures	Time (min)	Mean score	Standard deviation
Thoracic limb bones	100	8.3	3.9	0.46
Thoracic limb muscles	56	10.0	3.7	0.59
Pelvic limb bones	111	9.2	3.8	0.57
Pelvic limb muscles	39	16.0	3.6	0.63
All structures	306	9.9	3.8	0.55

Student Pre Interaction Survey

All students (n = 8) responded to the pre- and post-interaction surveys. A summary of pre-interaction Likert scale survey responses is provided in Table 3. Prior to their interaction with the APEX table, students generally enjoyed CAL (median = 4), and were excited about using the APEX table (median = 5). They reported strong disagreement with using CAL in place of hands on dissection (median= 1), and overwhelmingly agreed that CAL cannot completely replace cadaver-assisted anatomy education (median = 4.5).

Table 3.

Student Likert response for Pre APEX table interaction survey (N = 8)

	Likert scale question
Category	What is the general attitude and experience with CAL educational tools and the virtual anatomy table?	Median	Range
1	Computer assisted learning was commonplace in my undergraduate studies.	2	1–5
1	I relied heavily on computer assisted resources during my previous education.	2	1–5
1	I enjoy computer assisted learning.	4	3–5
1	I could happily do without computer assisted learning.	2	1–4
1	I think students would benefit by having all learning resources computerized.	2.5	1–5
1	I am excited about using the APEX table.	5	5
Category	What is the perceived educational value of the virtual anatomy table in relation to other learning resources?	Median	Range
2	I would rather use computer assisted learning than paper text.	3	2–5
2	I would rather use computer assisted learning than attend live lectures.	2	1–5
2	I would rather use computer assisted learning than hands on experience of cadaver dissection.	1	1–2
2	I wish I could have more of my educational resources provided in computerized from, rather than more traditional forms like text, live lectures and laboratory exercises.	2	1–5
2	I wish that all of my learning resources were in hard copy text supplemented with hands on experience.	3	1–5
2	I think that there is no substitute for hands on experience no matter how realistic a computerized simulation may be for learning.	4.5	4–5
2	I think that computerized resources should be used as a supplement to traditional learning resources such as text, live lectures and laboratory exercises, but should never replace them.	4	2–5
2	I think that computerized resources should replace some, but not all, traditional learning resources like text, live lectures and laboratory exercises.	4	3–5
2	I would like the APEX table (or a similar program) to completely replace traditional cadaver assisted anatomy learning in the future.	1	1–2
2	I do not believe the APEX table (or a similar program) could ever completely replace cadaver assisted anatomy education.	4.5	3–5
2	I believe a mixture of traditional cadaver assisted anatomy lessons parallel and complementary to computer assisted learning would be the best possible experience for my education.	5	4–5

Likert scale; 1 = strongly disagree, 2 = disagree, 3=neutral, 4=agree, 5=strongly agree

Student Post-Interaction Survey

Survey results are summarized in Table 4. Utilization of the APEX table was found to be enjoyable (median = 4), beneficial to their knowledge of anatomy (median = 4), and agreed that it would have been helpful to have an APEX table application for their mobile device to study from while enrolled in the anatomy courses (median = 4). Students indicated that they would recommend use of the APEX table to future anatomy classes (median = 4.5). Once more, students strongly disagreed with the ability of CAL to completely replace the use of canine cadavers for anatomic education in the future (median = 1).

Table 4.

Student Likert response for post APEX table interaction survey (n = 8)

	Likert scale question
Category	1) What is the general attitude and experience with CAL educational tools and the virtual anatomy table?	Median	Range
1	I enjoyed using the “APEX” table.	4	3–5
1	I appreciate that the “APEX” table could help to reduce the number of canine cadavers needed for anatomy instruction.	3	1–5
1	I appreciate the ability of the “APEX” table in reducing the environmental consequences of chemically preserved cadavers for anatomy education.	3	2–5
1	I would recommend using the “APEX” table in future RUSVM anatomy classes.	4.5	1–5
1	If I had access to the “APEX” table when I was taking the anatomy courses, I would not have had enough time to spend with the “APEX” table because there are so many other anatomy learning resources provided in the veterinary anatomy course curriculum.	2	1–3
Category	2) What is the perceived educational value of the virtual anatomy table in relation to other learning resources?	Median	Range
2	I believe that computerized learning models and simulation should completely replace the use of canine cadavers for anatomic education in the future.	1	1–2
2	There are already enough computerized anatomy learning resources available for study and I feel that the addition of the “APEX” table is an unnecessary burden to the anatomy study load.	1.5	1–3
2	I found the “APEX” table more useful than some of the other electronic anatomy learning resources provided in the course.	4	4
2	I would have preferred to spend more time with the “APEX” table rather than some of the other computer assisted resources provided when I was taking the veterinary anatomy course.	3	1–4
Category	3) What is the consequence of the prototype virtual anatomy table’s lack of accuracy?	Median	Range
3	I predict the “APEX” table will be more useful when the detail, accuracy and fidelity are increased with advancement in software.	4.5	4–5
3	I would like to see the “APEX” table brought to a higher level of fidelity and accuracy.	5	4–5
3	Even though the fidelity and accuracy of the “APEX” table was not perfect, I found its use to be beneficial to my overall knowledge.	4	4–5
3	The “APEX” table obviously lacks the detail of a cadaver canine specimen and I found these imperfections to be a significant hindrance to my learning.	2	2–5
3	The anatomic inaccuracies of the table made it difficult to increase my anatomic knowledge from the “APEX” table.	2.5	1–4
3	I believe I would have learned more anatomy if I could have interacted with a “APEX” table that was anatomically perfect.	4	2–5
Category	4) Will the virtual anatomy table be an educational benefit?	Median	Range
4	The “APEX” table was beneficial to my knowledge of veterinary anatomy.	4	3–5
4	I believe the “APEX” table and other virtual learning tools will be an essential part of anatomy education in the future.	4	3–4
4	It would have been helpful to have a “APEX” table application for my mobile device when I took the RUSVM anatomy courses.	4	3–5
4	If there were an application for my mobile device that was similar to the “APEX” table, I would use it as a study aid for future veterinary courses.	4	4–5
4	After spending over 15 h with the “APEX” table, I feel my canine anatomic knowledge is significantly improved.	4	3–5
4	Discovering and rectifying the anatomic inaccuracies within the “APEX” table improved my anatomic knowledge.	5	4–5
4	I believe I learned more anatomy from discovering and fixing inaccuracies within the table, than I would have if the table were anatomically perfect.	4	2–5
4	I believe my experience with this version of the “APEX” table will be helpful for my future education and career.	4	4–5

Likert scale; 1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, 5 = strongly agree

Faculty Survey Post-Interaction with the Prototype APEX Table

Survey responses have been cumulated in Table5. Likert scale responses reveal that faculty were in disagreement with the statement that the prototype version of the APEX table was ready to be integrated into the RUSVM curriculum (mean = 2.0). Despite faculty’s general discontent with the initial prototype, they believed that this type of 3D, virtual anatomy model could be an excellent benefit to anatomy students in the future (mean = 4.3). Faculty agreed that the “APEX” table (or a similar program) could never completely replace cadaver based anatomy education (mean = 4.00).

Table 5.

Faculty survey Likert response and p value comparisons of means between prototype and improved APEX perceptions

		Perceptions of prototype (n = 32)		Perceptions after students’ improvements (n = 29)
Category	Likert scale question	Mean	Standard deviation	Mean	Standard deviation	p value (paired Wilcoxon of means)
Category	Category 1) What is the general attitude and experience of the APEX table?
1	I enjoyed using the virtual anatomy table.	3.6	0.8	4.3	0.6	< 0.001
2	Category 2) What is the perceived educational value of CAL and the APEX table in relation to other learning resources?
2	I do not believe that the “APEX” table (or a similar program) could ever completely replace cadaver based anatomy education.	4.0	1.1	4.4	0.8	0.04
2	I believe that a mixture of traditional cadaver based anatomy lessons parallel and complementary to computer based learning would be the best possible option for promoting anatomy education.	4.6	0.6	4.7	0.6	0.6
3	Category 3) Is the accuracy, fidelity and content of APEXL table suitable for this anatomy course?
3	I believe the “APEX” table is ready to enter into the RUSVM curriculum, in its current state of fidelity, anatomic accuracy and content.	2.0	1.2	3.9	0.7	< 0.001
3	I believe this type of three-dimensional, virtual anatomy model will be an excellent benefit to anatomy students in the future.	4.3	0.7	4.5	0.6	0.4
3	I am concerned that a student could learn incorrect anatomy because of the “APEX” table’s inaccuracies.	3.2	0.9	2.2	0.7	< 0.001
3	The “APEX” table has great potential; however it is not ready for implementation into the RUSVM curriculum.	3.8	1.0	Not applicable
3	The virtual anatomy table looked realistic enough to learn the thoracic and pelvic limb anatomy effectively.	Not applicable		4.0	4.4	0.6
3	This new version of the virtual anatomy table exhibits more accurate anatomy of the thoracic and pelvic musculoskeletal structures than the previous version.	Not applicable		5.0	4.6	0.5

Likert scale; 1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, 5 = strongly agree

Faculty Survey Post-Interaction with Student-Improved APEX Table

The second survey was completed by 29 (90.63%) of the original volunteers. Faculty noted that the improved APEX table exhibited more accurate anatomy of the canine thoracic and pelvic limb musculoskeletal structures (mean = 4.6), and that the represented anatomy looked realistic enough to effectively promote learning (mean = 4.4). Concerns that students could learn incorrect anatomy because of the “APEX” table’s inaccuracies significantly decreased (from mean 3.2 to 2.2, p < 0.001).

Faculty indicated that the updated version of the virtual anatomy table was ready to be integrated into the RUSVM curriculum to supplement teaching of musculoskeletal structures of the thoracic and pelvic limb (mean = 3.9), which was significantly improved over their perceptions of the prototype version (p < 0.001).

Discussion

The results of this study demonstrate the value of involving veterinary students in the development of the RUSVM APEX table. Students’ efforts in identifying and describing inaccurate anatomical structures resulted in the correction of 306 anatomic structures on the APEX prototype with excellent precision. This improvement in accuracy achieved by the students can potentially alleviate some of the aforementioned issues surrounding the production of learning tools recognized previously, including investment of time, money, and expertise [33].

Students and faculty reported a generally positive experience with the APEX table. Furthermore, participants reported a positive perception toward its accuracy, content, and overall benefit toward facilitating the learning of veterinary anatomy. Statistically significant improvements were noted in faculty perceptions of the improved version of APEX table with respect to readiness for incorporation into the curriculum (p = < 0.001) and decreased concern for inaccuracies (p = 0.001) in comparison to the prototype. These findings are similar to other studies which have shown CAL to be enjoyable by students [4, 34, 35], effective [18], and well accepted in delivery of anatomic information [36–38]. This type of learning technology may facilitate discovery of important material, mental organization of the subject, and assimilation of knowledge [39].

Although student and faculty perceptions regarding the effectiveness of the APEX table were positive, participants in this study were opposed to the concept of replacing cadaveric dissection with a virtual learning resource. The forward-looking survey questions in this study were created to discover the extent of student and faculty acceptance in supplementing traditional cadaveric dissection with virtual anatomy tools. Computer models have been shown to rely heavily on the user’s own innate visuospatial capabilities [40] making the design of a universally effective computer-based resource problematic [41]. In agreement with previous literature [38], it is the authors’ opinion that CAL programs should not replace traditional methods of teaching anatomy. We believe that hands on dissection is an essential part of veterinary anatomy education.

Virtual anatomic simulation offers an attractive option to circumvent some of the vast challenges affecting traditional veterinary anatomy education [10]. As there is no single anatomy teaching strategy proven to be superior to all others, instructors must enhance students’ academic achievements by maintaining flexibility in their teaching techniques [17]. The goal of educational research should not be to determine higher acceptance or effectiveness of one teaching methodology over another but rather to most efficiently utilize the learning benefits available from each teaching method [42]. This premise may explain the great variation in responses received when students were asked if they would have learned more had they interacted with an APEX table that was anatomically perfect. These results also suggest that involving students in the development of teaching resources may be a useful learning technique.

A few limitations associated with this project exist. This study used a relatively small cohort of paid student assistants, and by definition may not have been completely representative of the class as a whole. We acknowledge that these results do not address the effectiveness of the APEX tool in enhancing student understanding or exam outcomes and emphasize that the focus of the current study is to determine the feasibility of student efforts in the development of virtual anatomy educational tools.

Although the results of this study may not be unexpected regarding students’ ability to correctly identify anatomic inaccuracies, it is noteworthy to describe a proven mechanism by which students may be used to assist in the development of CAL and how to objectively measure their accuracy. We understand that CAL technology may be financially limiting as a developmental venture as well as acquisition of commercially available products. By utilizing student efforts during development of CAL, perhaps some financial burden may be limited.

Judgements about computer-based learning tools vary widely, and it is clear that much work is left to be done, both in developing and in evaluating new instructional systems [20, 43, 44]. Future work is necessary to assess the effect of the APEX table interaction on student anatomy examination outcomes. Continued evaluation is also warranted to assess if virtual anatomy tools can decrease student dependence upon instructors during laboratory dissection, if knowledge attained with this resource is retained over longer periods of time, and if that knowledge is transferable to other courses of study.

Conclusions

Involving veterinary student assistants offers a novel approach to the development of veterinary anatomy teaching resources. Although students have been co-producers of their educational tools in the past, this study specifically addresses student evaluation as the driving force of CAL development. Students accurately identified and documented where the virtual cadaver required improvement. In regard to their experience with the APEX table, students overwhelmingly reported that the experience was enjoyable as well as helpful to their education.

RUSVM faculty perceptions overwhelmingly supported the use of the APEX table indicating that the student-improved version of the software exhibited accurate anatomy and fidelity and was ready to be incorporated into the RUSVM anatomy curriculum. Virtual simulation offers an ethical, safe and novel method of enhancing the teaching of veterinary gross anatomy. Further research is indicated to assess students’ examination outcomes following the use of APEX table.

Funding Information

Funding for this project was provided by an intramural grant from Ross University School of Veterinary Medicine Center-4, Research and Innovation in Veterinary and Medical Education.

Compliance with Ethical Standards

All participants were asked to read and sign an informed consent form prior to the start of the study. Standards, guidelines, and approval for the use of student cohorts relative to this research were administered by the RUSVM institutional review board (IRB).

Conflict of Interest

The authors declare that they have no conflict of interest.

This manuscript does not contain images, tables or figures which are under copyright. All authors have read and accept responsibility for this manuscript.