Due to the COVID‐19 pandemic, there is increased interest to effectively deliver educational curricula remotely to diverse student populations. Case‐based cadaveric MRI visualization and extended reality (XR) technology enhances learning experiences in medicine. The purpose of this study was to demonstrate that a virtual, multi‐departmental workflow utilizing MRI, XR technology, and a “patient” group, represented by the John A. Burns School of Medicine (JABSOM) Willed Body Program, supplements case‐based learning and promotes student exploration and engagement equally in cross‐cultural cohorts represented by American and Turkish medical students. Virtual case‐based learning activities were developed and presented to American medical students at JABSOM and Turkish medical students, selected based on education and English proficiency, via Zoom. Subject, medical history, and physical exam data were presented to students who were then divided into breakout rooms where hypotheses regarding cadaveric, neurological findings were generated. Students then reviewed radiology and pathology reports and accessed relevant 3D segmented, photogrammetric and illustrative models. An optional survey was completed to evaluate student opinion based on a 5‐point Likert scale. Comparisons between groups were performed using a non‐parametric Mann‐Whitney U test. Data was reported as mean, median (min‐max), and percentile. Significant differences (two‐tailed P) less than 0.05 were significant. Results revealed significant differences between American (n=40) and Turkish (n=16) student opinion. The Turkish scale was significantly higher when asked if MRI scans of cadavers were useful as online learning tools (p =0.002), if MRI scans of cadavers provided an understanding of relevant anatomy (p<0.001), if 3D models provided a better understanding of anatomical relationships (p<0.001), whether students would like more interactive sessions using MRI scans (p<0.001), and if students would use similar resources in the future (p<0.001). The American scale was higher when asked if students were able to communicate effectively with their breakout groups (p=0.037). The learning activity was positively received by both cohorts as shown by no average score less than a 4 out of 5 for each question. The American scales may have been lower due to having previous experience with similar activities, whereas the learning activity was novel and exciting to Turkish students. Differences in communicating effectively in breakout rooms can be explained by the fact that American students were broken into longitudinal dissection groups, whereas Turkish students were randomly assigned. Based on these results, case‐based learning, utilizing MRI and XR technology, enhances the learning experience of medical students and can be expanded to cross‐cultural student populations.
Anatomical analysis of conjoined twins provides important information concerning embryological development. Museum specimens provide a unique sample that can be analyzed non‐intrusively using advanced biomedical imaging and displayed online which is currently important due to limited in‐person learning opportunities as a result of the COVID‐19 pandemic. The purpose of this study is to create an extended reality (XR) workflow for visualization of dicephalic parapagus full‐term conjoined twins obtained by Dr. Jacob Henle sometime between 1844‐1852 for use in anatomy education. The workflow comprised image capture, segmentation, and visualization. The cadaver twins were curated at the University of Heidelberg and were subjected to CT and MR imaging. Relevant bones and soft tissues were manually segmented to create XR models, post‐processed for visualization using Unity‐based systems. A learning module was created and posted to Rad3d.com for presentation to students including visualization on Z‐space computers (zspace.com) and sketchfab.com online. Osteology analysis showed commonality in the upper limb and shared ribs. Two vertebral columns were identified, and a single pelvic girdle was present with a single set of lower limbs. Duplicated supradiaphragmatic structures included two hearts (one with situs inversus) and four lungs, but single subdiaphragmatic visceral organs were observed. In particular, the gut was continuous on the right, but terminated at the distal esophagus on the left. One large liver occupied the abdomen with one large spleen located on the left. These observations suggest zygote fission was blocked near the yolk sac during midgut formation, but with secondary fusion of midline upper extremities and ribs. A radiology report was developed and presented to medical students as an embryology clinical correlation. This application indicates that university based museum specimens are useful as supplemental instructional subjects and, in this case, almost 170 years after arriving in the Department of Anatomy at the University of Heidelberg.
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