Abstract:

Introduction:
Learning anatomy faces significant challenges when delving into intricate structures such as the Middle Ear due to the difficulty of preserving its complex anatomic landmarks in cadaveric materials and its small size. Novel technologies like Virtual Reality (VR) could potentially enhance the anatomical learning of the middle ear. This pilot study investigated whether the use of VR for learning Middle Ear anatomy is equivalent or non-inferior to traditional teaching methods.

Methodology:
This comparative cross-sectional study examines the effects of different anatomy teaching practices by analyzing data collected from two medical student groups simultaneously. After developing the VR scenario, an Expert (Anatomy Faculty) reviewed and validated it. Medical students were recruited during their remote instruction in 2021-2022 by voluntary enrollment, with previous informed consent. They were randomly divided into VR (n=21) and non-VR groups (n=18), stratified by Age, Gender, and Comfort with technologies. The voluntary teaching experience had three steps. First, an online synchronous session through Zoom where both groups attended an introductory Middle Ear Anatomy class. Second, a guided question-and-answer exercise where students were divided into two groups (VR and non-VR) to solve a study guide with questions about the middle ear helped by either the VR scenario in the VR group, or with the traditional methods, 2D images, and textbooks, in the non-VR group. And finally, a written assessment using a questionnaire with multiple choice questions to evaluate their learning outcomes from this activity.

Results:
Our findings revealed that VR was non-inferior to traditional methods in terms of overall scores in the final questionnaire. However, in one spatial and one factual question, students in the VR group had higher accuracy (57.14% and 85.71%) than the non-VR group (22.2% and 55.56%; p= 0.0291 and p=0.0395 respectively).

Discussion and Conclusion:
While some studies on 3D models suggest a superiority of these technologies compared to traditional teaching methods, our findings align with VR studies showing equivalence or non-inferiority. About the strengths of our research, it is noteworthy that the design of the VR scenario was centered on one of the main difficulties students experience while learning this basic science crucial in undergraduate medical education. Also, the implementation in a non-English-speaking country. Some limitations worth mentioning include the small sample size, the necessity to use computers/smartphones instead of proper VR headsets due to the pandemic, limited exposure time that may not lead to a significant impact on the learning of the students, and the limitation of using multiple-choice examinations, which may not fully capture the benefits of VR in enhancing spatial abilities. Future research aims for a larger-scale multicentered study with an improvement of the scenario assisted by otolaryngologists with experience in Ear surgeries and integrating this VR scenario into a formal anatomy course for a more comprehensive impact assessment.

This study serves as an initial exploration into using VR technology to enhance the understanding of complex and small anatomical structures, such as the Middle Ear. Despite its limitations, this study highlights VR’s potential as an effective learning tool, paving the way for a broader implementation and more thorough impact evaluation in future research.

Keywords:

Middle ear, Anatomy, Virtual Reality, Medicine, Education, Otolaryngology.