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Successful learning of surgical liver anatomy in a computer-based teaching module

  • Felix Nickel
  • Jonathan D. Hendrie
  • Thomas Bruckner
  • Karl F. Kowalewski
  • Hannes G. Kenngott
  • Beat P. Müller-Stich
  • Lars FischerEmail author
Original Article

Abstract

Aim

To analyze factors influencing the learning of surgical liver anatomy in a computer-based teaching module (TM).

Methods

Medical students in their third to fifth year of training (N \(=\) 410) participated in three randomized trials, each with a different primary hypothesis, comparing two- (2D) and three-dimensional (3D) presentation modes in a TM for surgical liver anatomy. Computed tomography images were presented according to the study and allocation group. Students had to answer eleven questions on surgical liver anatomy and four evaluative questions. Scores and time taken to answer the questions were automatically recorded. Since the three studies used the same 15 questions in the TM, a pooled analysis was performed to compare learning factors across studies.

Results

3D groups had higher scores (7.5 ± 1.7 vs. 5.6 ± 2.0; p < 0.001) and needed less time (503.5 ± 187.4 vs. 603.1 ± 246.7 s; p < 0.001) than 2D groups. Intensive training improved scores in 2D (p < 0.001). Men gave more correct answers than women, independent of presentation mode (7.2 ± 2.0 vs. 6.5 ± 2.1; p \(=\) 0.003). An overall association was found between having fun and higher scores in 11 anatomical questions (p < 0.001). In subgroup analysis, 3D groups had more fun than 2D groups (84.7 vs. 65.1 %; p < 0.001). If given the option, more students in the 2D groups (58.9 %) would have preferred a 3D presentation than students in the 3D group (35.9 %) would have preferred 2D (p  < 0.001).

Conclusion

3D was superior to 2D for learning of surgical liver anatomy. With training 2D showed similar results. Fun and gender were relevant factors for learning success.

Keywords

Liver Hepatic Surgery Education Oncology 

Abbreviations

ANOVA

Analysis of variance

CS

Couinaud segment

CT

Computed tomography

MRI

Magnetic resonance imaging

TM

Teaching module

2D

Two-dimensional presentations

2D+

Two-dimensional CT images presented together with four “key views”

3D

Three-dimensional presentations

3Dr

“Real” three-dimensional presentation, only visible with 3D glasses (red and cyan glasses)

3Dc

Colored three-dimensional presentations

Notes

Acknowledgments

The current study was conducted within the setting of research group SFB/TRR 125 “Cognition-Guided Surgery” supported by the German Research Foundation (DFG).

Author contributions  Müller-Stich BP, Nickel F, Kenngott HG, and Fischer L designed the research; Nickel F, Bruckner T, Kenngott HG, Fischer L, Hendrie JD, and Kowalewski KF acquired the data; Bruckner T, Fischer L, Nickel F, and Müller-Stich BP analyzed and interpreted the data; Nickel F, Kenngott HG, Hendrie JD, and Kowalewski KF drafted the manuscript; Bruckner T, Müller-Stich BP, and Fischer L provided critical revision.

Compliance with ethical standards

Conflict of interest

Felix Nickel, Jonathan Hendrie, Thomas Bruckner, Karl Kowalewski, Hannes Kenngott, Beat Müller, and Lars Fischer declare that they have no conflicts of interest or financial ties to disclose.

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Copyright information

© CARS 2016

Authors and Affiliations

  • Felix Nickel
    • 1
  • Jonathan D. Hendrie
    • 1
  • Thomas Bruckner
    • 2
  • Karl F. Kowalewski
    • 1
  • Hannes G. Kenngott
    • 1
  • Beat P. Müller-Stich
    • 1
  • Lars Fischer
    • 1
    Email author
  1. 1.Department of General, Visceral and Transplantation SurgeryHeidelberg UniversityHeidelbergGermany
  2. 2.Institute for Medical Biometry and Informatics Heidelberg UniversityHeidelbergGermany

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