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



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


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.


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).


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.

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Fig. 1
Fig. 2



Analysis of variance


Couinaud segment


Computed tomography


Magnetic resonance imaging


Teaching module


Two-dimensional presentations


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


Three-dimensional presentations


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


Colored three-dimensional presentations


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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.

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Corresponding author

Correspondence to Lars Fischer.

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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.

Additional information

Parts of this study were presented at the congress of the German Society of Surgery 2014 in Berlin, Germany. The individual results from each of the three randomized trials have been published separately [13].

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Nickel, F., Hendrie, J.D., Bruckner, T. et al. Successful learning of surgical liver anatomy in a computer-based teaching module. Int J CARS 11, 2295–2301 (2016).

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  • Liver
  • Hepatic
  • Surgery
  • Education
  • Oncology