A total of 10 first-year medical students at Campbell University School of Osteopathic Medicine were recruited to participate in the study. Inclusion criteria were students who must be first-year medical students on their first attempt of the anatomy curriculum. All participating students had experience with cadaveric dissection but had yet to complete labs on respiratory gross anatomy and histology. A random number generator (GraphPad Software, San Diego, CA) evenly assigned the 10 recruited students to either control or experimental groups. Students who volunteered in the research activity were given a subscription to Complete Anatomy Student Edition (3D4Medical, Dublin, Ireland).
This study was approved by the Campbell University Institutional Review Board by expedited review procedure as determined by 45 Code of Federal Regulations part 46.111, Categories 6 and 7. Informed consent was obtained by all participants in the study before commencement of research activities.
Anatomical Models and Histology Slides
The Microsoft HoloLens (1st generation) is a MR headset. The headsets were connected to the Internet using Campbell University’s secure wireless network and the program HoloHuman (GIGXR, Venice, CA) was downloaded to each headset. HoloHuman was used to create MR anatomical models (Fig. 1a) used in the experimental group.
Histology slides used in this project came from normal organ teaching sets. Glass slides were scanned to permit virtual microscopy via Aperio ImageScope – Pathology Slide Viewing Software (Aperio, Buffalo Grove, IL). Digital photomicrographs of the desired histology were then imported out of the program as Joint Photographic Experts Group images and placed into a Microsoft PowerPoint (Redmond, WA) presentation. This PowerPoint presentation was uploaded to each HoloLens so participants of the experimental group could view histology in a MR environment (Fig. 1b). The control group viewed glass histology slides using light microscopes (Labomed Lx 400, 912601, Associated Microscope, Elon, NC).
Students in each group completed a 30-min faculty-led learning activity on respiratory gross anatomy and histology. At the beginning of the learning activity, students completed a 14-question pre-activity assessment consisting of 12 multiple choice gross anatomy and histology questions and 2 self-perceived understanding rating scales.
In the control group, an anatomy faculty member demonstrated components of respiratory anatomy on a pre-dissected human cadaver, then a pathology faculty member used light microscopes and glass slides to teach respiratory histology. In the experimental group, an anatomy faculty member demonstrated components of respiratory anatomy on HoloHuman, an application for HoloLens, then a pathology faculty member used photomicrographs, viewed via PowerPoint on the HoloLens, to teach respiratory histology. Each faculty member followed a written script during their respective aspects of the learning activity. The same script and faculty members were used for both control and experimental learning activities.
After completion of each learning activity, students completed a post-activity assessment. This assessment was the same as the pre-activity assessment with addition of a Likert scale. Students were also able to leave written feedback regarding their experience with the learning activity. Lastly, 7 days after the learning activity, participants completed a follow-up assessment. This assessment contained the same content as the pre-activity assessment. The self-perceived understanding rating scales in the pre- and post-activity assessments asked participants to rate their current understanding of respiratory gross and microscopic anatomy (1 for no understanding to 5 for very strong understanding). All assessments were developed and collected using the Qualtrics application (Qualtrics, Provo, UT).