A Scoping Review On The Trends of Digital Anatomy Education

Received: 22 July 2022 Revised: 11 December 2022 Accepted: 12 December 2022
DOI: 10.1002/ca.23995
REVIEW
A scoping review on the trends of digital anatomy education
Sharmeen Adnan 1 | Junhua Xiao 1,2
1
Department of Health Sciences and
Biostatistics, School of Health Sciences, Abstract
Swinburne University of Technology,
Digital technologies are changing the landscape of anatomy education. To reveal the
Hawthorn, Australia
2
School of Allied Health, La Trobe University,
trend of digital anatomy education across medical science disciplines, searches were
Bundoora, Australia performed using PubMed, EMBASE, and MEDLINE bibliographic databases for
Correspondence
research articles published from January 2010 to June 2021 (inclusive). The search
Junhua Xiao, Department of Health Science was restricted to publications written in English language and to articles describing
and Biostatistics, School of Health Sciences,
Swinburne University of Technology,
teaching tools in undergraduate and postgraduate anatomy and pre-vocational clinical
Hawthorn, Victoria 3122, Australia. anatomy training courses. Among 156 included studies across six health disciplines,
Email: jxiao@swin.edu.au
35% used three-dimensional (3D) digital printing tools, 24.2% augmented reality (AR),
22.3% virtual reality (VR), 11.5% web-based programs, and 4.5% tablet-based apps.
There was a clear discipline-dependent preference in the choice and employment of
digital anatomy education. AR and VR were the more commonly adopted digital tools
for medical and surgical anatomy education, while 3D printing is more broadly used
for nursing, allied health and dental health education compared to other digital
resources. Digital modalities were predominantly adopted for applied interactive
anatomy education and primarily in advanced anatomy curricula such as regional
anatomy and neuroanatomy. Moreover, there was a steep increase in VR anatomy
combining digital simulation for surgical anatomy training. There is a consistent
increase in the adoption of digital modalities in anatomy education across all included
health disciplines. AR and VR anatomy incorporating digital simulation will play a
more prominent role in medical education of the future. Combining multimodal digital
resources that supports blended and interactive learning will further modernize anat-
omy education, moving medical education further away from its didactic history.
KEYWORDS
3D printing, anatomy, apps, augmented reality, digital anatomy, medical education, simulation,
virtual reality
1 | I N T RO DU CT I O N (VR) and augmented reality (AR) are used and embraced to support
the study of the human body and healthcare delivery, has advanced
Anatomy is the prerequisite for medical education. Over the past and matured. VR uses an individual's sense of sight, hearing, and
10 years, digital anatomy education, where the technologies of the motion to fully immerse them in a simulated 3D environment that
three-dimensional (3D) reconstruction of human body, virtual reality mimics the real-world properties using head-mounted displays, stereo
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© 2022 The Authors. Clinical Anatomy published by Wiley Periodicals LLC on behalf of American Association of Clinical Anatomists and British Association of Clinical
Anatomists.
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472 ADNAN AND XIAO
headphones, and motion tracking systems (Moro et al., 2017). In the enhance anatomical education across multiple health disciplines
health education world and particularly for anatomy education and (Pringle & Paul, 2018). Digital approaches are being combined with
surgical training, VR allows for practical learning experience and acqui- the blended learning for lectures and practical applied classes (Xiao &
sition of factual and spatial anatomy knowledge (ZhaoJ et al., 2020). Adnan, 2022).
AR is a technique that permits users to superimpose virtual objects on The application of anatomy teaching using digital modalities
physical objects and allows interaction with both simultaneously extends beyond undergraduate courses toward postgraduate pre-
(Iwanaga, Loukas, et al., 2021; Taylor et al., 2022) Mixed reality (MR) vocational and vocational healthcare trainings (Wickramasinghe
can be considered as a subcategory of AR that adds an additional layer et al., 2022). AR and VR modalities with improved fidelity in anatomy
of interactivity by merging the real and virtual worlds to create ele- have been successfully incorporated for not only medical and allied
ments of new environment and visualization in front of the user health education (Bork et al., 2019; Brewer et al., 2012; Darras
(Taylor et al., 2022). The physical and digital objects co-exist as the et al., 2020) but also operative skill trainings involving endoscopy
individual looks through a head-mounted device. The rapid develop- (Alwani et al., 2020; Breimer et al., 2017; Dharmawardana et al., 2015;
ment of medical and digital technologies opens new opportunities Haerle et al., 2013; Khan et al., 2018; Walsh et al., 2012), laparoscopy
that allow anatomy education to overcome ethic constraints, technical (Aoki et al., 2020) and robotics (Bhandari et al., 2020). Moreover, realis-
variations, and geographic barriers. Indeed, anatomical education is tic digital simulation such as haptic feedback are being applied to a
shifting toward a greater focus on adopting digital technologies and wide range of surgical training including ear, nose or throat (Huang
blended learning strategies (Drake et al., 2009; Uhl J-FJ et al., 2021; et al., 2015; Piromchai et al., 2015), orthopedic (Brouwers et al., 2020),
Wickramasinghe et al., 2022). This is a continuously evolving process vascular (Agarwal et al., 2012), ophthalmic (Chhaya et al., 2018; Famery
and has been further accelerated by the recent COVID-19 pandemic et al., 2019; Pahuta et al., 2012) and neurosurgeries (Clifton
(Xiao & Evans, 2022). et al., 2020; Coelho et al., 2020; Haerle et al., 2013; Morone
Anatomical knowledge, pre-requisite for medical and health sci- et al., 2019; Yudkowsky et al., 2013). AR or VR anatomy teaching
ence courses and effective clinical skill practice, is either delivered as shows clear benefits of improving surgical confidence (Locketz
discipline-specific courses (health science or biomedical science) or et al., 2017) and performance (Yudkowsky et al., 2013) in complex con-
medical/healthcare-specific training sequences (combined human ditions such as neurological and cardiovascular diseases (Stromberga
anatomy, clinical/operative skills and/or surgical anatomy). Under- et al., 2021). A clear benefit of digital anatomy simulation reported by
standing the 3D nature of the human body structure and function is health professionals is that it increases the confidence (Locketz
imperative for effective clinical practice. In this context, digital anat- et al., 2017), and performance (Yudkowsky et al., 2013), postinterven-
omy modalities create numerous opportunities to enhance aspects of tion knowledge and skills (Gerup et al., 2020; Kyaw et al., 2019; Zhu
medical and healthcare foundation courses and subsequent profes- et al., 2014) of operative performance, particularly pertinent for novice
sional training. A diverse range of digital technologies including the trainees (Linke et al., 2013; Yudkowsky et al., 2013).
AR, VR, 3D printing, web-based programs and tablet-based apps with Despite the growing importance of digital anatomy teaching in medi-
supplementary features have been established and actively implemen- cal education and its benefits to both students and educators, it remains
ted in an array of anatomy courses and operative skill trainings across unclear, however, where the adoption of digital anatomy modalities is
multiple disciplines (Uhl J-FJ et al., 2021; Wickramasinghe trending across different health disciplines and whether there is a disci-
et al., 2022). The metaverse is another immersive platform that is used pline preferred digital approach for anatomy education. The present
as a mainstream technology in many industries including but not lim- study reviewed the literature published in the past 10 years with the aim
ited to entertainment, gaming, business and education and has only to identify the overall trajectory of digital modalities adopted for teaching
recently gained recognition in healthcare (Iwanaga et al., 2022). It is a human topographic anatomy across multiple health disciplines including
new concept that aims for immerse experience with the help of VR medicine, surgical training, dentistry, nursing, allied health, health and bio-
headsets, AR goggles, artificial intelligence, smartphones, tablets, and medical sciences. This study comprehensively analyzed the published lit-
more (Iwanaga et al., 2022; Rahaman, 2022). It is a VR world indepen- erature that explored digital anatomy teaching tools among
dent of the real world where people can socialize, engage, interact, undergraduate and postgraduate courses across six health disciplines.
and manipulate their environment using avatars (Iwanaga et al., 2022). Here we will summarize recent findings and present emerging trends for
Virtual dissection resources including the virtual dissection table (Bru- anatomy education adopting digital technologies.
coli et al., 2020), multimedia dissector and the virtual human dissector
(Houser & Kondrashov, 2018) have been effectively implemented for
medical education, providing alternative experience to understand 2 | M A T E R I A L S A N D M ET H O D S
human body complexity and layers of internal structures. The extent
of availability and sophistication of digital technologies is advancing, 2.1 | Search strategy
which is accompanied by an increasing acceptance and understanding
of digital technology in anatomy education (Xiao & Evans, 2022). Searches were performed using PubMed, EMBASE, and MEDLINE bib-
Junior medical students perceive the use of virtual dissection as a liographic databases for research articles published from January 2010
valuable tool for learning anatomy and radiology (Darras et al., 2020). to June 2021 (inclusive). Combinations of the following search terms
The majority of literature support the notions that digital technologies and subheadings were considered appropriate for the present
ADNAN AND XIAO 473
investigation: “anatomy,” “digital anatomy,” “gross anatomy,” “topo- in digital simulation were secondary and critical areas of interest. All
graphic anatomy,” “VR,” “AR,” “apps,” “3D,” “allied health,” comparative studies reporting at least one of the primary or the sec-
“physiotherapy,” “occupational therapy,” “speech pathology,” “health,” ondary interests were considered suitable for inclusion. Studies not
“biomedical science,” “health science,” “medical,” “dental,” “teaching,” including useful elements for the analysis were excluded in a second
“education,” “knowledge,” “training,” “instruction,” “tutorial,” and round of selection. The first exclusion step was based on screening of
“learning.” the titles of publications and the second step was based on screening
of abstracts. Original articles were then retrieved, and full texts were
screened for final inclusion and data extraction. Any differences were
2.1.1 | Inclusion and exclusion criteria resolved following discussions between and thus by consensus. The
preferred reporting items for systematic reviews and meta-analyses
Publications (between January 2010 and June 2021) chosen were (PRISMA) statement (Moher et al., 2009) were used as a guideline for
restricted to those written in English and to original research articles the present review.
that described human anatomical education or training within health
and medical science courses (Table 1). Articles that were published in
the field of non-human anatomy education or microscopic anatomy 2.3 | Data extraction
were excluded in the research. Studies involving retrospective studies,
book chapters, expert reviews, systematic reviews, scoping reviews, A table was developed to chart the key information from the selected
narrative reviews, editorials, comments, and case-reports as well as articles as follows: author(s) and year of publication, study design,
technical reports solely for producing or developing education study method, characteristics of the study subjects, studied digital
resources (without evaluation) were excluded. anatomy tools, and measurement of the final outcomes. The data from
each included article were extracted by two independent researchers,
who then crosschecked selected articles and extracted data for the
2.2 | Study selection accuracy or missing information. Selected data with opposing informa-
tion were re-evaluated by the entire team, and a final decision on the
The primary interest of this study was related to digital modalities/ charted data was reached via consensus. Key themes and studies' ele-
approaches that have been used to teach undergraduate and post- ments of extracted data were defined, and a descriptive document
graduate anatomy as well as operative skills in pre-vocational/ with definitions was developed for data preparation. No ethical clear-
vocational healthcare training courses (i.e., impact on learner engage- ance was required for this study since all selected studies had previ-
ment, confidence and performance in anatomy knowledge and under- ously received ethical approval from local institutional review boards.
standing including anatomical structures recognition, organ
relationships). The selection of digital modalities and their applications
2.4 | Data summarizing and analysis
TABLE 1 Study screen criteria A descriptive analysis of the qualitative variables was carried out employ-
Eligibility criteria Criteria ing relative (percentage) frequencies. GraphPad Prism, version 9 (Graph-
Pad Software, Inc., La Jolla, CA) was used for analyzing the distribution
Eligibility criteria for • Written in English
abstract screen • Publication from January 2010 to June or trends of selected digital anatomy tools adopted by six different disci-
2020 (inclusive) plines (medicine, nursing, allied health, dentistry, surgical training, bio-
• An original article medical and health sciences). Descriptive statistics about the digital
• Evidence of human gross anatomy
anatomy technologies and distribution of the selected articles were col-
education or training
• Evidence of adopting digital technologies lected. Moreover, a descriptive analysis that evaluates the outcomes
in gross anatomy teaching (strengths and limitations) that each category of digital technologies plays
• Evidence of evaluation on digital anatomy in the learning and teaching of anatomy within the six disciplines as well
teaching approach
as its practice was performed to provide the evidence and potential gaps
Eligibility criteria for • Written in English in the current knowledge. A formal meta-analysis was not performed
full text screen • An original article
because of the heterogeneity of the retrieved data.
• Evidence of human gross anatomy
education or training
• Evidence of clear methodology on the
measurement of the outcome(s) 3 | RE SU LT S
• Evidence of well-designed research
study/intervention
• Evidence of evaluation on digital anatomy 3.1 | Selection of the studies
teaching approach
• Evidence of at least one quantitative or The search through the scientific literature identified 4992 citations.
qualitative assessment outcome
After applying all exclusion criteria, 1887 articles were identified for
474 ADNAN AND XIAO
published in the field of allied health compared to other disciplines

Articles identifed from
database search (n=4992) (Figure 2A). Out of the 156 studies, 41 were randomized or non-
randomized controlled trials with the rest being observational and
pilot studies. The studies evaluated the effectiveness of AR, VR, MR,
3D printing tools, web-based programs, tablet-based programs and
Irrelavant and duplicate
Articles screened articles excluded gamification tools. Based on the adoption of digital technologies,
(n=4992) (n=3105) 35.0% of the studies have used 3D printing, 24.2% AR, 22.3% VR,
11.5% web-based platforms/programs, and 4.5% tablet-based mobile
apps (Figure 2B) which shows that 3D printing (35.0%), AR (24.2%),
Articles excluded after and VR (22.3%) have been the most commonly adopted digital
Article abstracts assessed abstract screen
for eligibility (n=1887) (n=1209) resources (total 81.5%) for teaching anatomy (Figure 2B). In contrast
MR is the least adopted approach with only one article (0.6%) report-
ing it on anatomy teaching (Wish-Baratz et al., 2020), indicating MR is
Articles excluded after still a developing technology and is yet to be consumer-ready for
Full-text articles assessed full-text screen anatomy education at this time (Stirling, 2020).
for eligibility (n=678) (n=522)
Among the 156 studies, there are 41 randomized or nonrando-
mized controlled trials conducted to evaluate the effectiveness of dig-
ital anatomy education. Among the 41 controlled trials, 9 (22.0%)
Articles included in evaluated the effectiveness of AR, 12 (29.3%) VR, 17 (41.5%) 3D
qualitative synthesis
printing, 2 (4.9%) web-based and only 1 (2.4%) evaluated the effec-
(n=156)
tiveness of gamification tools. There were none for MR or tablet-
based programs. Most of the controlled trials have been conducted
for medical education (32 studies, 91.4%).
Articles included in
quantitative synthesis
(n=0)
3.3 | Trends of selected digital anatomy modalities
F I G U R E 1 A PRISMA flow diagram showing the articles selection
for systematic reviews. Out of 4992 articles search from databases, To understand whether there is a disciplinary preference in the selec-
678 advanced to full-text screening and 156 articles were eligible for tion of digital anatomy technologies, the distribution of reported digi-
inclusion in this scoping review tal modalities based on their reported discipline of teaching was
analyzed. Analysis of the proportional distributions of selected digital
modalities indicates that the six disciplines exhibited distinct patterns
title and abstract screen, followed by 678 for full text screen and in their selection of digital technologies. Medicine adopted the most
finally 156 after full text review. 156 studies were selected, as sum- diverse range of digital modalities in anatomy teaching, with all seven
marized in the PRISMA flowchart (Figure 1). digital approaches (VR, AR, MR, tablets-based apps, 3D-printing, web-
based programs, and gamification tools) being reported compared to
other disciplines (Figure 3). This was followed by surgical training and
3.2 | Characteristics of the included studies dentistry, which reported four digital approaches including VR, AR,
3D-printing, and web-based programs (Figure 3). Allied health
The disciplines that adopted digital technologies for anatomy or anat- adopted the least variety of digital anatomy resources, with two
omy related education are primarily medicine, surgical training, den- modalities (AR and 3D-printing) being reported within the included
tistry, nursing, allied health, biomedical and health sciences as well as studies (Figure 3). Among the included 156 studies, 49.3% (77 out of
patient education. Six disciplines (excluding patient education) have 156) and 26.9% (42 out of 156) were for medical and surgical anat-
applied digital anatomy education to learners at all levels, from under- omy training, respectively (Figure 2A). This finding is in-line with the
graduate and postgraduate curricula through to advanced pre- result that medicine and surgical training represent the two primary
vocational and vocational training courses. Among 156 included stud- disciplines that adopt the most diverse range of digital anatomy
ies published between January 2010 and June 2021, 119 studies approaches (Figure 3).
(total 76.3%) (Figure 2A) were undertaken in the fields of medicine 3D printing (55 paper, 35.0%), AR (38 paper, 23.0%), and VR
and surgical training (medicine 77 paper, 49.4% and surgical training (35 paper, 22.3%) represents the three primary digital modalities that
42 paper, 26.9%), indicating medical education represents the main have been adopted for anatomy teaching across all health disciplines
discipline that occupies the largest share of digital anatomy teaching (Figure 2B). In supporting of this, the discipline-based analysis indi-
due to its high demand in anatomy knowledge. In contrast, the lowest cates that 3D-printing, AR and VR represent the three primary
proportion of digital anatomy research paper (3 paper, 1.9%) were approaches being adopted for anatomy teaching in medicine, surgical,
ADNAN AND XIAO 475
F I G U R E 2 Major characteristics of included studies. Pie charts showing the proportions of included studies based on the heath education
field (A) and the adopted digital anatomy tools (B)
F I G U R E 3 Distribution of the
adopted digital anatomy tools
based on each discipline. Column
graph showing the distribution of
the adopted digital anatomy tools
for each discipline
F I G U R E 4 Line graph showing the

trend of anatomy education adopting
digital tools. Correlation of the year and
the number of each digital anatomy tools
published for all disciplines
and dental training (Figure 3). In addition, web-based programs suggesting an upward trend in the implementation of digital modal-
appeared to be widely adopted for teaching anatomy in other disci- ity in anatomy education. Of the seven modalities, there was a
plines including dentistry (40.0%) and nursing (25.0%) (Figure 3). steady increase in the number of articles that reported 3D-printing,
To further understand the trend of selected digital anatomy AR and VR in anatomy education in the past 10 years (Figure 4). In
modalities, we plotted the number of published articles per year contrast, the number of articles that studied tablets, web-based pro-
(Figure 4). There is an overall increase in the number of studies grams or gamification tools for anatomy education remained largely
evaluating digital anatomy tools across all disciplines, indirectly unchanged (Figure 4).
476 ADNAN AND XIAO
F I G U R E 5 Trends of studies on digital

anatomy simulation. Graph showing the
number of published articles reporting
anatomy simulation education using
digital technologies
Digital technologies have not only been used for teaching anat- web-based computer programs were primarily (84.5%, 11 out of 13)
omy theory but also practical simulation (Wickramasinghe used for teaching anatomy in lectures (Table 5). While the analysis of
et al., 2022). Among the reported digital tools, many of them have included article indicates a discipline-specific preference in the adop-
begun to be implemented in the training for digital simulation. While tion of digital anatomy modalities (Figure 3), the selected seven
the total number is still low, there is a steady and steep increase in the modalities have been implemented in a broad spectrum of anatomy
number of articles reporting and evaluating digital anatomy technolo- curricula including systemic, visceral and somatic anatomy, regional
gies for operative simulation courses (Figure 5). Among the included anatomy (visceral and musculoskeletal anatomy), neuroanatomy as
studies, surgical training represents the lead discipline (47.6%, 20 out well as advanced anatomy courses such as surgical anatomy
of 42 studies) that adopts digital anatomy simulation (Alwani (Tables 2–5). This review identified that regional anatomy was the
et al., 2020; Barber et al., 2018; Famery et al., 2019; Fasel et al., 2016) most common curriculum where AR (52.9%, Table 2), VR (66.7%,
which is followed by dental training (13.3%, 2 out of 15 studies) Table 3) and 3D anatomy printing (68%, Table 4) has been predomi-
(Reymus et al., 2020; Zorzal et al., 2021) and medicine (3.9% 3 out of nantly adopted. In addition, AR (26.5%, Table 2) and VR (26.7%,
77 studies) (Deng et al., 2018; Fang et al., 2014; Gopal et al., 2018). Table 3) have been commonly used for teaching neuroanatomy, pri-
This finding speaks to the unique demand of anatomy knowledge and marily in medical and surgical training.
operative skills by these disciplines. Moreover, the finding that surgi- This review also yielded identified research outcomes and limita-
cal anatomy training adopts a substantially higher proportion of digital tions on learning experiences and effectiveness. These together with
anatomy tools for practical simulation training compared to other dis- recommendation strategies identified for each digital modality in the
ciplines suggests that this is not only a discipline-driven outcome but included studies are summarized (Table 6). Increased learner immer-
that the technologies are maturing to better meet the demand of sion and engagement (Abdalla, 2020; Barmaki et al., 2019; Bernard
medical advancement. et al., 2020; Bogomolova et al., 2020; Ferrer-Torregrosa et al., 2016;
Lo et al., 2020; Ma et al., 2016; Moro et al., 2017; Zafar &
Zachar, 2020) is a consistent finding among the selected studies that
3.4 | Identified outcomes of digital anatomy reported digital anatomy modalities in a range of anatomy curricula.
modalities The enhanced student interaction and participation in the class
(Abdalla, 2020; Lorenzo-Alvarez et al., 2020; Vuchkova et al., 2012),
This review yielded seven digital modalities, many of which were pri- key element of learning engagement, will lead to positive learning
marily adopted for applied interactive anatomy education such as experience. Six of the seven selected digital anatomy modalities were
practical and simulation classes in advanced anatomy curricula such as largely implemented for on-campus anatomy laboratory classes
regional anatomy and neuroanatomy (Tables 2–5). AR was adopted (Tables 2–5). Web-based programs were found to enable unlimited
for practical or simulation classes in all the included studies (Table 2). practice opportunities overcoming time and geographical restraints,
Over 90% of the included studies (28 out of 30) that adopted VR were supported by positive learning experience (Abdalla, 2020; Lorenzo-
also practical classes, with only 10% (3 out of 30) being used in lec- Alvarez et al., 2020; Vuchkova et al., 2012). Majority of the included
tures (Table 3). Within the included studies that reported 3D anatomy studies (70%) have shown that students viewed that their under-
printing, 66% of them (33 out of 50) were practical and simulation standing of the clinical relevance of anatomy including disease and
classes, and 24% (12 out of 50) and 12% (6 out of 50) were used for pathophysiology was improved by digital tools and virtual dis-
lectures and patient education, respectively (Table 4). In contrast, the section tables. Moreover, digital modalities were found to be
ADNAN AND XIAO 477
TABLE 2 Details about the studies that studied AR
Author year Country/district Discipline Anatomy curriculum Classes

Pahuta et al., 2012 Canada Medicine (undergraduate and Regional anatomy (Pelvis) Practical classes
postgraduate)
Yudkowsky USA Surgical training Neuroanatomy Practical classes
et al., 2013 Digital simulation
Ferrer-Torregrosa Spain Medicine and allied health Regional anatomy (Lower limb) Practical classes
et al., 2016 (undergraduate)
Moro et al., 2017 Australia Health science medicine Regional anatomy (Skull) Practical classes
(undergraduate)
Bogomolova Netherlands Biomedical science medicine Musculoskeletal anatomy Practical classes
et al., 2020 (undergraduate)
Lo et al., 2020 United Kingdom Health science Regional anatomy (Lower limb) Practical classes
Abdalla, 2020 USA Dentistry (undergraduate) Dental anatomy Lectures
Practical classes
Kim-Berman USA Dentistry (undergraduate) Dental anatomy Practical classes
et al., 2019
Zafar & Australia Dentistry (undergraduate) Regional anatomy (head and neck) Practical classes
Zachar, 2020
Yao et al., 2014 USA Medicine (undergraduate) Reginal anatomy (Sinus and skull) Practical classes
Surgical training
(Otolaryngology)
Barmaki et al., 2019 USA Health/Biomedical science (pre-medical Musculoskeletal anatomy Practical classes
undergraduate)
Bernard et al., 2020 France Medicine (undergraduate) Neuroanatomy Practical classes
Bork et al., 2019 Germany Medicine (undergraduate) Regional anatomy (Thorax, abdomen, Practical classes
and pelvis)
Challoner & United Kingdom Medicine (undergraduate) Visceral anatomy Practical classes
Erolin, 2013
Darras et al., 2018 Sweden Medicine (undergraduate) Gross anatomy Practical classes
(virtual dissection)
Darras et al., 2020 Sweden Medicine (undergraduate) Gross anatomy Practical classes
Darras et al., 2019 Sweden Medicine (undergraduate) Neuroanatomy Practical classes
Flynn et al., 2021 United Kingdom Medicine (undergraduate) Neuroanatomy, visceral anatomy, Online classes
musculoskeletal anatomy
Henssen et al., 2020 Netherlands Biomedical science Neuroanatomy Practical classes
Medicine (undergraduate)
Küçük et al., 2016 Turkey Medicine (undergraduate) Neuroanatomy Practical classes
Ma et al., 2016 USA Medicine (undergraduate and Visceral anatomy, musculoskeletal Practical classes
postgraduate resident) anatomy
Mitrousias Greece Medicine (undergraduate) Regional anatomy (Upper limb) Lectures
et al., 2018 Practical classes
Ng et al., 2015 Singapore Medicine (undergraduate) Regional anatomy (Ear) Practical classes
Nickel et al., 2016 Germany Medicine (undergraduate) Reional anatomy (Liver) Practical classes
O'Rourke Australia Medicine (undergraduate) Regional anatomy (Sinus) Practical classes
et al., 2020
Peterson & USA Medicine (undergraduate) Neuroanatomy Practical classes
Mlynarczyk, 2016
Radetzki et al., 2013 Germany Medicine (undergraduate) Musculoskeletal anatomy (bones) Practical classes
Weeks et al., 2021 USA Medicine (undergraduate) Regional anatomy (Head and neck) Practical classes
White et al., 2018 USA Medicine (postgraduate pediatric Visceral anatomy (Heart) Practical classes
resident)
Coelho et al., 2020 Brazil Surgical training Neuroanatomy Practical classes
(Continues)
478 ADNAN AND XIAO
TABLE 2 (Continued)

Davis et al., 2016 USA Surgical training Neuroanatomy Practical classes
Endoscopy Online classes
Lin et al., 2019 China Surgical training Regional anatomy (Thorax and Practical classes
abdomen)
Logishetty United Kingdom Medicine (undergraduate) Regional anatomy (Pelvis) Practical classes
et al., 2019 Surgical training Digital simulation
Morone et al., 2019 USA Medicine (undergraduate) Regional anatomy (Skull) Practical classes
Surgical training Neuroanatomy Digital simulation
compatible with traditional cadaver-based teaching and simulation undergraduate and postgraduate anatomy courses and a combination
classes, the latter of which target operative skills. Four studies of different digital tools that possess complementary features is a
reported that digital anatomy modalities increased learner satisfaction strategy adopted for teaching advanced anatomy curricula
and perception compared to traditional learning resources including (Wickramasinghe et al., 2022). In addition, cybersickness associated
cadaveric and plastinated models (Adams et al., 2015; Backhouse with VR anatomy (Moro et al., 2017) represents an ongoing logistic
et al., 2019; Tan et al., 2021) as well as textbook-based learning (Du issue and limit its application for large cohort of training.
et al., 2020). AR and 3D-printing have been successfully integrated Moreover, current findings on the learning effectiveness of digital
with traditional cadaver-based anatomy classes (Adams et al., 2015; modalities upon anatomy knowledge and understanding are not only
Backhouse et al., 2019; Darras et al., 2019; Tan et al., 2021). The limited but controversial. Among the included 156 studies, there are
capacity of enabling practical simulation represents another clear 29 studies that conducted randomized trials studies (16 in medicine,
advantage of digital anatomy modalities in contemporary classes. VR 9 in surgical training, 2 in biomedical science and 2 in dental training).
anatomy (Aoki et al., 2020; Dharmawardana et al., 2015; Huang While digital modalities have been consistently found to improve
et al., 2015; Locketz et al., 2017; Wada et al., 2020) and 3D-printed learning experience and engagement, VR (Moro et al., 2017; Stepan
models (Barber et al., 2018; Famery et al., 2019), have been imple- et al., 2017), AR (Abdalla, 2020; Bogomolova et al., 2020; Henssen
mented for digital simulation and were found feasible for surgical et al., 2020; Küçük et al., 2016; Lo et al., 2020; Moro et al., 2017) and
training (Alwani et al., 2020; Barber et al., 2018; Famery et al., 2019; 3D-printing (Lozano et al., 2017) were found to exert no significant
Fasel et al., 2016). The digital simulation classes were found to influence upon learning performance assessed by theory-based
improve clinical confidence for novice or inexperienced surgical exams. In contrast, however, tablet-based apps were found to
trainees (Alwani et al., 2020; Arora et al., 2012; Dharmawardana improve performance as assessed by laboratory practical examinations
et al., 2015; Kong et al., 2016; Locketz et al., 2017), but was relatively (Chakraborty & Cooperstein, 2018). Moreover, web-based programs
less beneficial for advanced trainees (Breimer et al., 2017; Dharma- were found to improve learning outcomes based on post-exposure
wardana et al., 2015). Analysis of included studies revealed that both quiz results (Allen et al., 2016) and problem-solving skills (Lorenzo-
VR and 3D-printing are compatible with digital simulation classes Alvarez et al., 2020), but exerted no influence upon exam-based learn-
(Table 6). Although the total number is still low, there is a steep ing performance in dental students (Abdalla, 2020; Al-Thobity
increase in the articles reporting and evaluating digital anatomy tech- et al., 2017; Kwon et al., 2015). Overall, the mixed learning outcomes
nologies for simulation courses (Figure 5), indicating a clear trend of different digital modalities were attributable to the functional
moving forward. nature of individual anatomy resources and their technical capacity,
and importantly the assessment design and level of content being
assessed. Therefore, to gain a better understanding of the learning
3.5 | Identified limitations of digital anatomy effectiveness of digital modalities in anatomy teaching, randomized
modalities trial studies integrating formal evaluations that differentiates theory
and practical-based learning outcomes tailed toward learning objec-
There are also clear limitations of the reported digital anatomy modali- tives will be required.
ties, at least in their current version (Table 6). Most of the limitations In addition, technical training to both instructors and learners is
associated with digital anatomy modalities are largely technical, relat- another important factor identified from the selected articles. Almost
ing to the image resolution and extent of anatomy details. For exam- all studies mentioned that training is required for most digital modali-
ple, current VR and AR anatomy are short of high fidelity and ties in order to familiarize with the hardware and software settings
sophisticated resources including the haptic feedback features (Kong and functions, indicating the importance of pre-class technical training
et al., 2016), hence posing limitation for advanced anatomy curricula, for all users. However, of the 156 included studies, little data is avail-
in particular pre-vocation and vocational medical training. Despite able regarding the number of training hours and the extent of training
this, digital anatomy modalities have been implemented in both level provided to users for the selected digital modalities. Indeed,
ADNAN AND XIAO 479
TABLE 3 Details about the studies that studied VR

Aoki et al., 2020 Japan Surgical training Regional (visceral) anatomy Practical classes
Laparoscopy
Arora et al., 2012 United Kingdom Surgical training (Otolaryngology) Regional anatomy Practical classes
Breimer et al., 2017 Canada Surgical training Neuroanatomy Practical classes
Endoscopy Digital simulation
Brouwers et al., 2020 Netherlands Surgical training Regional anatomy (pelvis) Practical classes
Compton et al., 2020 Canada Surgical training Regional anatomy Practical classes
Otolaryngology Digital simulation
Dharmawardana Australia Surgical training Regional anatomy (sinus) Practical classes
et al., 2015 Otorhinolaryngology Nasendoscopy Digital simulation
Gasco et al., 2014 USA Surgical training Neuroanatomy Practical classes
Digital simulation
Huang et al., 2015 Canada Surgical training Regional anatomy Practical classes
Otolaryngology Endoscopy Digital simulation
Linke et al., 2013 Germany Surgical training Regional anatomy (ENT) Practical classes
Otolaryngology Digital simulation
Locketz et al., 2017 USA Surgical training Regional anatomy (ENT, head, and Practical classes
Otology neck) Digital simulation
LeBlanc et al., 2013 Canada Surgical training Regional anatomy (Upper limb) Practical classes
Orthopedics Digital simulation
Cannon et al., 2014 USA Surgical training Regional anatomy (Lower limb) Practical classes
Orthopedics Digital simulation
Diesen et al., 2011 USA Surgical training Laparoscopy Practical classes
Digital simulation
Wada et al., 2020 Japan Surgical training Regional anatomy (Groin) Practical classes
Laparoscopy Digital simulation
Chen et al., 2020 China Medicine (undergraduate) Regional anatomy (Skull) Lectures
Practical classes
de Faria et al., 2016 Brazil Medicine (undergraduate) Neuroanatomy Practical classes
Deng et al., 2018 China Medicine (undergraduate) Neuroanatomy Lectures
Practical classes
Du et al., 2020 China Medicine (undergraduate) Neuroanatomy Lectures
Practical classes
Erolin et al., 2019 Scotland Health science Visceral anatomy Practical classes
Musculoskeletal anatomy
Neuroanatomy
Fang et al., 2014 Taiwan Medicine (undergraduate) Regional anatomy (Skull) Practical classes
Surgical training (postgraduate)
Goodarzi et al., 2017 USA Heath science (novice undergraduate) Neuroanatomy Practical classes
Gopal et al., 2018 USA Medicine (undergraduate) Regional anatomy (Thorax) Practical classes
Bronchoscopy Digital simulation
Hu et al., 2020 Taiwan Medicine (undergraduate) Regional anatomy (Thorax and Practical classes
abdomen)
Janssen et al., 2015 Australia Medicine (undergraduate) Regional anatomy (Lower limb) Practical classes
Kockro et al., 2015 Germany Medicine (undergraduate) Neuroanatomy Lectures
Maresky et al., 2019 Canada Medicine (undergraduate) Regional anatomy (Heart) Practical classes
Digital simulation
Stepan et al., 2017 USA Medicine (undergraduate) Neuroanatomy Practical classes
Reymus et al., 2020 Germany Dentistry Dental anatomy (root canal) Practical classes
(undergraduate)
Zorzal et al., 2021 Portugal Dentistry Dental anatomy (implant Practical classes
(postgraduate) placement)
Moro et al., 2017 Australia Health science and medicine Regional anatomy (Skull) Practical classes
(undergraduate)
480 ADNAN AND XIAO
users' competency and attitude toward the implemented digital review shows the adoption of studied tablets, web-based programs or
modalities is like to influence the teaching and learning effectiveness. gamification tools for anatomy education has been consistently low
compared to AR and VR, indicating that these three digital approaches
are likely to be used as supplementary resources than primary educa-
4 | DISCUSSION tion tools by the instructors (Lewis et al., 2014). Tablet-based apps are
primarily used as a supplementary tool in anatomy classes for self-
To identify the trajectory of digital anatomy teaching across multiple revisions across all disciplines. A way forward is about balancing an
disciplines, this paper draws on recent research of anatomy education intuitive technological solution to effectively connect students to the
using digital modalities in six health disciplines. Analysis of the relevant and supporting digital modalities that best meet the content
selected studies demonstrates that the experience and benefits of design and learning objectives.
anatomy education integrating digital technologies are increasing and
more universally accepted. There are both advantages and limitations
associated with individual digital anatomy tools, indicating the neces- 4.2 | A blended approach in future anatomy
sity of anatomists' expert recommendations toward industry suppliers ecosystems
for technical and content design. Intuitively, the students' positive
perception of digital modalities is accompanied by controversial out- There is a discipline-specific preference in the selection of digital anat-
comes on learning performance and teaching effectiveness in medical omy tools, primarily driven by the current reach of applications for
education. The understanding of the applications and learning effec- digital anatomy and the curricular design. Substantial initial set up cost
tiveness of digital anatomy resources is still an evolving process. such as the hardware and software investment (Wickramasinghe
Therefore, future research will be required to evaluate the learning et al., 2022) together with the lack of funding could be another factor
and teaching effectiveness of current and new digital anatomy modali- that could perturb the use and wider adoption of digital anatomy
ties in order to satisfy learning objectives and curricular outcomes. technologies compared to existing resources. The breadth and depth
of anatomy teaching varies among medical science disciplines, each of
which possess their unique demand of anatomy knowledge and skills.
4.1 | A user-driven selection of digital anatomy Despite the increasing adoption of digital technologies in anatomy
modalities teaching, there is no one such digital approach that fits for all health
disciplines, neither the mode of delivery. Across all disciplines, digital
A clear advantage of adopting digital anatomy tools is the positive modalities have been viewed as a valuable tool for both fundamental
outcome on student learning experience and engagement, overcom- and advanced anatomy curricula. This study identifies a clear trend of
ing previous ethical restrictions and technical variations. Many of the digital anatomy teaching in applied practical and interactive classes
digital modalities possess unique and sometimes complementary including simulation, which is likely to be adopted in more anatomy
applications. Analysis of the selected studies indicates that 3D- laboratory classes and extends into large-scale lectures of the future.
printing have been primarily used for teaching skull anatomy, orbital Due to the complementary features of a diverse range of digital
anatomy and dental anatomy (Adams et al., 2015; Backhouse modalities plus simulation capacities, a diverse combination of digital
et al., 2019; Locketz et al., 2017; Ugidos Lozano et al., 2019) com- resources is likely to be employed in medical and surgical anatomy
pared to visceral and musculoskeletal anatomy, while AR has been education.
more widely used for teaching systemic and regional anatomy includ- That said, full digital delivery of anatomy curricula does not suit
ing visceral and musculoskeletal anatomy compared to skull or orbital all courses, in particular those tailored toward future health profes-
anatomy (Abdalla, 2020; Barmaki et al., 2019; Bernard et al., 2020; sionals. However, with wider and better understanding of digital tech-
Bogomolova et al., 2020; Ferrer-Torregrosa et al., 2016; Lo nologies, the digital based teaching is likely to be adopted in a greater
et al., 2020; Ma et al., 2016; Moro et al., 2017; Zafar & Zachar, 2020). proportion for anatomy practical classes. Competent operative skills
Among the selected digital modalities, VR has been the one showing and the education opportunity for learners' feelings about death are
the broadest applications across systemic, somatic and visceral anat- critical learning objectives for medical trainees in preparation for their
omy as well as advanced anatomy curricula including regional anat- clerkships and residency programs. In this context, cadaveric dis-
omy, neuroanatomy, dental and surgical anatomy (Alwani et al., 2020; section provides a boutique opportunity. However, due to various
Aoki et al., 2020; Arora et al., 2012; Dharmawardana et al., 2015; levels of constraints (Montanari, 2020; Ooi & Ooi, 2020), the cadav-
Huang et al., 2015; Kong et al., 2016; Locketz et al., 2017; Wada eric dissection class is likely to be further prioritized for surgical resi-
et al., 2020). dents or medical trainees with surgical intention. Encouragingly, new
Notably, not all reported digital anatomy modalities are ready for forms of anatomy teaching and learning such as virtual anatomy labo-
large-scale implementation. MR, in particular, has not been widely ratory have been established and well received by trainees (Flynn
used due to its current status of user's experience and technical devel- et al., 2021; Singh et al., 2021). Digital simulation via the virtually dis-
opment that is still immature and requires improvement (Stirling, 2020; section table has been used for emergency bedside ultrasound
Wickramasinghe et al., 2022; Wish-Baratz et al., 2020). Analysis in this courses, leading to improved trainee performance (Shi et al., 2019).
ADNAN AND XIAO 481
TABLE 4 Details about the studies that studied 3D-printing
Country/
Author year district Discipline Anatomy curriculum Classes
Jones & Seckeler, 2017 USA Medicine (postgraduate Regional anatomy Lectures
resident) (Thorax)
Bogomolova et al., 2020 Netherlands Biomedical science Regional anatomy Practical
(Undergraduate) (Lower limb)
Ugidos Lozano Spain Biomedical science Regional anatomy (skull) Practical
et al., 2019 (Undergraduate)
Adams et al., 2015 Australia Allied health/Medicine Regional anatomy (head, neck and orbital) Practical
(Postgraduate)
Backhouse et al., 2019 Australia Allied health Regional anatomy (skull) Practical
(Undergraduate)
Höhne & Germany Dentistry Dental anatomy Practical
Schmitter, 2019 (Undergraduate)
Kustra et al., 2021 Poland Dentistry Dental anatomy Practical
(Undergraduate)
Reymus et al., 2020 Germany Dentistry Dental anatomy Practical
(Undergraduate) (Root canal)
AbouHashem Australia Medicine Osteology Practical
et al., 2015 (Undergraduate)
Cai et al., 2019 Singapore Medicine Regional anatomy (knee joint) Lecture
(undergraduate)
Chen et al., 2020 China Medicine Regional anatomy (gastrocolic trunk) Lecture
(post graduate)
Costello et al., 2014 USA Medicine Regional anatomy (heart) Seminar/ Lecture
(undergraduate)
Garas et al., 2018 Australia Medicine Regional anatomy (heart, shoulder and thigh) Practical
(Undergraduate)
Ghazy et al., 2019 Germany Medicine Systemic anatomy (Tracheobronchial system) Resident training
(postgraduate)
Govsa et al., 2017 Turkey Medicine Vascular anatomy Practical
(Undergraduate and (Aortic arch)
postgraduate)
Hojo et al., 2019 Japan Medicine Regional anatomy (pelvic) Lecture and
(postgraduate and surgeons) training
Kong et al., 2016 China Medicine Regional anatomy Lecture
(undergraduate) (Hepatic anatomy)
Kong et al., 2016 China Medicine Visceral anatomy Lecture
(undergraduate) (Hepatic anatomy)
Li et al., 2015 China Medicine Regional anatomy (spine) Lecture
(undergraduate)
Lim et al., 2016 Australia Medicine Regional anatomy (external cardiac) Practical/Tutorial
(undergraduate)
Low et al., 2019 USA Medicine Regional anatomy (sinus) Lectures
(postgraduate)
Mahmoud & Ireland Medicine Regional anatomy (Abdomen) Practical/training
Bennett, 2015 (Undergraduate and
postgraduate)
Mogali et al., 2018 Singapore Medicine (Undergraduate) Regional (upper limb) Practical
O'Reilly et al., 2016 Ireland Medicine Regional (lower limb) Practical and
(Undergraduate and training
postgraduate)
Biglino et al., 2017 United Nursing (postgraduate) Regional anatomy (heart) Lecture
Kingdom
(Continues)
482 ADNAN AND XIAO
TABLE 4 (Continued)
Country/
Author year district Discipline Anatomy curriculum Classes
Tan et al., 2021 China Nursing (postgraduate) Systemic anatomy (cardiovascular) Tutorial
Bernhard et al., 2016 USA Patient education Regional anatomy (Kidney) Patient education
Chou et al., 2018 USA Patient education Regional anatomy (Cleft lip and palate) Patient education
Eisenmenger et al., 2017 USA Surgery (postgraduate) Osteology Patient education
Kyung et al., 2019 Korea Surgery (postgraduate) Renal anatomy Patient education
Liew et al., 2015 United Neurosurgery trainees Regional anatomy (lumbar spinal) Patient education
Kingdom
Zhuang et al., 2019 China Patient education Regional anatomy (lumbar spinal) Patient education
Alwani et al., 2020 USA Surgery (postgraduate) Regional anatomy (sino-nasal) Surgical training/
simulation
Barber et al., 2018 USA Surgery (postgraduate) Regional anatomy (Tracheooesophageal) Surgical training/
simulation
Brouwers et al., 2020 Netherlands Surgery (postgraduate) Regional anatomy (lower limb) Surgical training
Casciato et al., 2018 USA Surgery/Allied health Regional anatomy (lower limb) Lecture/practical
(Undergraduate)
Clifton et al., 2020 USA Surgery (postgraduate) Regional anatomy (cervical spinal) Surgical training/
simulation
Cote et al., 2018 USA Surgery (postgraduate) Regional anatomy (cleft palate) Surgical training/
simulation
de Ribaupierre & Canada Surgery (Postgraduate) Neuroanatomy Surgical training
Wilson, 2012
Famery et al., 2019 France Surgery (postgraduate) Ocular anatomy Surgical training
Fasel et al., 2016 Switzerland Surgery (postgraduate) Regional anatomy (head, neck, thorax, abdomen, Practical
and pelvis)
Ghizoni et al., 2018 Brazil Surgery (postgraduate) Neuroanatomy (cranial anatomy) Surgical training/
simulation
Govsa et al., 2017 Turkey Surgery (postgraduate) Vascular anatomy (internal carotid artery) Surgical training
Lichtenstein et al., 2017 Germany Surgery (postgraduate) Orbital anatomy Surgical training/
simulation
Marconi et al., 2017 Italy Surgery Visceral anatomy Practical/training
(Undergraduate and
postgraduate)
Pietrabissa et al., 2016 Italy Surgery (postgraduate) Visceral anatomy Training/pre-
operative
planning
Rose et al., 2015 USA Surgery (postgraduate) Regional anatomy (Otolaryngeal) Surgical training/
simulation
Nam et al., 2021 Korea Surgery (postgraduate) Regional anatomy (thorax and heart) Surgical training/
simulation
Cai et al., 2020 China Surgery (postgraduate) Neuroanatomy Lecture/practical
(Craniovertebral junction)
Teaching surgical anatomy using a VR workspace has also been trialed have the capacity to cause a paradigm shift in medical advancement.
with positive feedback (Iwanaga, Kamura, et al., 2021). Digital anat- In addition, proficiency in surgical care is complex as it not only
omy simulation has unique attributes toward improving learning expe- involves the knowledge of instrumentation procedures but also a
rience and outcomes (Logeswaran et al., 2021). Thus, more learner- comprehensive knowledge integration for the organ being operated.
centered digital simulation teaching could be implemented for opera- In this context, digital resources could provide sophisticated tools per-
tive skills training in healthcare education, where these technologies tinent to pre-operative studies (Xiao & Adnan, 2022). Overall, future
ADNAN AND XIAO 483
TABLE 5 Details about the studies that studied web-based programs

Abdalla, 2020 USA Dentistry Dental anatomy Lectures/practical
(Undergraduate)
Al-Thobity et al., 2017 Kingdom of Saudi Arabia Dentistry Dental morphology Lectures
(Undergraduate)
Elgreatly & Mahrous, 2020 USA Dentistry Dental anatomy Lectures
(Undergraduate)
Kwon et al., 2015 USA Dentistry Dental anatomy Lectures/practical
(undergraduate)
Vuchkova et al., 2012 Australia Dentistry Radiological anatomy Lectures
Lorenzo-Alvarez et al., 2020 Spain Medicine Regional anatomy (thorax, Lectures
(undergraduate) abdomen, and
musculoskeletal system)
Allen et al., 2016 Canada Medicine Neuroanatomy Lectures
(Undergraduate) (e-learning module)
Border, 2019 United Kingdom Medicine Gross anatomy Lectures/practical
Brown et al., 2012 United Kingdom Medicine Vascular anatomy Lectures
(Undergraduate)
Richardson-Hatcher et al., 2014 USA Medicine Neuroanatomy Lectures/practical
(Undergraduate) (Cranial nerve anatomy)
Grønlien et al., 2021 Norway Nursing Gross anatomy Lectures
(Undergraduate)
Kantar et al., 2018 USA Surgery Regional anatomy (cleft) Digital simulation
(postgraduate)
Koury et al., 2019 USA Surgery Regional anatomy (pelvic) Patient Education
anatomy ecosystems may incorporate physical and/or digital operative skill competence are required. Systemic evaluative work will
cadavers, particular in the field of medical and surgical training. be pivotal to gain a concrete understanding about the real implications
of the various digital technologies implemented in order to inform
decision making regarding digital technologies' selection and invest-
4.3 | Evaluation of learning effectiveness using ment in future medical or clinical schools. Moreover, more controlled
digital anatomy modalities trial studies including appropriate longitudinal analysis will be required
to directly measure the learning effectiveness of the digital pedagogy
Anatomists have explored a variety of digital approaches and teaching upon the influence and changes in learners' skills, behavior, and prac-
strategies with the aim to improve learning experience and effective- tices, which is critical for digital-based clinical training over the long-
ness in terms of both short-term and long-term knowledge retention. term. In addition, while digital modalities are being implemented in
It is clear that there has been a large volume of papers published in anatomy teaching, knowledge assessment is still largely didactic.
the literature (with many cited within this scoping review) reporting Therefore, this invites future new strategies that focus on applied
on the digital modalities and resources introduced and implementa- practical assessments through using the digital anatomy approaches
tion made to the way in which leaners' experience and rate of satis- with the support of online learning management system.
faction have been improved. Many of these reports have focused on
assessing and reporting the educators' and students' perception
toward users' experience of implemented technologies. While this has 4.4 | Future trends
been informative and insightful, relatively limited results are available
as to what effect the implemented digital technologies in a range of Analysis of the selected studies shows a clear tendency in accepting
anatomy courses have had on the anatomy knowledge gain of stu- and implementing digital technologies in anatomy education including
dents and health professional trainees, in particular over the long both theoretical (lectures) and applied (practical and simulation) clas-
term. Empirical evidence supporting current digital technologies is lim- ses. Digital anatomy technologies are becoming more accessible with
ited. Add to this, the impact of anatomy training using digital technol- high fidelity. We need to challenge whether anatomy education of the
ogies on the surgical competencies of future medical residents over future can be further advanced by taking advantage of the evolving
the long term is unclear. More in-depth evaluation of the digital tools digital technologies to allow more personalized and more effective
used, and the resulting learning outcomes of anatomy knowledge and learning opportunities for interactive education. Moreover, the
484 ADNAN AND XIAO
TABLE 6 Outcomes and recommendations identified from the included studies
Implemented
Digital tools Identified outcomes Identified limitations teaching area Recommendations
Virtual • Improving learner engagement • Cybersickness in some • Musculoskeletal • Suitable for undergraduate
reality (Moro et al., 2017) students (Moro et al., 2017) anatomy science and medical students
• Compatible with digital • Current VR anatomy limited • Regional • Technical training required for
simulation (Aoki et al., 2020; on sophisticated resources and (visceral) instructors and students
Dharmawardana et al., 2015; haptic feedback features for anatomy • Limit time spent on VR to
Huang et al., 2015; Locketz advanced curricula (Kong • Dental anatomy avoid adverse effects
et al., 2017; Moro et al., 2017; et al., 2016) • Neuroanatomy
Wada et al., 2020) • Current VR anatomy not • Surgical
• Feasible for surgical training, in practical for intra-operative anatomy
particular novice trainees use (Brouwers et al., 2020)
(Alwani et al., 2020; Arora • Assessments-based learning
et al., 2012; Dharmawardana performance remaining
et al., 2015; Kong et al., 2016; unclear (Moro et al., 2017;
Locketz et al., 2017) Stepan et al., 2017), in
• Enhancing operative sk kill particular advanced trainees
accuracy and safety (Alwani (Breimer et al., 2017;
et al., 2020) Dharmawardana et al., 2015)
• Initial software and hardware
cost and license maintenance
Augmented • Improving learner engagement • Current AR anatomy limited • Musculoskeletal • Suitable for undergraduate
reality (Abdalla, 2020; Barmaki on resources with high validity anatomy students including medical
et al., 2019; Bernard for advanced anatomy • Regional students
et al., 2020; Bogomolova curricula (visceral) • Technical training required for
et al., 2020; Ferrer-Torregrosa • Assessments-based learning anatomy both instructors and students
et al., 2016; Lo et al., 2020; performance remaining • Dental anatomy
Ma et al., 2016; Moro unclear (Abdalla, 2020; • Neuroanatomy
et al., 2017; Zafar & Bogomolova et al., 2020;
Zachar, 2020) Henssen et al., 2020; Küçük
• Outperforming traditional et al., 2016; Lo et al., 2020;
teaching approaches in Moro et al., 2017)
knowledge retention and • Initial software and hardware
student engagement (Barmaki cost and license maintenace
et al., 2019; Bernard
et al., 2020)
• Improving understanding of
clinical relevance (Darras
et al., 2020)
• Feasible for personalized
teaching material preparation
(Ma et al., 2016)
• Compatible with traditional
anatomy class using cadavers
(Darras et al., 2019)
Mixed reality • Accessing a variety of • Technical issues with teacher- • Regional • A technique still under
anatomy models student and student–student (visceral) developing
simultaneously (Wish-Baratz interactions (Wish-Baratz anatomy
et al., 2020) et al., 2020)
• Current MR anatomy still
immature
3D-printing • Improving learner perception • Resource development • Regional • Valuable tools for teaching
compared to traditional tools replying on the available (visceral) osteology, orbital and dental
(Adams et al., 2015; materials, printers and anatomy anatomy (Adams et al., 2015;
Backhouse et al., 2019; Tan softwares. • Dental anatomy Ugidos Lozano et al., 2019)
et al., 2021) • “Over-priced” manufactory • Orbital anatomy • Suitable for personalized
• Compatible with digital cost associated with 3D • Surgical anatomy teaching (Biglino
simulation (Barber et al., 2018; printing for structural precision anatomy et al., 2017; Marconi
Famery et al., 2019) • Assessment -based learning et al., 2017; Tan et al., 2021),
• Improving operative skills, in outcomes remaining unclear surgical training and patient
particular junior trainees (Lozano et al., 2017) education (Bernhard
(Alwani et al., 2020; Barber et al., 2016).
ADNAN AND XIAO 485
TABLE 6 (Continued)
Implemented
Digital tools Identified outcomes Identified limitations teaching area Recommendations
et al., 2018; Famery
et al., 2019; Wang et al., 2020)
• Feasible for surgical training
(Alwani et al., 2020; Barber
et al., 2018; Famery
et al., 2019; Fasel et al., 2016)
• Enable disease specific
teaching (Tan et al., 2021)
• Rapid reproduction and
implementation
Tablet-based • Improving learning experience • Stylized anatomy images with • Dental anatomy • A supplementary teaching tool
apps (Chakraborty & low fidelity (Lewis et al., 2014) • Neuroanatomy • Optimal iPad - student ratio to
Cooperstein, 2018; Stewart & • Initial cost of purchasing the enhance learning
Choudhury, 2015) and active tablet devices and ongoing • Suitable for patient education
learning (Samra et al., 2016) program upgrade (Lewis • Training required for teaching
• Enhancing patient-provider et al., 2014) preparation (Alsaid, 2016)
communication (Bohn
et al., 2018)
• Compatible with other digital
anatomy modalities (Lewis
et al., 2014)
Web-based • Improving learning experience • Delivery relying on stable • Musculoskeletal • A supplementary teaching tool
programs (Abdalla, 2020; Border, 2019; internet connection Anatomy • Adoption of screencast
Lorenzo-Alvarez et al., 2020; • Assessment -based outcomes • Regional technology blended with face-
Vuchkova et al., 2012) remaining unclear (visceral) to-face learning
(Abdalla, 2020; Allen anatomy
et al., 2016; Al-Thobity • Dental anatomy
et al., 2017; Kwon et al., 2015) • Neuroanatomy
• Not always user friendly
(Richardson-Hatcher
et al., 2014)
Gamification • Interactive learning (Du • Competition may cause stress • Musculoskeletal • Suitable for interactive in-class
tools et al., 2020) to some students (Du system quizzes and self-revision
• Improving assessment et al., 2020) • Regional
performance (Du et al., 2020; (visceral)
Janssen et al., 2015) anatomy
• Improving patient
communication and informed
consent (Briggs et al., 2014)
increasing adoption of digital technologies in anatomy education not Vlachopoulos et al., 2018). This is expected to have a significant
only advances the delivery of existing provision but opens an oppor- impact on future precision surgery and the development of surgical
tunity for anatomists to develop new courses via collaborative efforts. education curricula at an international level. Future medical education
Cross-institutional and cross-disciplinary anatomy curricula integrating ecosystem may include a digital anatomy laboratory as part of the
digital technologies could be developed and offered in the future. clinical skill facilities.
The phenomenon of implementing digital technologies in anat-
omy and operative skill training has substantially improved the way
the health professional handles the clinical phases. Digital-based oper- 5 | LIM I TAT I ON S OF T HE ST UD Y
ative education such as virtual surgical simulator (Kantar et al., 2018;
Plana et al., 2018) is now feasible and can overcome time and geo- This review was built upon a conceptual framework that assesses
graphic barriers, paying the way for virtual surgery rehearsal. Recent topographic anatomy teaching and training adopting digital technolo-
advances in the digital acquisition of patient-specific anatomy data gies over the past 10 years (when the authors began their studies
are able to report substantial information to the clinician, hence com- search in June 2021); therefore, literatures published before 2010 and
plex surgeries and less invasive local therapies can be easily planned after June 2021 were not included. Due to the high heterogeneity of
(Schieferbein et al., 2019; Soler et al., 2015; Soler et al., 2021; the retrieved data, no qualitative analysis including a formal meta-
486 ADNAN AND XIAO
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1162–1167.
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Remenschneider, A. K., & Deschler, D. G. (2018). 3D-printed tracheoe-
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Received: 22 July 2022 Revised: 11 December 2022 Accepted: 12 December 2022

A scoping review on the trends of digital anatomy education

Sharmeen Adnan 1 | Junhua Xiao 1,2

Clinical Anatomy. 2023;36:471–491. wileyonlinelibrary.com/journal/ca 471

published in the field of allied health compared to other disciplines

F I G U R E 4 Line graph showing the

F I G U R E 5 Trends of studies on digital

TABLE 2 Details about the studies that studied AR

Author year Country/district Discipline Anatomy curriculum Classes

Author year Country/district Discipline Anatomy curriculum Classes

TABLE 3 Details about the studies that studied VR

Author year Country/district Discipline Anatomy curriculum Classes

TABLE 4 Details about the studies that studied 3D-printing

TABLE 5 Details about the studies that studied web-based programs

Author year Country/district Discipline Anatomy curriculum Classes

TABLE 6 Outcomes and recommendations identified from the included studies

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