The amazing possibilities of new technology are on display in HKUMed’s anatomy classes, where Dr Jian Yang, Dr Tomasz Cecot, Dr Mandy Liu, and Dr Rocky Cheung are using virtual reality (VR) to enhance traditional learning that uses cadavers.
While the tech aficionados still believe in the value of using cadavers, they believe that VR can provide an additional dimension to a medical student’s education.
We spoke with the team to learn more about their efforts to bring anatomy courses into new realms.*
HKUMed: When ‘virtual reality’ is mentioned, most people think of tech and gear heads, not learning. How do you respond to that?
Dr Rocky Cheung: We are all anatomists teaching this subject. Most of our training has been based on cadaveric dissection using human specimens. We bring that sensibility to our use of VR.
HKUMed: What were your initial thoughts on VR as a teaching tool?
Dr Tomasz Cecot: I thought that it was just a gimmick. You know, we already have a very good anatomy class. We also have computerized classes where you can move, rotate, and zoom in or out of anatomy structures, which means that we already have this capability. But virtual reality is something different. There is a third dimension, even the fourth dimension, because now you can interact with The Human Anatomy Atlas, you can move things around, so you are very, very immersed in this entire experience.
Dr Rocky Cheung: There is a trend nowadays of digitizing everything and that’s a challenge. We believe we should still use cadavers and human specimens, but with opportunities to learn about virtual reality or other kinds of digital dimensions. These tools do help because ultimately, there are still limitations when learning with cadavers.
Dr Mandy Liu: VR is a useful complementary tool. Sometimes during dissection, students accidentally remove something without knowing there is a structure there. But with the help of virtual reality, they have the chance to build a concept about which structures are roughly at which location. So when they do dissection, they already have this 3d image in their mind.
Dr Rocky Cheung: Yes, virtual reality helps students to visualize things that they perhaps have no chance of seeing during the dissection.
HKUMed: What do you mean by, sometimes students remove something that they shouldn’t?
Dr Jian Yang: For a lot of small anatomical structures, students only have one chance to see it, and if they destroy it in the cadaver, they will lose the chance forever to actually visualize it. A lot of students may have no idea about what are the most delicate and tiny structures. They remove something accidentally and then at the end of the dissection, realize they missed this valuable chance to identify that part.
Dr Mandy Liu: If they work on a task in virtual reality first, then they will know about the important structures in a location before they come to the dissection lab to work on it. This means that during dissection, they will have a better chance of preserving important structures and visualizing these in the real cadaver.
HKUMed: So, VR will help minimise these errors?
Dr Jian Yang: With virtual reality, they can review the structure in a three-dimensional way and then know the correlations of the anatomical structure. Then when they come to the dissection, they’re much better prepared.
HKUMed: How did the VR Anatomy project come together?
Dr Jian Yang: The project started about two or three years ago. Our team was given the task to make our dissection class more active and more attractive, and to improve the student learning experience so they can better achieve their learning outcomes. Virtual reality at that time was already becoming mature enough for us to utilise it to turn our vision into reality.
HKUMed: I was told the initial version wasn’t fit for University teaching, what was the reason?
Dr Tomasz Cecot: The problem was that it was quite immature in that the models were slightly plastic. I would say something like secondary school models. They weren’t as good as they needed to be.
Dr Jian Yang: Actually, virtual reality anatomy is not a cutting-edge concept. Around six years ago at one of the big medical education conferences we visited, there were already companies demonstrating virtual reality anatomy software. It was pretty fun to play with, but there were a lot of bugs, and it was not very intuitive. It was just too simplified, as Tom said. Probably suitable for primary school, even kindergarten learning, but not for tertiary learning.
HKUMed: How were you able to bring it up to university level teaching standards?
Dr Tomasz Cecot: We went to mainland China and found a company that creates dissection and anatomy software. They actually started working with virtual reality about six years ago, but nobody was interested because it’s very expensive to get the hardware. When we received the hardware, we started to collaborate with this company and tailor the software to our needs. First of all, we needed an English version because it was only in Chinese. Second, we needed to customise the software, and this is very important. It’s something we couldn’t do with other companies. We collaborated very closely with the VR company and I think that the outcome is excellent. As far as I’m concerned, it’s the best on-demand VR software.
Dr Jian Yang: As Tom mentioned, before all this we thought VR was cool but only a gimmick. Neither the hardware nor the software met our tertiary education requirements or were up to our standards. Once we acquired funding for VR, though, we started to push forward to get the kind of equipment and software that would work for us. First we acquired the hardware, then came the software, but that was difficult because no one was developing software for universities or medical schools. They hadn’t imagined that we would purchase a hundred VR sets and turn that into a teaching tool.
HKUMed: So what were they developing then?
Dr Jian Yang: They were focused on pseudo virtual reality, which is a 3d monitor where you wear a pair of glasses as if you were in a 1950s cinema. It’s hard to manipulate, and it wasn’t workable for us. They had this prototype, but they had stopped developing it.
When we met with them, we asked, “do you still have an interest in developing this software up to a university-level teaching standard?” They had very good visualised human bodies from the Visible Body China program. There are digital models of complete sections, the whole human body, and everything reconstructed. Everything you see is from a real specimen. The models also show a lot of anatomical variations in the body so they’re not like a textbook, which is good.
We ended up with this completely customizable, licensed for life software that is constantly evolving. We’re going to keep collaborating with them to make the software even better.
Dr Rocky Cheung: There’s a funny thing about our programme. The models are all based on a male person, we don’t have a female model.
HKUMed: Wait, there is a gender bias in the software?
Dr Jian Yang: Haha, no, no. They are creating a female model through a female cadaver. So later, it will be added to the software.
HKUMed: Most medical schools are not crazy enough to buy a hundred-odd sets of VR, so why HKUMed?
Dr Tomasz Cecot: We were brave enough. Haha. I think what is important is here, is that we’re not doing demonstrations. We’re doing explorations, and this is the pedagogical concept. This is a different approach to virtual reality. We’re not just showing students, “oh, look at this here, it’s so cool”.
We’re using virtual reality to solve clinical tasks, and this is the major difference between our approach and other medical schools. It’s important because we don’t know what the future will hold. We don’t know if the skills gained in operating on three-dimensional subjects won’t be the skills of the future.
HKUMed: You think this might play a key role in clinical settings 20 years from now?
Dr Tomasz Cecot: Maybe. It might be that a surgeon will sit in one room in one country and the operation will take place somewhere else. We don’t know if that will actually happen, but we would like to prepare our students for this possibility.
Dr Jian Yang: This is a great point, because we just finished our BIMHSE Frontiers of Medical Education conference. One of the keynote speakers predicted the exact future Tom described, of tele-doctors. They will use a virtual environment through electronic devices and control surgical tools, and then performance surgeries in the virtual environment. This skill of being able to orientate yourself and navigate in the three-dimensional world will be crucial, maybe even in five years’ time. Who knows? Because technology advances very quickly.
Another point Tom hit on is that when we started to design this, there were already a lot of different Atlases. We did not want to create a virtual reality version of an anatomical Atlas. That is didactic education. What we wanted was active learning that involves students performing different tasks. So we designed our software as a platform where students can interact and use this as a pedagogical tool to perform tasks, rather than just have an Atlas of different structures.
Dr Rocky Cheung: This would tick a lot of boxes, if you think about active learning versus actively exploring how to complete tasks. We are seeing students do this. Also, they must work in pairs, so they engage in peer-to-peer learning and working together as a team, too.
HKUMed: It sounds like you were designing scenarios or even games for students to solve?
Dr Mandy Liu: We give students the opportunity to explore. Even though students can learn from textbooks such as the Atlas, they are always having information input into them and do not have the chance to output their own information. Through these tasks, they can output knowledge that has been absorbed and developed in their minds. They can explore this and mimic clinical situations through VR.
Dr Jian Yang: Gamification is one word now trending in the educational field. We probably could tick that box. Whether it can be or should be a game, we have our different opinions. But one thing we agree on is that you can have more enthusiasm.
We always want students to be more interested and enjoy the experience. Learning is not supposed to be entertainment, but that does not mean that we cannot make it enjoyable.
HKUMed: Does VR make it easier for students who are afraid of seeing cadavers?
Dr Tomasz Cecot: I think it’s the opposite to be very honest. They are not afraid to see real cadavers, especially medical students.
Dr Mandy Liu: Most of them are excited to see that.
Dr Tomasz Cecot: I think entering this space, the dissection room is something incredibly unique for the students.
Dr Jian Yang: This dissection lab is like a sacred place in medical school. I think in medical education, in any med school, the dissection lab is where students encounter their first patient; the first human body experience.
*This Q and A was edited from a conversation with the anatomy team.