By Kritima Kapoor and Amandeep Singh
Teaching Veterinary Anatomy in a virtual world is an utmost requirement of the ongoing era of COVID-19 pandemic. Due to sudden lockdown, all the educational institutes, professional medical and veterinary colleges were closed (except emergency services) and academic activities were suspended altogether. This situation was challenging as well as thought-provoking for various academicians and professors to rethink about the means to keep the conduit of imparting education unceasing. This review focuses on the virtual reality aids that are being adopted worldwide and the initiatives taken by academicians during this era to impart best practical anatomy lessons yet being in a socially distant world. However, during the lockdown and social distancing, face-to face interactions were not feasible, and therefore, number of distant learning methods were created on virtual platforms for continuing the process of teaching veterinary anatomy closer to reality available at their doorsteps where academic staff was actively involved to reconstruct and renovate resources, upgraded their digital competencies to develop new ways to shift from one on one and merged to remote online teaching, and anatomy teaching was transformed to an abrupt ‘virtual mode’. Adopting virtual reality (VR) aids such as 3D animations, software packages, virtual dissections and E-museum serves as a great saviour throughout this unprecedented pandemic in a socially distant world to continue the teaching connexion.
The whole world humanity started facing crisis in March 2020 due to COVID-19 pandemic shackling the life of millions of people across the globe. Most of the countries imposed strict lockdown to curb the COVID-19 spread, likewise in India as well all the activities were suspended due to nationwide lockdown. Moreover, this pandemic emerged as a major blow to education system worldwide. Due to sudden lockdown as per Government of India guidelines, all the educational institutes, professional medical and veterinary colleges were closed (except emergency services) and academic activities were suspended altogether. This situation was challenging as well as thought-provoking for various academicians and professors to rethink about the means to keep the conduit of imparting education unceasing. To provide quality veterinary education to undergraduates under the restrictions of lockdown and social distancing close to real-time teachings was challenging, especially for subjects which need hands-on experience.
In veterinary education, anatomy is one of the most vital courses. Veterinary Anatomy is offered as an extensive and descriptive subject that requires face-to-face interactions with practical approach. It is essential for students to get acquainted with anatomical knowledge to build a strong foundation for future exposure to clinical cases as a practitioner. In traditional method of teaching anatomy, it is a subject that is taught using diverse teaching methods such as use of charts, atlas, slides and books for theoretical part but most essentially by the use of wet animal specimens and dissection of cadavers for practical hands-on learning experience. However, during the lockdown and social distancing, face-to face interactions were not feasible. As a result, number of distant learning methods was created on virtual platforms for continuing the process of teaching veterinary anatomy closer to reality that was accessible at their doorsteps. During this turbulent situation, the academic staff was actively involved to reconstruct and renovate resources, upgraded their digital competencies to develop new ways so as to shift from one-on-one teaching to remote online teaching. The traditional anatomy teaching was therefore transformed to an abrupt ‘virtual mode’ (Evans et al., 2020).
The main goal line is to document various traditional methods and recent educational approaches adopted for teaching veterinary anatomy to undergraduates under the influence of COVID-19 pandemic restrictions and the future innovative additions to anatomy education.
2 TRADITIONAL METHODS VERSUS VIRTUAL LEARNING METHODS DURING COVID-19 PANDEMIC
The traditional method of teaching veterinary anatomy includes imparting descriptive theoretical anatomical knowledge to students in classroom learning by face-to-face interactive studies. It was replaced completely by virtual teaching methods during COVID-induced restrictions by government agencies. However, it cannot be entirely substituted by virtual approaches; nevertheless, it is the need of existing times which has both advantages and disadvantages.
2.1 Actual classroom versus virtual classroom learning
Teaching Veterinary Anatomy by traditional methods includes classroom system with the aim to teach students the basic learning objectives of anatomy. In the actual classroom system, the group of students present in a common lecture room are taught the theoretical aspects of anatomy by professor using routine board teaching or different teaching aids such as presentations, pictures from atlas, textbooks and animal models. It is followed by routine laboratory sessions including actual exposure to bones in osteology, cadaver dissections and wet animal specimens through face-to-face interactive studies. In modern approaches, student-friendly strategies such as team-based learning and applied learning are also introduced to improve student collaboration, commitment and shift the focus of teaching from knowledge transmission to knowledge construction by the students during routine classroom method (Bell et al., 2019). The traditional way with improvised learning interactions is still the most preferred way for practical learning of the subject; however, the pandemic changed the scenario completely. Therefore, during this period, there was a need to switch to distance learning by adopting unique virtual classrooms so as to continue the process of professional education.
Several online platforms such as Zoom, Google classroom and Team link are being chosen and designated as virtual classrooms. It serves as an excellent medium for teacher–student interaction while being at their respective places during lockdown. Virtual classrooms are a blend of traditional classroom and practical learning where the teacher can impart basic anatomy knowledge by using presentations and 3D pictures from atlas while explaining theoretical aspects of gross anatomy and histology. Besides, it is followed by live demonstration of gross anatomy specimens, for example bones of different species covering osteology, arthrology and wet specimens of visceral organs in the virtual classroom via online mode (Figure 1). Initially, grasping virtual anatomy teaching can be difficult for students as compared to professors as it is challenging for students to visualize the three-dimensional topography while professors already have exposure to real specimens, but gradually students and professors get acquainted with it to utilize its utmost benefits. IT professionals are also upgrading into new skills and features, trying for new software to fulfil the needs of students (Kelsey et al., 2020). Some veterinary institutes in India also created groups for students on application available such as WhatsApp and Google classroom and tried to make anatomy teaching feasible by uploading relevant study material into these groups for explaining veterinary anatomy to them practically and clear their doubts. It was followed by a huge positive response from students for this innovative teaching; however, face-to-face teaching methodology was still missed by students (Chaudhary, 2021).
The virtual classroom method has several advantages where students can have live interactive sessions with teacher on their relevant doubts by actually observing the specimens demonstrated by the teacher. They can also record these live sessions delivered on virtual platforms and save for their later reference any time they wish to revise the subject. These technologies enhanced learning methods have only disadvantage that it cannot completely substitute the one-on-one teaching methods as it is difficult to visualize the three-dimensional topographical anatomy and feel of texture of the specimens but that is the need of existing times.
2.2 Animal Models versus 3D Animations/ Digital models
The plastic or clay animal models are in common use in basic veterinary anatomy teaching although they lack vital precise details of actual specimens. Models or imitation of wet specimens enables the students to perform independent learning of anatomical topography by trial and to repeat the procedure any number of times. However, virtual simulation models are the new foundation of virtual anatomy teaching systems which includes three-dimensional (3D) animations or digital anatomical models. First step to construct such 3D animations or digital models is to extract relevant anatomical knowledge from textbooks, correct anatomical nouns and terminology covering the points that are essential for students. It is followed by converting this knowledge to modelling of morphological structures to construct a 3D animation or digital model by using software. The 3D animations provide actual representation of the anatomy near to live animal experience as it can rotate in all possible directions giving near to real three-dimensional structures, for example muscles of forelimb, blood supply to muscles of forelimb and nerve supply to that region, with 360 degrees’ rotation showing all the anatomical surfaces of that particular region (Figure 2). Therefore, the virtual simulation of anatomical teaching systems must address three core issues: modelling, perception and interaction (Zhang et al., 2019). Modelling refers to the kind of specific models to be constructed to meet the requirements of virtual simulation; perception denotes to the kind of knowledge and understanding that needs to be communicated by the model, as well as how effectively they can be perceived by learner; interaction refers to ensuring that the form of interaction with the system is an effective means of knowledge dissemination (Zhang et al., 2019). The only disadvantage is that students cannot have tactile perception of that particular anatomical region and thus texture of specimen perception is compromised. These 3D animations can be converted into a physical object by three-dimensional printing (3DP) digital models which is a modern enjoyable and effective method (Garas et al., 2018; Silver, 2019). It can be made of several materials such as nylon, polyvinyl alcohol, polylactic acid, acrylonitrile butadiene styrene, wood, metal and carbon fibre filaments, more flexible and durable in comparable to conventional plastic models (Iwanaga et al., 2021). Since 3D animations and 3DP simulation contribute to enjoyable practical experiences in studying veterinary anatomy for deeper examination of anatomical structures, it also facilitates the study of topography of large animal specimens by reducing the need and time of dissecting the whole body parts such as visceral organs or limbs. Nevertheless, it is not an alternative contrary to actual topographic anatomy in an animal as it is unable to deliver a fully immersive experience of dissection. The only drawback associated with it is that it might lead to an inadequacy of understanding the actual size and the relative regional and topography associated with other anatomical structures.
2.3 Cadaver dissection versus virtual dissection
Cadaver is necessary for veterinary anatomy as it is known as a ‘silent teacher’ of medical professionals to learn clinical skills and surgical training. However, as per animal ethics, a healthy animal should not be killed for teaching or dissection purposes and the animal cadaver should be obtained from terminally ill or donated animals euthanized in a humane way. Cadaveric dissections generally aid students to recognize anatomical structures with tactile exposure of tissue or organ texture besides their 3D visualization. Simultaneously, it enables them to master the skill of using scalpel, various types of scissors and forceps, training their hands as future surgeon and contribute to an increase in surgical efficacy and self-confidence (Lim et al., 2018), though the cadaver-less or virtual dissections started as an innovative method little period ago but it took momentum to be implemented during COVID-19 pandemic.
Virtual dissection or digital dissection facilitates students with the innovative learning opportunities in veterinary anatomy. Nowadays, virtual dissection can be done with the help of animated anatomical structures on anatomy visualization table or virtual dissection table (Youssef, 2021). It is possible through the powerful software interactions where students can operate the computerised dissection on screen to accomplish through touch to understand the complex anatomic relationships (Darras et al., 2019). It provides actual size digital cadavers of different animals preferably Ox, which can be rotated, magnified, zoom-in and zoom-out, labelled and dissected with virtual scalpels. Several virtual dissection software packages of different species are created by professional keeping in view about technical anatomical aspects and are available for purchase as well. Students can visualize and separate anatomical structures in 3D form, dissect, recreate, magnify and transect regions to appreciate anatomical form and associated structures. In this facility, a unique feature allows them to save the dissections also facilitating students to visualize these saved files anytime they require (Karkera, 2021). These software-initiated dissections can be used by students during this taxing COVID-19 pandemic time being at their respective places as well. Also, students can perform virtual dissections with greater time-efficiency and more seamless than cadaveric dissections.
However, throughout COVID-19 pandemic, the use of these virtual dissections gathered more push while teaching students via virtual classrooms. In the absence of cadaver dissection, the pre-dissected cadaver specimens known as prosected have been widely used in teaching anatomy to undergraduates (Collins, 2008). The video lessons of actual demonstrations can be shot on prosected specimens, especially of forelimbs and hind limbs of Ox which can be utilized later for teaching in virtual classrooms on several online platforms. Such videos can be played via virtual classrooms, and structures dissected can be demonstrated live to students. The teacher can play and pause the video dissections as per their requirement, and students can have live interactions and discussion for their doubts on the same. This way the students can have the access to the laboratory while being at their own homes as its mandatory to follow social distancing during this pandemic. Similarly, the video demonstrations of visceral organs comprising splanchnology part are of great help and facilitate the learner. These can also be uploaded on social media platforms like YouTube for their future reference (Figure 3).
There are a few drawbacks associated with virtual dissection. However, the major disadvantage of cadaver-less anatomy is that it may impact the clinical skills of a budding surgeon as it prevents students from appreciating the feel and texture of specific anatomical structures such as muscles, tendons, bones, heart and lungs. It basically restricts the tactile form of learning. Smooth and effective integration of technology into the classroom can be challenging. Another challenge faced during this COVID-19 pandemic was lack of exposure of faculty and students to this online mode or platform available. Faculty gradually got well averse to digital platforms and also found new virtual ways of incorporating technology into teaching. Other technical disadvantages are the Internet connectivity which is sometimes freezing, sluggish and low signal periods in some areas. However, if these technical difficulties are rectified, maximum benefits can be utilized from these virtual dissections and videos that can be shown on virtual platforms especially during this pandemic.
2.4 Actual gross anatomy museum versus online/E-museum
The gross anatomy museum usually comprises of stacks of museum jars showing varied organ specimens in display for scholars. It is utilized by learners as a good source of one-stop zone for self-study, but during COVID-19 pandemic, students lost the access to this facility as well. Moreover, Veterinary Anatomy is a subject which requires continuous exposure of learner to the specimens and organs. Therefore, to facilitate them, one-stop zone can be provided to them on online platforms designated as E-Museum or Online Veterinary Anatomy Museum. For that purpose, an online site can be created with the aim to provide open access to various veterinary anatomical resources. Several veterinary institutes and publishing houses from around the world are contributing resources that have been aggregated and methodically arranged into a readily searchable environment making them easily discoverable by learners around different parts of the world. Such museum currently contains compilation of over 1,000 different resources including images, PowerPoint presentations, flash animations and videos covering an array of topics related to veterinary anatomy such as histology, dissection, osteology and even some embryology (Phillips et al., 2012). The interface design of E-museum is so as to provide a spontaneous, engaging and dynamic environment which represents in house the museum experience. This E-museum also provides number of learning resources in the form of interactive ‘one click’ online activities such as multiple-choice quiz questions, visual compilations of organ images, prosected specimen images. Once the learner clicks on the name of a particular organ or structure that they want to visualize, it will navigate them to related images and animations on the same. This interactive aid can be further used by the students to amalgamate their knowledge (Figure 4). The material is structured systematically on various e-platforms by species, body systems and body regions accommodating different learning styles and preferences. It serves to provide a useful tool for learners and to academicians in their teaching if some instructional material is lacking at their own institutions. The content can also be searched by using the search function for ‘keywords’. The impact of the museum is likely to be at several different levels. However, the sharing of such platforms of E-museum should be under common licencing to permit the use of materials to supplement lectures and enabling scholars across the globe to be benefited from access to varied material. Although gross anatomy museum will continue to play an important role in the education of future veterinarians as one-stop zone, but it can be a good source of learning for the students during this pandemic obeying social distancing yet not compromising on learning anatomy. It will give them the opportunity for self-study and to prepare for practical learning by utilizing virtual materials available, in order to benefit more from anatomy teaching during this socially distant era.
3 VIRTUAL REALITY (VR) IS THE NEED OF SOCIALLY DISTANT ERA
During COVID-19, the use of virtual reality (VR) or augmented reality (AR) had become the necessity to keep the education process continuous as it cannot be stagnated at any cost. It provides a new type of learning environment in which the user is fully engrossed in that set-up and experiences reality in a virtual setting. In virtual or augmented reality, number of facilities can be utilized as discussed above like virtual animated anatomical models of different species or software models with complete virtual dissection that depicted the user a near view of the real-world anatomical structures. VR aids have made the student learning easier especially during this pandemic where they have to stick to social distancing norms as well. Scholars can utilize several VR aids through their routine devices including desktops, mobiles and iPad via screen-based virtual platforms such as ZOOM and Google classroom. Several studies indicated that students who used mobile VR had significantly higher test scores than those used text, two-dimensional pictures and graphs (Küçük et al., 2016). Another group of studies accounting for VR claimed that students often feel the virtual dissection as a suitable teaching technique and students who used the virtual dissection scored the same or better results. Moreover, after their first laboratory exposure with VR, 40% students indicated the VR program was extremely effective for learning anatomical features, 78% indicated the labelling was effective and 83% specified that they could transfer the anatomical locations from the VR dog model as compared to the live dog (DeBose, 2020). Additional VR aid adopted by academicians is preshow videos on prosected specimens can be either shown on live virtual classrooms to students or uploaded on YouTube as videos for their future reference and self-study. Studying animal anatomy by VR makes it still possible to study veterinary anatomy despite limited access to animal cadavers and during limited or restricted access to classrooms during the COVID-19 pandemic following social distancing.
In order to be conclusive, Veterinary Anatomy can be taught well to learners by following these VR or AR aids in the socially distant era of COVID-19 as well. However, we propose based upon our experiences also, and complete replacement of anatomy dissection with virtual dissection is not desirable, but it can be supplemented with high end software-created VR aids, videos, etc., to enhance student learning and to be utilized in case of scarcity or unavailability of cadavers and to prevent animal cruelty. However, based upon our collective experiences, we propose that complete replacement of anatomy dissection with virtual dissection is not desirable, but it can be supplemented with high end software-created VR aids, videos, etc., to enhance student learning and can be utilized efficiently in case of scarcity or unavailability of cadavers and also to prevent animal cruelty. Therefore, utilizing different virtual methods of learning veterinary anatomy like virtual dissections, E-museum, 3D digital models or animations on virtual classroom platforms serves as a great saviour throughout this unprecedented pandemic, most importantly in prevailing socially distant world to continue the teaching connexion.
The authors are thankful to Guru Angad Dev Veterinary and Animal Science University (GADVASU), Ludhiana, India, for providing the opportunity to conduct teaching on various online platforms to encourage learning among students. We wish to extend special thanks to undergraduate students of B.V.Sc. & A.H for their inputs towards various virtual teaching methods adopted by professors in veterinary universities during the pandemic.