Effect of teaching tools in spatial understanding in health science education: a systematic review





Background: The concept of spatial orientation is integral to health education. Students studying to be healthcare professionals use their visual intelligence to develop 3D mental models from 2D images, like X-rays, MRI, and CT scans, which exerts a heavy cognitive load on them. Innovative teaching tools and technologies are being developed to improve students’ learning experiences. However, the impact of these teaching modalities on spatial understanding is not often evaluated. This systematic review aims to investigate current literature to identify which teaching tools and techniques are intended to improve the 3D sense of students and how these tools impact learners’ spatial understanding.

Methods: The preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines were followed for the systematic review. Four databases were searched with multiple search terms. The articles were screened based on inclusion and exclusion criteria and assessed for quality.

Results: Nineteen articles were eligible for our systematic review. Teaching tools focused on improving spatial concepts can be grouped into five categories. The review findings reveal that the experimental groups have performed equally well or significantly better in tests and tasks with access to the teaching tool than the control groups.

Conclusion: Our review investigated the current literature to identify and categorize teaching tools shown to improve spatial understanding in healthcare professionals. The teaching tools identified in our review showed improvement in measured, and perceived spatial intelligence. However, a wide variation exists among the teaching tools and assessment techniques. We also identified knowledge gaps and future research opportunities.


Metrics Loading ...

Author Biographies

Nazlee Sharmin, University of Alberta

Assistant Teaching Professor, School of Dentistry, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta

Ava K Chow, University of Alberta

Associate Professor, School of Dentistry, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta

Sharla King, University of Alberta

Professor, Department of Educational Psychology, Faculty of Education, University of Alberta


Dennis I, Tapsfield P. Human abilities: rheir nature and measurement. Lawrence Erlbaum Associates; 1996.

Garofalo SG, Farenga SJ. Xognition and spatial concept formation: comparing non-digital and digital instruction using three-dimensional models in science. Tech Know Learn. 2021; 26, 231-241. https://doi.org/10.1007/s10758-019-09425-6 DOI: https://doi.org/10.1007/s10758-019-09425-6

Daniel Ness, SJ. Spatial intelligence: why it matters from birth through the lifespan. Routledge, Taylor & Francis Group; 2017. DOI: https://doi.org/10.4324/9781315724515

McGee MG. Human spatial abilities: psychometric studies and environmental, genetic, hormonal, and neurological influences. Psychol Bull. 1979;86(5):889-918. https://doi.org/10.1037/0033-2909.86.5.889 DOI: https://doi.org/10.1037/0033-2909.86.5.889

Langlois J, Wells GA, Lecourtois M, Bergeron G, Yetisir E, Martin M. Sex differences in spatial abilities of medical graduates entering residency programs. Anat Sci Educ. 2013;6(6):368-75. https://doi.org/10.1002/ase.1360 DOI: https://doi.org/10.1002/ase.1360

Lufler RS, Zumwalt AC, Romney CA, Hoagland TM. Effect of visual-spatial ability on medical students' performance in a gross anatomy course. Anat Sci Educ. 2012;5(1):3-9. https://doi.org/10.1002/ase.264 DOI: https://doi.org/10.1002/ase.264

Techentin C, Voyer D, Voyer SD. Spatial abilities and aging: a meta-analysis. Exp Aging Res. 2014;40(4):395-425. https://doi.org/10.1080/0361073X.2014.926773 DOI: https://doi.org/10.1080/0361073X.2014.926773

Garg A, Norman GR, Spero L, Maheshwari P. Do virtual computer models hinder anatomy learning? Acad Med. 1999;74(10 Suppl): S87-9. https://doi.org/10.1097/00001888-199910000-00049 DOI: https://doi.org/10.1097/00001888-199910000-00049

Hegarty M, Keehner M, Cohen C, Montello DR, Lippa Y. The role of spatial cognition in medicine: applications for selecting and training professionals. In G. L. Allen (Ed.), Applied spatial cognition: From research to cognitive technology. Lawrence Erlbaum Associates Publishers. 2007; pp. 285-315. https://doi.org/10.4324/9781003064350-11 DOI: https://doi.org/10.4324/9781003064350-11

Garg AX, Norman G, Sperotable L. How medical students learn spatial anatomy. Lancet. 2001;357(9253):363-4. https://doi.org/10.1016/S0140-6736(00)03649-7 DOI: https://doi.org/10.1016/S0140-6736(00)03649-7

Dünser A, Walker L, Horner H, Bentall D. Creating Interactive physics education books with augmented reality. in proceedings of the 24th Australian Computer-Human Interaction Conference (Melbourne, Australia) (OzCHI" 12). 2012; Association for Computing Machinery, New York, NY, USA, 107-114. https://doi.org/10.1145/2414536.2414554 DOI: https://doi.org/10.1145/2414536.2414554

Marsh KR, Giffin BF, Lowrie DJ Jr. Medical student retention of embryonic development: impact of the dimensions added by multimedia tutorials. Anat Sci Educ. 2008;1(6):252-7. https://doi.org/10.1002/ase.56 DOI: https://doi.org/10.1002/ase.56

Evans DJ. Using embryology screencasts: a useful addition to the student learning experience? Anat Sci Educ. 2011;4(2):57-63. https://doi.org/10.1002/ase.209 DOI: https://doi.org/10.1002/ase.209

Sweller J. Cognitive load theory and educational technology. Education Tech Research Dev 2020; 68(1):1-16. https://doi.org/10.1007/s11423-019-09701-3 DOI: https://doi.org/10.1007/s11423-019-09701-3

Narayan R, Rodriguez C, Araujo J, Shaqlaih A, Moss G. Constructivism-Constructivist learning theory. In B. J. Irby, G. Brown, R. Lara-Alecio, & S. Jackson (Eds.), The handbook of educational theories. IAP Information Age Publishing. 2013; pp. 169-183.

McGaghie WC, Harris IB. learning theory foundations of simulation-based mastery learning. Simul Healthc. 2018;13(3S Suppl 1): S15-S20. https://doi.org/10.1097/SIH.0000000000000279 DOI: https://doi.org/10.1097/SIH.0000000000000279

Page MJ, Moher D, Bossuyt PM, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ. 2021;372:n160. https://doi.org/10.1136/bmj.n160 DOI: https://doi.org/10.1136/bmj.n160

Cook DA, Reed DA. Appraising the quality of medical education research methods: the Medical Education Research Study Quality Instrument and the Newcastle-Ottawa Scale-Education. Acad Med. 2015;90(8):1067-76. https://doi.org/10.1097/ACM.0000000000000786 DOI: https://doi.org/10.1097/ACM.0000000000000786

Lee J, Kim H, Kim KH, Jung D, Jowsey T, Webster CS. Effective virtual patient simulators for medical communication training: a systematic review. Med Educ. 2020;54(9):786-795. https://doi.org/10.1111/medu.14152 DOI: https://doi.org/10.1111/medu.14152

Ventola CL. Medical Applications for 3D printing: current and projected uses. P T. 2014;39(10):704-11.

Schubert C, van Langeveld MC, Donoso LA. Innovations in 3D printing: a 3D overview from optics to organs. Br J Ophthalmol. 2014;98(2):159-61. https://doi.org/10.1136/bjophthalmol-2013-304446 DOI: https://doi.org/10.1136/bjophthalmol-2013-304446

Lone M, Vagg T, Theocharopoulos A, et al. Development and assessment of a three-dimensional tooth morphology quiz for dental students. Anat Sci Educ. 2019;12(3):284-299. https://doi.org/10.1002/ase.1815 DOI: https://doi.org/10.1002/ase.1815

Awan OA, Sheth M, Sullivan I, et al. Efficacy of 3D printed models on resident learning and understanding of common acetabular fracturers. Acad Radiol. 2019;26(1):130-135. https://doi.org/10.1016/j.acra.2018.06.012 DOI: https://doi.org/10.1016/j.acra.2018.06.012

Hu KC, Salcedo D, Kang YN, et al. Impact of virtual reality anatomy training on ultrasound competency development: A randomized controlled trial. PloS one, 2020; 15(11), e0242731. https://doi.org/10.1371/journal.pone.0242731 DOI: https://doi.org/10.1371/journal.pone.0242731

Akle V, Peña-Silva RA, Valencia DM, Rincón-Perez CW. Validation of clay modeling as a learning tool for the periventricular structures of the human brain. Anat Sci Educ. 2018;11(2):137-145. https://doi.org/10.1002/ase.1719 DOI: https://doi.org/10.1002/ase.1719

Yao WC, Regone RM, Huyhn N, Butler EB, Takashima M. Three-dimensional sinus imaging as an adjunct to two-dimensional imaging to accelerate education and improve spatial orientation. Laryngoscope. 2014;124(3):596-601. https://doi.org/10.1002/lary.24316 DOI: https://doi.org/10.1002/lary.24316

Biglino G, Capelli C, Koniordou D, et al. Use of 3D models of congenital heart disease as an education tool for cardiac nurses. Congenit Heart Dis. 2017;12(1):113-118. https://doi.org/10.1111/chd.12414 DOI: https://doi.org/10.1111/chd.12414

Yeo CT, MacDonald A, Ungi T, et al. Utility of 3D reconstruction of 2D liver computed tomography/magnetic resonance images as a surgical planning tool for residents in liver resection surgery. J Surg Educ. 2018;75(3):792-797. https://doi.org/10.1016/j.jsurg.2017.07.031 DOI: https://doi.org/10.1016/j.jsurg.2017.07.031

Weiss NM, Schneider A, Hempel JM, et al. Evaluating the didactic value of 3D visualization in otosurgery. Eur Arch Otorhinolaryngol. 2021;278(4):1027-1033. https://doi.org/10.1007/s00405-020-06171-9 DOI: https://doi.org/10.1007/s00405-020-06171-9

Gao R, Liu J, Jing S, et al. Developing a 3D animation tool to improve veterinary undergraduate understanding of obstetrical problems in horses. Vet Rec. 2020;187(9):e73. https://doi.org/10.1136/vr.105621 DOI: https://doi.org/10.1136/vr.105621

Wada Y, Nishi M, Yoshikawa K, et al. Usefulness of virtual three-dimensional image analysis in inguinal hernia as an educational tool. Surg Endosc. 2020;34(5):1923-1928. https://doi.org/10.1007/s00464-019-06964-y DOI: https://doi.org/10.1007/s00464-019-06964-y

Lin C, Gao J, Zheng H, et al. Three-dimensional visualization technology used in pancreatic surgery: a valuable tool for surgical trainees. J Gastrointest Surg. 2020;24(4):866-873. https://doi.org/10.1007/s11605-019-04214-z DOI: https://doi.org/10.1007/s11605-019-04214-z

AlAli AB, Griffin MF, Calonge WM, Butler PE. Evaluating the Use of cleft lip and palate 3D-printed models as a teaching aid. J Surg Educ. 2018;75(1):200-208. https://doi.org/10.1016/j.jsurg.2017.07.023 DOI: https://doi.org/10.1016/j.jsurg.2017.07.023

Chekrouni N, Kleipool RP, de Bakker BS. The impact of using three-dimensional digital models of human embryos in the biomedical curriculum. Ann Anat. 2020; 227:151430. https://doi.org/10.1016/j.aanat.2019.151430 DOI: https://doi.org/10.1016/j.aanat.2019.151430

Morales-Vadillo R, Guevara-Canales JO, Flores-Luján VC, Robello-Malatto JM, Bazán-Asencios RH, Cava-Vergiú CE. Use of virtual reality as a learning environment in dentistry. Gen Dent. 2019;67(4):21-27.

Cui D, Wilson TD, Rockhold RW, Lehman MN, Lynch JC. Evaluation of the effectiveness of 3D vascular stereoscopic models in anatomy instruction for first year medical students. Anat Sci Educ. 2017;10(1):34-45. https://doi.org/10.1002/ase.1626 DOI: https://doi.org/10.1002/ase.1626

Hoyek N, Collet C, Di Rienzo F, De Almeida M, Guillot A. Effectiveness of three-dimensional digital animation in teaching human anatomy in an authentic classroom context. Anat Sci Educ. 2014;7(6):430-7. https://doi.org/10.1002/ase.1446 DOI: https://doi.org/10.1002/ase.1446

Kolla S, Elgawly M, Gaughan JP, Goldman E. Medical student perception of a virtual reality training module for anatomy education. Med Sci Educ. 2020;30(3):1201-1210. https://doi.org/10.1007/s40670-020-00993-2 DOI: https://doi.org/10.1007/s40670-020-00993-2

Lane JC, Black JS. Modeling medical education: the impact of three-dimensional printed models on medical student education in plastic surgery. J Craniofac Surg. 2020;31(4):1018-1021. https://doi.org/10.1097/SCS.0000000000006567 DOI: https://doi.org/10.1097/SCS.0000000000006567

Fan G, Zhu S, Ye M, et al. Three-dimensional-printed models in bladder radical cystectomy: a valuable tool for surgical training and education. Int J Clin Exp Med. 2019; 12(8):10145-10150.

Maher MM, Kalra MK, Sahani DV, Perumpillichira JJ, Rizzo S, Saini S, Mueller PR. Techniques, clinical applications and limitations of 3D reconstruction in CT of the abdomen. Korean J Radiol. 2004;5(1):55-67. https://doi.org/10.3348/kjr.2004.5.1.55 DOI: https://doi.org/10.3348/kjr.2004.5.1.55

Alraddadi A. Literature review of anatomical variations: clinical significance, identification approach, and teaching strategies. Cureus, 2021;13(4), e14451. https://doi.org/10.7759/Cureus.14451 DOI: https://doi.org/10.7759/cureus.14451




How to Cite

Sharmin N, Chow AK, King S. Effect of teaching tools in spatial understanding in health science education: a systematic review. Can. Med. Ed. J [Internet]. 2023 Mar. 1 [cited 2024 Jun. 17];14(4):70-88. Available from: https://journalhosting.ucalgary.ca/index.php/cmej/article/view/74978



Reviews, Theoretical Papers, and Meta-Analyses