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December 02, 2020

Taking medical instruction remote and to mixed reality at Case Western

When Case Western built a new Health Education Campus, it did so with the understanding that the new campus would house the most advanced medical learning facilities and technology available. Central to this effort is the Sheila and Eric Samson Pavilion, where medical, dental, and nursing students engage in lectures, special speaking events, and cutting-edge education.

Case Western Reserve University

One of the initiatives connected to the Pavilion is the development and implementation of the HoloAnatomy application, a mixed reality anatomy application intended to replace cadaver dissections and built for the Microsoft HoloLens. Prior to the COVID-19 crisis, the HoloAnatomy technology was already being used successfully in classroom applications. It was when the school moved to distance learning, however, that the technology demonstrated how it could empower student success. 

Anatomy instruction, mixed reality, and education without disruption

Augmented and mixed reality technology have been deployed, to varying degrees, in fields like medicine to help doctors and students in surgery planning, anatomy education, and patient engagement. HoloAnatomy was built to expand the possibilities of mixed reality with even more highly detailed and interactive models that could stand in for cadavers in educational settings. With HoloAnatomy, holograms of bodies, anatomical structures, and other information project into a holographic space where students can interact with digitized cadavers. 

HoloAnatomy wasn’t a new invention, however, but rather the culmination of nearly six years of development to create accurate and effective models that can supplement or replace in-person cadaver labs. “We got to the point in the planning [the new campus] where we had to think about the cadaver lab,” says Erin Henninger, Executive Director of Digital Commons at Case Western. “And through that process, we were introduced to HoloLens,” and the potential for mixed reality. 

According to Dr. Mark Griswold, Professor in the Department of Radiology at Case Western, this approach was a “bit revolutionary.”

“We got some of the first HoloLenses available,” says Dr. Griswold, “and we sent an email out to anatomists to see if they wanted to check this out. We received many messages back that just said ‘no’ because they didn’t think it was possible.”

Many faculty members were not initially supportive, but came around after several demonstrations. One such member was Dr. Susanne Wish-Baratz, Professor of Anatomy at Case Western.

“I said we will fail when we go into the abdomen,” she says, “It’s too complex. There is a membrane around our GI organs. But I saw that the model artists created that, and that doesn’t exist anywhere else [in other software]. That’s where I was convinced.” Dr. Wish-Baratz now actively teaches in the HoloAnatomy class.

She adds, “I feel like we are teaching anatomy to medical students, able to demonstrate things they can’t see on a cadaver, and able to do it as effectively and more efficiently.”

Henninger and Griswold began running trials with small groups of students starting in 2016. However, it was the onset of COVID-19 in March 2020, and the necessity of remote learning, that accelerated implementation in ways that no one would have expected at the time. 

The class was not disrupted: Remote anatomy and HoloLens

On March 24, the School of Medicine decided to ship 97 HoloLens devices to each of the students in the anatomy class—the largest networking of HoloLens devices the school had attempted. 

The initial launch of the first remote class went remarkably well, according to Dr. Griswold. “The first day of class opened at 10:00. We set aside 25 minutes to set up, but by 10:07 we were teaching.” 

He adds, “We were asked to make a diaphragm as a challenge. It’s important, but you can’t see it in a cadaver. When we showed it to students [in HoloAnatomy], there were audible gasps. They were rolling on the floor looking under the hologram, they couldn’t believe it.”

The largest success was maintaining the significant gains in learning that came with HoloAnatomy. According to Dr. Griswold, students are, in some cases, improving by in the remote lab a whole letter grade compared to the traditional cadaver lab. Over the longer term, students in the HoloLens lab scored 50 percent better on their retention tests and required 40 percent less class time—a trend expected to continue remotely.

From the students’ side, the experience of using HoloAnatomy in the classroom and at home was nearly identical. “For us, it was not different at all,” says MD candidate Ellen Kendall. “You put on the HoloLens, you signed in, slide one was ready. The slide was in your living room.”

“I think that HoloAnatomy is one of the constants we have,” says medical student Sabrina Wong. “It’s not much different than when we are physically present. It’s a stability that I appreciate, especially with online classes.”

Conclusion

All the faculty emphasized the value of cadaver-based training--the proximity to death and anatomy as a personal experience are a critical part of any medical education that involves working on living or deceased patients. The success of HoloAnatomy, however, is in how it has not only transformed this kind of education, but improved it, and made it more responsive to the needs of students and faculty alike.  

“I’m not very tech-savvy and I’m able to manage. You don’t have to have a lot of knowledge to use this. If you can have a HoloLens, you can learn anatomy. You don’t have to be in the room anymore.”

Dr. Susanne Wish-Baratz, Professor of Anatomy, Case Western Reserve University

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