• we

Application of 3D visualization in combination with a problem-based learning model in teaching spinal surgery | BMC Medical Education

To study the application of a combination of 3D imaging technology and a problem-based learning mode in clinical training related to spinal surgery.
In total, 106 students of the five-year course of study in the specialty “Clinical Medicine” were selected as subjects of the study, who in 2021 will have an internship in the department of orthopedics at the affiliated hospital of Xuzhou Medical University. These students were randomly divided into experimental and control groups, with 53 students in each group. The experimental group used a combination of 3D imaging technology and the PBL learning mode, while the control group used the traditional learning method. After training, the effectiveness of training in the two groups was compared using tests and questionnaires.
The total score on the theoretical test of the students of the experimental group was higher than that of the students of the control group. The students of the two groups independently assessed their grades in the lesson, while the grades of the students of the experimental group were higher than those of the students of the control group (P < 0.05). Interest in learning, classroom atmosphere, classroom interaction, and satisfaction with teaching were higher among students in the experimental group than in the control group (P < 0.05).
The combination of 3D imaging technology and PBL learning mode when teaching spine surgery can enhance the learning efficiency and interest of students, and promote the development of students’ clinical thinking.
In recent years, due to the continuous accumulation of clinical knowledge and technology, the question of what kind of medical education can effectively reduce the time it takes to transition from medical students to doctors and quickly grow excellent residents has become a matter of concern. attracted a lot of attention [1]. Clinical practice is an important stage in the development of clinical thinking and practical abilities of medical students. In particular, surgical operations impose strict requirements on the practical abilities of students and knowledge of human anatomy.
At present, the traditional lecture style of teaching still dominates in schools and clinical medicine [2]. The traditional teaching method is teacher-centered: the teacher stands on a podium and conveys knowledge to students through traditional teaching methods such as textbooks and multimedia curricula. The entire course is taught by a teacher. Students mostly listen to lectures, opportunities for free discussion and questions are limited. Consequently, this process can easily turn into one-sided indoctrination on the part of teachers while students passively accept the situation. Thus, in the process of teaching, teachers usually find that the students’ enthusiasm for learning is not high, the enthusiasm is not high, and the effect is bad. In addition, it is difficult to clearly describe the complex structure of the spine using 2D images such as PPT, anatomy textbooks and pictures, and it is not easy for students to understand and master this knowledge [3].
In 1969, a new teaching method, problem-based learning (PBL), was tested at the McMaster University School of Medicine in Canada. Unlike traditional teaching methods, the PBL learning process treats learners as a core part of the learning process and uses relevant questions as prompts to enable learners to learn, discuss and collaborate independently in groups, actively ask questions and find answers rather than passively accept them. , 5]. In the process of analyzing and solving problems, develop students’ ability for independent learning and logical thinking [6]. In addition, thanks to the development of digital medical technologies, clinical teaching methods have also been significantly enriched. 3D imaging technology (3DV) takes raw data from medical images, imports it into modeling software for 3D reconstruction, and then processes the data to create a 3D model. This method overcomes the limitations of the traditional teaching model, mobilizes students’ attention in many ways and helps students quickly master complex anatomical structures [7, 8], especially in orthopedic education. Therefore, this article combines these two methods to study the effect of combining PBL with 3DV technology and traditional learning mode in practical application. The result is the following.
The object of the study was 106 students who entered the spinal surgical practice of our hospital in 2021, who were divided into experimental and control groups using the random number table, 53 students in each group. The experimental group consisted of 25 men and 28 women aged 21 to 23 years old, mean age 22.6±0.8 years. The control group included 26 men and 27 women aged 21-24 years, average age 22.6±0.9 years, all students are interns. There was no significant difference in age and gender between the two groups (P>0.05).
The inclusion criteria are as follows: (1) Fourth-year full-time clinical bachelor students; (2) Students who can clearly express their true feelings; (3) Students who can understand and voluntarily participate in the entire process of this study and sign the informed consent form. The exclusion criteria are as follows: (1) Students who do not meet any of the inclusion criteria; (2) Students who do not wish to participate in this training for personal reasons; (3) Students with PBL teaching experience.
Import raw CT data into simulation software and import the built model into specialized training software for display. The model consists of bone tissue, intervertebral discs and spinal nerves (Fig. 1). Different parts are represented by different colors, and the model can be enlarged and rotated as desired. The main advantage of this strategy is that CT layers can be placed on the model and the transparency of different parts can be adjusted to effectively avoid occlusion.
a Rear view and b Side view. in L1, L3 and the pelvis of the model are transparent. d After merging the CT cross-section image with the model, you can move it up and down to set up different CT planes. e Combined model of sagittal CT images and use of hidden instructions for processing L1 and L3
The main content of the training is as follows: 1) Diagnosis and treatment of common diseases in spinal surgery; 2) Knowledge of the anatomy of the spine, thinking and understanding of the occurrence and development of diseases; 3) Operational videos teaching basic knowledge. Stages of conventional spine surgery, 4) Visualization of typical diseases in spine surgery, 5) Classical theoretical knowledge to remember, including the theory of Dennis’ three-column spine, the classification of spinal fractures, and the classification of herniated lumbar spine.
Experimental group: The teaching method is combined with PBL and 3D imaging technology. This method includes the following aspects. 1) Preparation of typical cases in spine surgery: Discuss cases of cervical spondylosis, lumbar disc herniation, and pyramidal compression fractures, with each case focusing on different points of knowledge. Cases, 3D models and surgical videos are sent to students a week before class and they are encouraged to use the 3D model to test anatomical knowledge. 2) Pre-preparation: 10 minutes before class, introduce students to the specific PBL learning process, encourage students to actively participate, make full use of time, and complete assignments wisely. Grouping was carried out after obtaining the consent of all participants. Take 8 to 10 students in a group, break into groups freely to think about case search information, think about self-study, participate in group discussions, answer each other, finally summarize the main points, form systematic data, and record the discussion. Select a student with strong organizational and expressive skills as a group leader to organize group discussions and presentations. 3) Teacher Guide: Teachers use the simulation software to explain the anatomy of the spine in combination with typical cases, and allow students to actively use the software to perform operations such as zooming, rotating, repositioning CT and adjusting tissue transparency; To have a deeper understanding and memorization of the structure of the disease, and help them to think independently about the main links in the onset, development and course of the disease. 4) Exchange of views and discussion. In response to the questions listed before the class, give speeches for class discussion and invite each group leader to report on the results of the group discussion after sufficient time for discussion. During this time, the group can ask questions and help each other, while the teacher needs to carefully list and understand the thinking styles of the students and the problems associated with them. 5) Summary: After discussing the students, the teacher will comment on the students’ performances, summarize and answer in detail some common and controversial questions, and outline the direction of future learning so that students can adapt to the PBL teaching method.
The control group uses the traditional learning mode, instructing students to preview the materials before class. To conduct theoretical lectures, teachers use whiteboards, multimedia curricula, video materials, sample models and other teaching aids, and also organize the course of training in accordance with the teaching materials. As a supplement to the curriculum, this process focuses on the relevant difficulties and key points of the textbook. After the lecture, the teacher summarized the material and encouraged the students to memorize and understand the relevant knowledge.
In accordance with the content of the training, a closed book exam was adopted. The objective questions are selected from relevant questions asked by medical practitioners over the years. Subjective questions are formulated by the Department of Orthopedics and finally evaluated by faculty members who do not take the exam. Participate in learning. The full mark of the test is 100 points, and its content mainly includes the following two parts: 1) Objective questions (mostly multiple-choice questions), which mainly test students’ mastery of knowledge elements, which is 50% of the total score; 2) Subjective questions (questions for case analysis), mainly focused on the systematic understanding and analysis of diseases by students, which is 50% of the total score.
At the end of the course, a questionnaire consisting of two parts and nine questions was presented. The main content of these questions corresponds to the items presented in the table, and students must answer the questions on these items with a full mark of 10 points and a minimum mark of 1 point. Higher scores indicate higher student satisfaction. The questions in Table 2 are about whether a combination of PBL and 3DV learning modes can help students understand complex professional knowledge. Table 3 items reflect student satisfaction with both learning modes.
All data were analyzed using SPSS 25 software; test results were expressed as mean ± standard deviation (x ± s). Quantitative data were analyzed by one-way ANOVA, qualitative data were analyzed by χ2 test, and Bonferroni’s correction was used for multiple comparisons. Significant difference (P<0.05).
The results of the statistical analysis of the two groups showed that the scores on objective questions (multiple choice questions) of the students of the control group were significantly higher than those of the students of the experimental group (P < 0.05), and the scores of the students of the control group were significantly higher, than students of the experimental group (P < 0.05). The scores of subjective questions (case analysis questions) of the students of the experimental group were significantly higher than those of the students of the control group (P < 0.01), see Table. 1.
Anonymous questionnaires were distributed after all classes. In total, 106 questionnaires were distributed, 106 of them were restored, while the recovery rate was 100.0%. All forms have been completed. Comparison of the results of a questionnaire survey on the degree of possession of professional knowledge between the two groups of students revealed that the students of the experimental group master the main stages of spinal surgery, plan knowledge, classical classification of diseases, etc. on the. The difference was statistically significant (P<0.05) as shown in Table 2.
Comparison of responses to questionnaires related to teaching satisfaction between the two groups: students in the experimental group scored higher than students in the control group in terms of interest in learning, classroom atmosphere, classroom interaction, and satisfaction with teaching. The difference was statistically significant (P<0.05). Details are shown in Table 3.
With the continuous accumulation and development of science and technology, especially as we enter the 21st century, clinical work in hospitals is becoming more and more complex. In order to ensure that medical students can quickly adapt to clinical work and develop high-quality medical talents for the benefit of society, traditional indoctrination and a unified mode of study encounter difficulties in solving practical clinical problems. The traditional model of medical education in my country has the advantages of a large amount of information in the classroom, low environmental requirements, and a pedagogical knowledge system that can basically meet the needs of teaching theoretical courses [9]. However, this form of education can easily lead to a gap between theory and practice, a decrease in the initiative and enthusiasm of students in learning, an inability to comprehensively analyze complex diseases in clinical practice and, therefore, cannot meet the requirements of higher medical education. In recent years, the level of spine surgery in my country has increased rapidly, and the teaching of spine surgery has faced new challenges. During the training of medical students, the most difficult part of surgery is orthopedics, especially spine surgery. Knowledge points are relatively trivial and concern not only spinal deformities and infections, but also injuries and bone tumors. These concepts are not only abstract and complex, but also closely related to anatomy, pathology, imaging, biomechanics, and other disciplines, making their content difficult to understand and remember. At the same time, many areas of spinal surgery are developing rapidly, and the knowledge contained in existing textbooks is outdated, which makes it difficult for teachers to teach. Thus, changing the traditional teaching method and incorporating the latest developments in international research can make the teaching of relevant theoretical knowledge practical, improve students’ ability to think logically, and encourage students to think critically. These shortcomings in the current learning process need to be addressed urgently in order to explore the boundaries and limitations of modern medical knowledge and overcome traditional barriers [10].
The PBL learning model is a learner-centered learning method. Through heuristic, independent learning and interactive discussion, students can fully unleash their enthusiasm and move from passive acceptance of knowledge to active participation in the teacher’s teaching. Compared to the lecture-based learning mode, students participating in the PBL learning mode have enough time to use textbooks, the Internet, and software to search for answers to questions, think independently, and discuss related topics in a group environment. This method develops students’ ability to think independently, analyze problems and solve problems [11]. In the process of free discussion, different students can have many different ideas about the same issue, which gives students a platform to expand their thinking. Develop creative thinking and logical reasoning ability through continuous thinking, and develop oral expression ability and team spirit through communication between classmates [12]. Most importantly, teaching PBL allows students to understand how to analyze, organize and apply relevant knowledge, master the correct teaching methods and improve their comprehensive abilities [13]. During our study process, we found that students were more interested in learning how to use 3D imaging software than in understanding boring professional medical concepts from textbooks, so in our study, students in the experimental group tend to be more motivated to participation in the learning process. better than the control group. Teachers should encourage students to speak boldly, develop student subject awareness, and stimulate their interest in participating in discussions. The test results show that, according to the knowledge of mechanical memory, the performance of students in the experimental group is lower than that of the control group, however, on the analysis of a clinical case, requiring the complex application of relevant knowledge, the performance of students in the experimental group is much better than in the control group, which emphasizes the relationship between 3DV and control group. Benefits of combining traditional medicine. The PBL teaching method aims to develop the all-round abilities of students.
The teaching of anatomy is at the center of the clinical teaching of spinal surgery. Due to the complex structure of the spine and the fact that the operation involves important tissues such as the spinal cord, spinal nerves, and blood vessels, students need to have spatial imagination in order to learn. Previously, students used two-dimensional images such as textbook illustrations and video images to explain the relevant knowledge, but despite this amount of material, students did not have an intuitive and three-dimensional sense in this aspect, which caused difficulty in understanding. In view of the relatively complex physiological and pathological features of the spine, such as the relationship between spinal nerves and vertebral body segments, for some important and difficult points, such as the characterization and classification of cervical vertebral fractures. Many students reported that the content of spine surgery is relatively abstract, and they cannot fully understand it during their studies, and learned knowledge is forgotten soon after class, which leads to difficulties in real work.
Using 3D visualization technology, the author presents students with clear 3D images, different parts of which are represented by different colors. Thanks to operations such as rotation, scaling and transparency, the spine model and CT images can be viewed in layers. Not only can the anatomical features of the vertebral body be clearly observed, but also stimulate the desire of students to get a boring CT image of the spine. and further strengthening knowledge in the field of visualization. Unlike the models and teaching tools used in the past, the transparent processing function can effectively solve the problem of occlusion, and it is more convenient for students to observe the fine anatomical structure and complex nerve direction, especially for beginners. Students can work freely as long as they bring their own computers, and there are hardly any associated fees. This method is an ideal replacement for traditional training using 2D images [14]. In this study, the control group performed better on objective questions, indicating that the lecture teaching model cannot be completely denied and still has some value in the clinical teaching of spinal surgery. This discovery prompted us to consider whether to combine the traditional learning mode with the PBL learning mode enhanced with 3D visualization technology, targeting different types of exams and students of different levels, in order to maximize the educational effect. However, it is not clear whether and how these two approaches can be combined and whether students will accept such a combination, which can be a direction for future research. This study also faces certain disadvantages such as possible confirmation bias when students complete a questionnaire after realizing they will be participating in a new educational model. This teaching experiment is implemented only in the context of spine surgery and further testing is needed if it can be applied to the teaching of all surgical disciplines.
We combine 3D imaging technology with the PBL training mode, overcome the limitations of the traditional training mode and teaching tools, and study the practical application of this combination in clinical trial training in spine surgery. Judging by the test results, the subjective test results of the students of the experimental group are better than those of the students of the control group (P < 0.05), and the professional knowledge and satisfaction with the lessons of the students of the experimental group are also better than those of the students of the experimental group. control group (P<0.05). The results of the questionnaire survey were better than those of the control group (P < 0.05). Thus, our experiments confirm that the combination of PBL and 3DV technologies is useful in enabling students to exercise clinical thinking, acquire professional knowledge, and increase their interest in learning.
The combination of PBL and 3DV technologies can effectively improve the efficiency of medical students’ clinical practice in the field of spine surgery, enhance the learning efficiency and interest of students, and help develop students’ clinical thinking. 3D imaging technology has significant advantages in teaching anatomy, and the overall teaching effect is better than the traditional teaching mode.
The datasets used and/or analyzed in the current study are available from the respective authors upon reasonable request. We do not have ethical permission to upload datasets to the repository. Please note that all study data has been anonymized for confidentiality purposes.
Cook D.A., Reid D.A. Methods for assessing the quality of medical education research: The Medical Education Research Quality Tool and the Newcastle-Ottawa Education Scale. Academy of Medical Sciences. 2015;90(8):1067–76. https://doi.org/10.1097/ACM.0000000000000786.
Chotyarnwong P, Bunnasa W, Chotyarnwong S, et al. Video-based learning versus traditional lecture-based learning in osteoporosis education: a randomized controlled trial. Clinical experimental studies of aging. 2021;33(1):125–31. https://doi.org/10.1007/s40520-020-01514-2.
Parr MB, Sweeney N.M. Using Human Patient Simulation in Undergraduate Intensive Care Courses. Critical Care Nurse V. 2006;29(3):188–98. https://doi.org/10.1097/00002727-200607000-00003.
Upadhyay S.K., Bhandari S., Gimire S.R. Validation of question-based learning assessment tools. medical education. 2011;45(11):1151–2. https://doi.org/10.1111/j.1365-2923.2011.04123.x.
Khaki A.A., Tubbs R.S., Zarintan S. et al. First-year medical students’ perceptions and satisfaction with problem-based learning versus traditional teaching of general anatomy: introducing problematic anatomy into the traditional curriculum of Iran. International Journal of Medical Sciences (Qasim). 2007;1(1):113–8.
Henderson KJ, Coppens ER, Burns S. Remove Barriers to Implementing Problem-Based Learning. Ana J. 2021;89(2):117–24.
Ruizoto P, Juanes JA, Contador I, et al. Experimental evidence for improved neuroimaging interpretation using 3D graphical models. Analysis of science education. 2012;5(3):132–7. https://doi.org/10.1002/ase.1275.
Weldon M., Boyard M., Martin J.L. et al. Using interactive 3D visualization in neuropsychiatric education. Advanced experimental medical biology. 2019;1138:17–27. https://doi.org/10.1007/978-3-030-14227-8_2.
Oderina O.G., Adegbulugbe I.S., Orenuga O.O. et al. Comparison of problem-based learning and traditional teaching methods among Nigerian dental school students. European Journal of Dental Education. 2020;24(2):207–12. https://doi.org/10.1111/eje.12486.
Lyons, M. L. Epistemology, Medicine, and Problem-Based Learning: Introducing the Epistemological Dimension into the Medical School Curriculum, Handbook of the Sociology of Medical Education. Routledge: Taylor & Francis Group, 2009. 221-38.
Ghani ASA, Rahim AFA, Yusof MSB, et al. Effective learning behavior in problem-based learning: A review of scope. Medical education. 2021;31(3):1199–211. https://doi.org/10.1007/s40670-021-01292-0.
Hodges HF, Messi AT. Outcomes of a thematic interprofessional training project between the Pre-Bachelor of Nursing and Doctor of Pharmacy programs. Journal of Nursing Education. 2015;54(4):201–6. https://doi.org/10.3928/01484834-20150318-03.
Wang Hui, Xuan Jie, Liu Li et al. Problem-based and topic-based learning in dental education. Ann translates medicine. 2021;9(14):1137. https://doi.org/10.21037/atm-21-165.
Branson T.M., Shapiro L., Venter R.G. 3D printed patient anatomy observation and 3D imaging technology improve spatial awareness in surgical planning and operating room execution. Advanced experimental medical biology. 2021;1334:23–37. https://doi.org/10.1007/978-3-030-76951-2_2.
Department of Spine Surgery, Xuzhou Medical University Branch Hospital, Xuzhou, Jiangsu, 221006, China
All authors contributed to the concept and design of the study. Material preparation, data collection and analysis were carried out by Sun Maji, Chu Fuchao and Feng Yuan. The first draft of the manuscript was written by Chunjiu Gao, and all authors commented on previous versions of the manuscript. The authors read and approved the final manuscript.
This study was approved by the Xuzhou Medical University Affiliated Hospital Ethics Committee (XYFY2017-JS029-01). All participants gave informed consent prior to the study, all subjects were healthy adults, and the study did not violate the Declaration of Helsinki. Ensure that all methods are performed in accordance with the relevant guidelines and regulations.
Springer Nature remains neutral on jurisdictional claims in published maps and institutional affiliation.
Open access. This article is distributed under the Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution, and reproduction in any medium and format, provided that you credit the original author and source, provided that the Creative Commons license link and indicate if changes have been made. Images or other third party material in this article is included under the Creative Commons license for this article, unless otherwise noted in the attribution of the material. If the material is not included in the article’s Creative Commons license and the intended use is not permitted by law or regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright owner. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons (http://creativecommons.org/publicdomain/zero/1.0/) public domain disclaimer applies to the data provided in this article, unless otherwise noted in the data’s authorship.
Sun Ming, Chu Fang, Gao Cheng, et al. 3D imaging combined with a problem-based learning model in teaching spine surgery BMC Medical Education 22, 840 (2022). https://doi.org/10.1186/s12909-022-03931-5
By using this site, you agree to our Terms of Use, your US state privacy rights, Privacy Statement and Cookie Policy. Your Privacy Choices / Manage the Cookies We Use in the Settings Center.

Post time: Sep-04-2023