title: Successful learning of surgical liver anatomy in a computer-based teaching module.
abstract: OBJECTIVE
  To analyze factors influencing the learning of surgical liver anatomy in a computer-based teaching module (TM).
  
  
  METHODS
  Medical students in their third to fifth year of training (N [Formula: see text] 410) participated in three randomized trials, each with a different primary hypothesis, comparing two- (2D) and three-dimensional (3D) presentation modes in a TM for surgical liver anatomy. Computed tomography images were presented according to the study and allocation group. Students had to answer eleven questions on surgical liver anatomy and four evaluative questions. Scores and time taken to answer the questions were automatically recorded. Since the three studies used the same 15 questions in the TM, a pooled analysis was performed to compare learning factors across studies.
  
  
  RESULTS
  3D groups had higher scores (7.5 ± 1.7 vs. 5.6 ± 2.0; p < 0.001) and needed less time (503.5 ± 187.4 vs. 603.1 ± 246.7 s; p < 0.001) than 2D groups. Intensive training improved scores in 2D (p < 0.001). Men gave more correct answers than women, independent of presentation mode (7.2 ± 2.0 vs. 6.5 ± 2.1; p [Formula: see text] 0.003). An overall association was found between having fun and higher scores in 11 anatomical questions (p < 0.001). In subgroup analysis, 3D groups had more fun than 2D groups (84.7 vs. 65.1 %; p < 0.001). If given the option, more students in the 2D groups (58.9 %) would have preferred a 3D presentation than students in the 3D group (35.9 %) would have preferred 2D (p  < 0.001).
  
  
  CONCLUSIONS
  3D was superior to 2D for learning of surgical liver anatomy. With training 2D showed similar results. Fun and gender were relevant factors for learning success.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Heidelberg University, INF 110, 69120, Heidelberg, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Nickel
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Heidelberg University, INF 110, 69120, Heidelberg, Germany.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Hendrie
authors.affiliation: Institute for Medical Biometry and Informatics, Heidelberg University, INF 305, 69120, Heidelberg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bruckner
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Heidelberg University, INF 110, 69120, Heidelberg, Germany.
authors.forename: Karl F
authors.initials: KF
authors.lastname: Kowalewski
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Heidelberg University, INF 110, 69120, Heidelberg, Germany.
authors.forename: Hannes G
authors.initials: HG
authors.lastname: Kenngott
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Heidelberg University, INF 110, 69120, Heidelberg, Germany.
authors.forename: Beat P
authors.initials: BP
authors.lastname: Müller-Stich
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Heidelberg University, INF 110, 69120, Heidelberg, Germany. lars.fischer@med.uni-heidelberg.de.
authors.forename: Lars
authors.initials: L
authors.lastname: Fischer
mesh_terms: D001662:Biliary Tract Surgical Procedures / Q000193:education*; D003194:Computer-Assisted Instruction; D004521:Educational Measurement; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008099:Liver / Q000033:anatomy & histology / Q000601:surgery*; D008297:Male; D014057:Tomography, X-Ray Computed
keywords: Education; Hepatic; Liver; Oncology; Surgery