Students Perceptions of an innovative and resilient approach in teaching human anatomy without cadaveric resources: the case of the Medical School of the University of Burundi

This study demonstrates that medical students at the University of Burundi perceive a multimodal, non-cadaveric teaching approach—combining lectures with 3D models, virtual apps, and surgical context—as an effective and preferred method for achieving anatomy learning objectives despite resource limitations.

The Gist

Imagine you are trying to teach a class of future doctors how to navigate the human body, but you have a massive problem: you have no bodies to study.

In many medical schools around the world, students learn anatomy by dissecting real cadavers (donated human bodies). But at the University of Burundi, the school didn't have the facilities or the resources to do this. It's like trying to teach someone how to drive a car, but you don't have a real car, a driving range, or even a parking lot. You only have a textbook.

So, the teachers asked: "How do we teach them to be expert drivers without ever sitting in a real car?"

The "Swiss Army Knife" Solution

Instead of giving up, the teachers at the University of Burundi came up with a creative, multi-tool approach. They realized that if they couldn't use one big tool (a real body), they could combine several smaller, digital, and physical tools to build a complete picture.

They built a "Multimodal Kitchen" for learning anatomy. Here is what they served up:

1. The Lecture (The Recipe Book): Teachers explained the theory first.
2. YouTube Videos (The Cooking Show): Students watched videos of real dissections happening elsewhere, like watching a chef cook on TV.
3. Plastic Models (The Toy Car): They used 3D plastic skeletons and organs that students could hold and touch.
4. Drawings (The Blueprint): Traditional sketches to show the layout.
5. The 3D App (The Virtual Reality Headset): This was the star player. Students used an app called "3D4Medical" on their phones or tablets. They could spin, zoom, and peel back layers of a virtual human body, just like playing a high-tech video game.

What the Students Said

The researchers asked 100 first-year students: "How did you feel about this new way of learning?"

Here is the verdict, translated into plain English:

• Mix and Match is Best: Students hated the idea of just listening to a lecture or just looking at a model. They loved the combination. It was like saying, "I don't just want to read the recipe, I want to watch the video, hold the plastic model, and play with the app all at once."
• The App Won the Race: When comparing the YouTube videos to the 3D App, the students preferred the App. Why? Because the App was interactive. With YouTube, you are a passive viewer watching someone else dissect. With the App, you are the surgeon. You can rotate the heart, zoom in on a nerve, and explore at your own speed. It felt more like a video game and less like a boring class.
• Real Doctors Make it Real: The anatomy classes were taught by actual surgeons. The students felt this was a huge plus. It was like having a professional race car driver teach you how to drive, rather than just a driving instructor. The surgeons could say, "This muscle is important because if you cut here during surgery, this is what happens," connecting the boring textbook facts to real-life emergencies.
• Small Groups Work: Students felt much more engaged when they worked in small groups rather than sitting in a giant lecture hall.

The One Thing They Missed

Despite loving this innovative, low-cost method, there was one honest admission from the students: They still wished they had a real body.

About 91% of the students said, "This method is great, but if we could also get to touch a real human body, we would understand even better." They missed the texture of real tissue and the profound respect that comes from working with a real donor.

The Big Takeaway

This study is a success story for resourcefulness.

It proves that you don't need a million dollars and a warehouse full of cadavers to teach anatomy effectively. By mixing lectures, videos, plastic toys, and high-tech apps, you can create a powerful learning experience that helps students visualize the human body in 3D.

The Analogy:
Think of learning anatomy like learning to play a complex song on the piano.

• The Old Way: You sit in a room with a real piano (the cadaver) and practice for years.
• The Burundi Way: You don't have a piano. So, you listen to the song on Spotify (YouTube), look at the sheet music (drawings), use a keyboard app on your phone (3D App), and hold a plastic toy piano (models).
• The Result: Even without the real piano, the students learned the song so well that they could play it in their heads. And while they admit a real piano would be the "cherry on top," they proved they could learn the music without it.

In short: When you lack resources, don't stop teaching. Get creative, mix your tools, and let technology fill the gaps.

Technical Summary

1. Problem Statement

The study addresses a critical resource constraint in medical education at the University of Burundi: the complete lack of dissection facilities and cadaveric resources. While cadaveric dissection is traditionally considered the gold standard for anatomy education—argued to foster compassion, respect, and 3D spatial understanding—many low-resource settings cannot support it. The authors sought to determine if an evidence-based, multimodal alternative could effectively teach human anatomy to first-year medical students, ensuring learning outcomes comparable to traditional methods while adapting to a low-resource environment.

2. Methodology

• Study Design & Population: A cross-sectional study involving 100 consenting first-year medical students (from a cohort of 123) at the University of Burundi during the 2024/2025 academic year. The sample size was calculated using Slovin's formula ($n=94$) with a 5% margin of error.
• Intervention (The Multimodal Approach):
  • Structure: Topics were introduced via lectures, followed by small-group practical sessions.
  • Tools: Four specific non-cadaveric resources were utilized:
    1. YouTube dissection videos.
    2. 3D plastic anatomical models.
    3. Anatomy drawings/annotations.
    4. The 3D4Medical virtual anatomy app.
  • Instructional Context: Practical sessions were led by surgeons to provide clinical context.
• Data Collection:
  • A Likert scale questionnaire was administered to assess student perceptions regarding:
    • Favorite didactic methods.
    • Achievement of learning objectives (specifically 3D understanding).
    • Engagement with content.
    • The value of surgeon-led instruction.
  • Statistical Analysis: The study employed McNemar tests and paired sample contingency tables to compare the statistical significance of preferences between different didactic methods and tools (e.g., App vs. YouTube, Combination vs. Single tool).

3. Key Contributions

• Validation of a Low-Resource Model: The paper provides empirical evidence that a structured, multimodal approach can successfully replace cadaveric dissection in resource-constrained settings without compromising student engagement or perceived learning outcomes.
• Tool Hierarchy: It identifies a hierarchy of effectiveness among digital and physical tools, specifically highlighting the superiority of interactive 3D apps over passive video content for spatial understanding.
• Role of Clinical Context: The study underscores the importance of having surgeons teach basic science, noting that this bridges the gap between theoretical anatomy and clinical application.
• Resilience in Education: It offers a scalable framework for other medical schools in similar environments to maintain curriculum standards despite infrastructure limitations.

4. Key Results

• Preference for Hybrid Learning:
  • 100% of students rejected "lectures only."
  • 79% preferred a combination of lectures and practical sessions.
  • 67% of students favored the combination of all four practical tools over any single tool used in isolation ($p < 0.001$).
• Tool Comparison:
  • The 3D4Medical virtual anatomy app was significantly preferred over YouTube dissection videos for achieving 3D understanding ($p = 0.018$).
  • Students attributed this to the app's interactivity, allowing self-paced exploration of structures.
• Learning Outcomes & Engagement:
  • 92% agreed that small-group sessions enhanced engagement and understanding.
  • 90% felt that instruction by surgeons added valuable clinical context, aiding knowledge transfer to real-life situations.
  • 75% disagreed that lectures alone were sufficient to meet learning objectives.
• Perception of Cadavers:
  • Despite the success of the alternative method, 91% of students acknowledged that access to cadaveric materials would have further enhanced their understanding, suggesting that while alternatives are viable, they are not viewed as a perfect substitute by the learners.

5. Significance and Conclusion

The study concludes that efficient anatomy education is achievable without cadavers by integrating multiple didactic tools that promote active learning and 3D visualization. The combination of physical models, interactive apps, and video, delivered in small groups by clinically active faculty, creates a robust learning environment.

Implications:

• For Low-Resource Institutions: This model offers a viable, immediate solution for maintaining anatomy curriculum standards where cadavers are unavailable.
• Pedagogical Shift: It supports the global shift from passive, lecture-based learning to student-centered, multimodal approaches.
• Future Outlook: While the alternative method is effective, the authors and students agree that cadaveric dissection remains a "gold standard" bonus that enhances 3D understanding and tissue texture appreciation. Therefore, the proposed model should be viewed as a resilient interim or primary solution, with the goal of reintegrating cadavers if resources ever permit.

Note: As this is a preprint (medRxiv), the findings have not yet undergone peer review.