Enhancing Spatial Thinking in Anatomy Education with Digital 3D Tools: A Systematic Literature Review of Comparative Studies

The mechanisms of how Spatial thinking using 3D visualizations improves performance in anatomy are not well understood. This review explores the integration of 3D visualizations in anatomy education, with a particular focus on their impact on spatial thinking. Search words and snowballing were used to identify 17 comparative studies, which were categorized by coding into three distinct comparisons: animated (dynamic) 3D vs. 2D visualizations, digital 3D vs. 2D visualizations without cross-sections, and 3D vs. 2D. Studies were done in eight countries with the number of participants (n = 1711). The results emphasize the advantages of digital 3D visualizations, particularly in scenarios where inferring spatial information from cross-sectional images proves challenging. Guidance and control over viewpoints are identified as crucial factors in enhancing learning outcomes. Media - 3D animated (dynamic) vs $2\mathrm{D}(\mathrm{n}=8), 3\mathrm{D}$ VS $2\mathrm{D}(\mathrm{n}=4), 3\mathrm{D}$ vs 2D cross-section $(\mathrm{n}=9)$. Assessment: post-test $(\mathrm{n}=13)$, assessment during the intervention $(\mathrm{n}=4)$. Outcomes: $3\mathrm{D}$ better $(\mathrm{n}=8)$, 3D sometimes better $(\mathrm{n}=3), 3\mathrm{D}=2\mathrm{D}(\mathrm{n}=7)$. This review highlights the benefits of digital 3D visualizations for anatomy education and underscores the importance of considering mediating mechanisms in future research. It calls for developing theories illuminating the learning processes associated with digital 3D visualizations in anatomy education to guide instructional design.