Keywords
Smartphone; Anatomy; Learning; Smartphone app
Abstract
Background: Anatomical teaching is going through several changes. Several studies observed that the students are deeming anatomy as outdated and irrelevant. The rates of lectures attendance and interest are declining. In this context, tools such as body painting, board games and team quizzes are appearing in the classroom to aid and motivate the student. Often, these complementary tools showed positive results towards their goals in the learning process of several branches of medicine. The smartphone has also been used for these purposes, although the literature lacks studies regarding anatomy. The study conducted herein aimed to create a pilot version of an anatomical application for the smartphone and disseminate its usage in nursing students
Methods: A smartphone application was self-produced with the tool known as Fábrica de Aplicativos© (https://fabricadeaplicativos.com.br) and consisted of anatomical terms and their meaning (Dictionary of Anatomy). The students had the opportunity to use this application during the semester and by the end of the period they answered a questionnaire with questions about the quality and efficacy of the app, with the option of submitting suggestions for its improvement.
Results: 100 graduation students were enrolled in this study. The overall evaluation of the dictionary was excellent/great (65%), while critics such as the lack of better images, the lack of a search resource and the lack of sections were pointed out.
Conclusion: As such, it was observed that the smartphone may have a positive effect in the learning process of anatomy, as demonstrated by our study
Citation
Pires LAS, de Oliveira Leite TF, Fonseca Junior A, Babinski MA and Chagas CAA. Anatomical Apps and Smartphones: A Pilot Study with 100 Graduation Students. SM J Clin Anat. 2018; 2(1): 1007
Introduction
The smartphone is a widely used tool for numerous daily activities. Its popularity significantly increased with the advent of modern operational systems. In particular, students are among the most common users of the smartphone, thus, it is a tool that is always at the hand of scholars [1].
Despite that, there are numerous reports that observed the negative impact of cell phone abuse and high rates of addiction among young individuals. Moreover, these conditions are significantly related to ailments such as depression, anxiety sleep disturbances and behavioral changes [2,3].
On the other hand, studies that address the positive effect of the smartphone regarding medical prescriptions, knowledge of diseases and patient care/education are exponentially increasing. As such, the smartphone has been considered as an effective tool for aiding the educational process [1,4-6].
Furthermore, several smartphone applications (known as “apps”) for the healthcare graduation student and healthcare professionals have been developed, although with more emphasis on nursing and medical practices and their tasks, as well as patient care improvement. However, basic disciplines, such as anatomy or histology are usually contemplated with applications similar to an atlas – according to our searches – and are rarely contemplated in evaluation studies [5-9].
Thus, due to the smartphone being widely used and the lack of anatomical apps that concern the anatomical terms, the study conducted herein aimed to assess the quality and efficacy of an anatomical dictionary app in nursing students from the authors’ institution.
Material and Methods
The present work was approved by the Morphology Department committee and was conducted according to the ethical principles. No individuals were identified throughout the study.
The app and its purpose
A self-produced smartphone app has been created with the purpose of aiding this study. It was produced with the tool known as Fábrica de Aplicativos© (https://fabricadeaplicativos.com.br).
The app was labeled as “Dicionario de Anatomia” (Anatomy Dictionary) and had several anatomical terms (e. g. abduction, pectineal, fascia, synovial joint) and their meaning as well as their etymology (Figure 1).
Figure 1: A schematic display of the “Dicionário de Anatomia” (Dictionary of Anatomy) app
All data was obtained from classic anatomical textbooks. The images included in the app were obtained from Google® and were free of copyright. This app was free of cost and was available for download until the completion of this study.
The authors opted to create a new app due to possible viruses, outdated definitions and lack of significant anatomical terms present in the available apps at the time.
Sample, quality assessment and statistical evaluation
The study was conducted in a single nursing student’s class for 1year (2 semesters). At the beginning of Anatomy lectures, they were introduced to the app and were instructed to download it in their smartphones
By the end of each semester, the students answered a questionnaire regarding multiple aspects of the app. The first seven questions were of Likert type, while the remaining questions were not (Table 1).
Table 1: Questionnaire used to assess the quality of the Anatomical Dictionary.
| Question | Statement text |
| 1 | I have difficulty in learning Anatomy. |
| 2 | I think other tools beyond lectures can help the student in learning. |
| 3 | I believe that the Smartphone can be a complementary tool to the learning process. |
| 4 | The presented app was easy to use. |
| 5 | The presented app was informative. |
| 6 | The presented app did not crash my smartphone. |
| 7 | The images used were good. |
| A | Did you find the app to be an Excellent, Great, Good, Regular, Bad, Awful tool? |
| B | What could be improved? What were the flaws of this app? Do you have any suggestions? |
The survey was created based in previous studies and the questions aimed to assess the usefulness of the app [9]. The student was also able to suggest, criticize and complement the software. The questionnaire was distributed in the last compulsory lecture and the students answered anonymously
Statistical analysis was performed with the SPSS version 21. The chi-square was used to observe significant differences in the answers of questionnaire among the students (p < 0.05 was considered statistically significant).
Results
A total of 100 students participated in this study. 44% ranked the app as “Great”, while 23% of students thought it was “excellent” (Figure 2).
Figure 2: Graphic showing the students opinion regarding the quality of the app. Results are displayed in percentage.
This was a statistically significant difference (p < 0.05).
69% of the students had significant difficulty in learning anatomy and 71% believe that complementary tools are needed to aid anatomical teaching. 67% of the students strongly agreed that the smartphone can be a useful tool to aid the learning process.
Regarding the app, 78% of the sample answered that the app was easy to use, although 31% of the students disapproved the images used in the app. The complete results can be observed in Table 2.
| Question | Strongly disagree | Disagree | Neutral | Agree | Strongly agree | p value |
| 1 | 11% | 3% | 17% | 28% | 41% | |
| 2 | 10% | 0% | 13% | 18% | 59% | |
| 3 | 16% | 7% | 0% | 9% | 67% | |
| 4 | 0% | 0% | 9% | 15% | 78% | |
| 5 | 3% | 5% | 9% | 19% | 64% | |
| 6 | 0% | 0% | 0% | 6% | 94% | <0.05 |
| 7 | 2% | 31% | 7% | 19% | 41% |
The critics were tabulated as follow: (1) The app lacked off-line access; (2) The app lacked a systematic or alphabetic division (the terms were displayed in a single list); (3) It lacked a search option.
Several students however, pointed out that the app: (1) was easy and fast; (2) had concise and informative definition of terms; (3) It worked in multiple operational systems for smartphones; (4) was clean, as it lacked advertising pop-ups.
Discussion
The anatomy dictionary app had a positive evaluation among the nursing students in the study presented herein. This corroborates the data from other studies performed in graduation students, regardless of gender, age and graduation course, although they used other disciplines, such as surgery, microbiology, emergency, clinics and several specialties (e.g. orthopaedics, neurology, otolaryngology) [1,4-6,10-13].
Essentially, anatomy can be taught in two different ways: through theoretical courses and dissection (practical) courses. According to classic anatomical textbooks, the dissection is primordial to the complete understanding of anatomy [14-16]. Moreover, anatomy may be taught systematically, topographically and clinically. The latter is gaining popularity, as the students are more prone to relate
Multidisciplinary approaches, the association with surface anatomy and imaging techniques, body painting and plastic models has been used to aid the student [18,25].
These various methods showed great benefit towards learning and increasing attendance rates. The students obtained capacity of self-study and increase in focus and concentration. Furthermore, after these methods were employed, the follow-up was very positive [11,19,21,22]
Another relevant point for the success of these complementary tools is the formaldehyde toxicity and exposition. It is known that formaldehyde is toxic and can produce discomfort, severe allergic reactions and exposition to it has been associated with cancer [26,27]. Thus, students are often discouraged to frequent dissection courses and to frequent the anatomy laboratory itself [19]. Furthermore, a recent study observed that not even 50% of 663 students deemed lectures classes as essential, and roughly 40% of them believes that the classes are “boring”. This reflects the need to promote newer activities in the educational field, as the non-attendance rates are increasing [28].
The smartphone, however, has several contra points: it is associated with behavioral changes, depression, low self-esteem, anxiety, while abusive usage can cause addiction [2,3,29]. Some studies propose that its use in education is not completely positive, since factors such as distraction from the lectures and dependency can pose a threat for the learning experience [30].
Despite the low number of enrolled students in the present study, the positive effects of the anatomical app were clearly observed. The study conducted herein may serve as a “pilot” for the creation of more elaborate apps and inclusion of a larger pool of students. Another limitation of the study was the enrollment of only nursing students and the lack of a more refined questionnaire.
Conclusions
Anatomy and other disciplines may benefit from complementary tools like body painting, simulation, quizzes and board games. With the rapid increase in smartphone usage rates, this technology can also be a tool to aid and enhance the learning process.
However, smartphone usage should be cautious, especially when dealing with graduation students. More studies are needed in order to evaluate the positive and negative effects of this possible complementary tool in teaching, despite the positive results presented in this study.
Acknowledgements
The authors wish to thank the students that participated in this study.
References
11. Zaki M, Drazin D. Smartphone use in neurosurgery? APP-solutely! Surg Neurol Int. 2014; 5: 113.
14. Goss CM, editor. Gray’s Anatomy of the Human Body. 29th edn. Philadelphia: Lea & Febiger. 1973.
15. Testut L, Latarjet A. Tratado de Anatomía Humana. Barcelona: Salvat. 1958.