Effects of Immersive VR, Non-Immersive VR, and 3D-Printed Models on Anatomy Learning and Cognitive Load

Following the theoretical lecture, participants in this group will receive anatomy training in an immersive virtual reality environment using a head-mounted display. They will actively manipulate, rotate, and examine the 3D models of the carpal bones, L2 vertebra, and sacrum to explore their anatomical structures.

All participants in the three groups will receive a 60-minute theoretical lecture on the anatomy of the carpal bones, L2 vertebra, and sacrum, supported by slides containing two-dimensional anatomical illustrations.Following the theoretical lecture, parti

Following the theoretical lecture, participants in this group will receive anatomy training in a non-immersive virtual reality environment using the same anatomy software as the immersive VR group, with the virtual environment displayed on a wall through a projector instead of a head-mounted display. They will directly manipulate, rotate, and examine the same 3D models of the carpal bones, L2 vertebra, and sacrum to explore their anatomical structures.

All participants in the three groups will receive a 60-minute theoretical lecture on the anatomy of the carpal bones, L2 vertebra, and sacrum, supported by slides containing two-dimensional anatomical illustrations. Following the theoretical lecture, participants in the non-immersive virtual reality group will use the same anatomy education application as the immersive VR group, with the virtual environment displayed on a wall using a short-throw projector. Participants will examine the anatomical structures of the carpal bones, L2 vertebra, and sacrum through direct manipulation of the projected 3D models.

Following the theoretical lecture, participants in this group will receive anatomy training using 3D-printed anatomical models produced from the same 3D files used in the virtual reality groups. They will directly handle, manipulate, rotate, and examine the physical models of the carpal bones, L2 vertebra, and sacrum to explore their anatomical structures through hands-on interaction.

All participants in the three groups will receive a 60-minute theoretical lecture on the anatomy of the carpal bones, L2 vertebra, and sacrum, supported by slides containing two-dimensional anatomical illustrations. Following the lecture, participants in the 3D-printed anatomical model group will examine the prominent anatomical structures of these bones for 30 minutes through direct manipulation of three-dimensional physical models.

To assess students' baseline knowledge of anatomical terminology and general anatomy, a general knowledge test will be administered before the pre-test, and participants will be allocated to groups based on their test scores. Learning performance will be assessed using a 20-item multiple-choice test and a five-station Objective Structured Practical Examination (OSPE), administered before and after the intervention. The assessments will cover bony landmarks, anatomical relationships, important anatomical structures, attachment sites, and functions.

Participants will be asked to assess post-session side effects using the Cyber-Sickness Questionnaire in Virtual Reality (CSQ-VR). The CSQ-VR is a 7-point Likert scale consisting of six questions that assess three types of cyber-sickness symptoms: Nausea, Vestibular, and Oculomotor. There are two questions for each symptom category. Participants rate the presence and intensity of each symptom on a scale ranging from "1 - none" to "7 - severe." The CSQ-VR provides a total score, which is the sum of the three subscores, with a maximum score of 42 (14 for each subscore).

The Different Types of Cognitive Load Scale will be used to assess cognitive load. The scale consists of 10 items, each rated from 0 to 10. Lower scores indicate lower cognitive load, whereas higher scores indicate higher cognitive load. Each item is rated from 1 to 10, yielding a total score ranging from 10 to 100, with higher scores indicating greater reported cognitive load.

The Instructional Materials Motivation Survey (IMMS) will be used to assess changes in students' motivation to learn associated with the instructional methods employed. The original questionnaire consists of 36 items and evaluates motivation across four subscales: attention, relevance, confidence, and satisfaction. Each item is rated on a five-point Likert scale, with total scores ranging from 36 to 180 for the original version and from 24 to 120 for the 24-item Turkish adaptation; higher scores indicate greater motivation.

The Test Anxiety Inventory (TAI) will be used to assess students' cognitive and emotional responses to examination-related anxiety. The inventory consists of 20 items rated on a four-point Likert scale and comprises two subscales: worry and emotionality. Total scores range from 20 to 80, with higher scores indicating greater test anxiety.

Participants will complete a feedback questionnaire evaluating the learning instruments using a visual analogue scale ranging from 0 (not at all) to 10 (extremely).

The MEC Spatial Presence Questionnaire (MEC-SPQ) will be used to assess participants' sense of spatial presence in virtual environments. The questionnaire consists of 64 items across eight subscales: Attention Allocation, Spatial Situation Model, Spatial Presence: Self-Location, Spatial Presence: Possible Actions, Higher Cognitive Involvement, Suspension of Disbelief, Domain-Specific Interest, and Visual Spatial Imagery. Each item is rated on a five-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). The theoretical total score ranges from 64 to 320, while individual subscale scores range from 8 to 40. Higher scores on the spatial presence subscales indicate a stronger sense of presence in the virtual environment.