RESEARCH REPORT

Effect of VisualSpatial Ability on Medical Students Performance in a Gross Anatomy Course

Rebecca S. Luer,1* Ann C. Zumwalt,2 Carla A. Romney,3 Todd M. Hoagland4 1 Department of Anatomy and Cellular Biology, Tufts University School of Medicine, Boston, Massachusetts 2 Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts 3 Science and Engineering Program, Boston University Metropolitan College, Boston, Massachusetts 4 Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin

The ability to mentally manipulate objects in three dimensions is essential to the practice of many clinical medical specialties. The relationship between this type of visualspatial ability and performance in preclinical courses such as medical gross anatomy is poorly understood. This study determined if visualspatial ability is associated with performance on practical examinations, and if students visualspatial ability improves during medical gross anatomy. Three hundred and fty-two rst-year medical students completed the Mental Rotations Test (MRT) before the gross anatomy course and 255 at its completion in 2008 and 2009. Hypotheses were tested using logistic regression analysis and Students t-test. Compared with students in the lowest quartile of the MRT, students who scored in the highest quartile of the MRT were 2.2 [95% condence interval (CI) 1.2 and 3.8] and 2.1 (95% CI 1.2 and 3.5) times more likely to score greater than 90% on practical examinations and on both practical and written examinations, respectively. MRT scores for males and females increased signicantly (P < 0.0001). Measurement of students preexisting visualspatial ability is predictive of performance in medical gross anatomy, and early intervention may be useful for students with low visualspatial ability on entry to medical school. Participation in medical gross anatomy increases students visualspatial ability, although the mechanism for this phenomenon is unknown. Anat Sci Educ 5: 39.
2011 American Association of Anatomists.

Key words: gross anatomy education; medical education; anatomy course performance; visualspatial ability; medical students; mental rotation test

INTRODUCTION
Visualspatial ability has been dened as the ability to mentally manipulate objects in three dimensions (Vandenberg and Kuse, 1978). The spatial ability literature has been evaluated and also dened spatial visualization as the ability to mentally rotate and manipulate two-dimensional (2D) and three-

*Correspondence to: Dr. Rebecca Luer, Department of Anatomy and Cellular Biology, 136 Harrison Avenue MV509, Boston, MA 02111, USA. E-mail: Rebecca.luer@gmail.com Received 6 June 2011; Revised 25 October 2011; Accepted 27 October 2011. Published online 29 November 2011 in Wiley Online Library (wileyonlinelibrary.com). DOI 10.1002/ase.264 2011 American Association of Anatomists

dimensional (3D) objects (McGee, 1979; Kozhevnikov et al., 2005). Such spatial abilities are essential to medical training, as seen in surgeons and surgical trainees (Wanzel et al., 2002, 2003; Boom-Saad et al., 2008), and they are even called on early in students education during the study of gross anatomy (Garg et al., 2001). To become procient in anatomy, one must be able to visualize and mentally manipulate 3D structures and able to recall this information, when the anatomy is presented in various planes (Fernandez et al., 2011). Though there are multiple ways to teach anatomy, students spatial ability plays a critical role when using learning resources that show the structures in multiple positions and from different directions (Garg et al., 2001). This not only suggests that visualspatial abilities may be related to students ability to learn anatomy but also suggests that pedagogical techniques could be developed to enhance these abilities and lead to greater success in medical gross anatomy and future medical training.
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The Mental Rotations Test (MRT) is a validated tool that measures a subjects ability to mentally visualize the rotation and orientation of a 3D object that is presented in a 2D plane (Vandenberg and Kuse, 1978). The MRT tests what cognitive psychology has determined a primary visualspatial ability, visual imagery involving 2D and 3D whole object rotations and translations (Anastakis et al., 2000). Studies using the MRT have demonstrated variability in visualspatial ability that corresponds with both gender and practice. The Vandenberg and Kuse version of the MRT has received considerable attention for revealing signicant gender effects in which males perform better on the test than females (Vandenberg and Kuse, 1978; Linn and Petersen, 1985; Voyer et al., 1995; Peters, 2005; Peters and Battista, 2008). Additional factors such as age, sexual orientation, handedness, and genetics have all been linked to visualspatial abilities, however, gender differences remain the strongest inuence on MRT performance (DeFries et al., 1976; Bouchard and McGee, 1977; McGee, 1979; Peters et al., 2006, 2007). In the effort to identify environmental factors that affect visualspatial ability, repeated testing has been shown to lead to increased scores (Baenninger and Newcombe, 1989); however, Peters et al. (1995) found minimal improvements in performance on the MRT during a one month period when administered weekly. Finally, in a study of physical education undergraduate students, practice of rotation tasks led to signicantly increased mental rotations test scores, however, this study did not nd any correlation between visualspatial ability and anatomy scores (Hoyek et al., 2009). Although there have been multiple studies regarding the effects of variables such as gender on visualspatial ability, few studies have examined the effects of taking an intensely visual course on students visualspatial ability and more attention needs to be turned to the implications of visualspatial ability on performance in preprofessional education programs. Learning spatially complex relationships is an essential aspect of medical education that occurs during the study of gross anatomy. Students inherent spatial ability has been shown to play a critical role in their ability to learn anatomical spatial relationships (Rochford, 1985; Garg et al., 2001; Guillot et al., 2009). For example, students abilities to learn carpal bone anatomy are affected by their visualspatial abilities and from studying the carpal bones from rotated views rather than in one static view (Garg et al., 2001). Guillot et al. (2007) also found signicant correlations between visualspatial abilities and results on a test composed of rotated anatomical structures. Both of these studies show relationships between visualspatial ability and a students ability to identify anatomical structures when shown rotated in 3D space. Rochford and coworkers demonstrated that students with poor scores on a battery of geometrical exercises also showed decits on anatomy spatial multiple-choice questions and practical examinations as compared to students with high geometrical exercise scores (Rochford, 1985). However, no differences in performance on nonspatial multiple-choice questions were found when comparing the two groups of students (Rochford, 1985). Further, spatial abilities have been correlated with success in mathematics (Hegarty and Kozhevnikov, 1999), dental education (Hegarty et al., 2009), and veterinary education (Provo et al., 2002), however, none have looked specically at rst-year medical student performance in a gross anatomy course in the United States. These studies suggest that educators could use knowledge of students visualspatial abilities to select pedagogical approaches that may
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help students to adjust their approach to learning. Early recognition of students who possess weak visualspatial abilities coupled with appropriately targeted academic interventions may lead to greater success in medical gross anatomy and in other aspects of their medical training. In this study, we investigate the relationship between visualspatial ability and performance in a medical gross anatomy course. To learn gross anatomy, it is imperative to understand the spatial relationships among anatomical structures. Therefore, we propose that visualspatial ability will be associated with academic performance in medical gross anatomy. Specically, we focus on students performance on laboratory practical examinations during which students must mentally rotate and manipulate structures from various views to identify anatomical structures. We tested the following two hypotheses: (1) visualspatial ability will be positively associated with practical examination scores and (2) students visualspatial abilities will increase during the medical gross anatomy course.

METHODS
Subjects in this study included Boston University School of Medicine rst-year medical students enrolled in the Medical Gross Anatomy course in Fall 2008 (Luer et al., 2010) and Fall 2009 (N 5 352). There were no exclusion criteria for this study. This study was given exempt status by the Institutional Review Board, which grants ethics approval for human subject research studies at Boston University School of Medicine. Participation in the study was voluntary and students could opt out at any time during the course.

Testing VisualSpatial Ability

We assessed visualspatial ability using the MRT, adapted by Vandenberg and Kuse in 1978. The test was administered at two time points: during orientation before the anatomy class began (August 2008 and 2009) and just before the students took the nal examination (December 2008 and 2009). The MRT was administered according to the instructions that accompany the test. Each item consists of a target gure and four comparison gures; each gure is composed of 10 blocks arranged in 3D space (Fig. 1). The students task was to determine which two comparison gures could be rotated into congruence with the target gure. The correct gures are identical to the target gure and only differ by rotation. The remaining two distracter gures are either rotated mirror images of the target gure or rotated images of a target gure belonging to a different item. This commonly used assessment of visualspatial ability was chosen, because it has a set time to complete the task (ve min to complete the rst set of 10 items and ve min to complete the second set of 10 items), thereby emulating the time pressure experienced by students when they take gross anatomy practical examinations. We scored the MRT by assigning each item two points that corresponded to the correct identication of both comparison gures. No points were given for one correct and one incorrect answer. When only one answer was given and it was correct, one point was awarded. This scoring approach discourages guessing and eliminates the need to apply a correction for guessing. The maximum possible score on this test was 40 points.
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Figure 1.
Sample item from the MRT. The rst and third gures can be rotated into congruence with the target gure on the left. Adapted with permission from Vandenberg and Kuse (1978).

Assessment of Student Population

During orientation, we collected baseline data when the students completed the MRT for the rst time and lled out a questionnaire. The questionnaire established students gender, undergraduate major and minor, previous gross anatomy and radiology experience, path before entering medical school, and course load at the time they were taking gross anatomy. Additionally, we obtained Medical College Admission Test 1 (MCAT ) scores to have a measure of baseline knowledge on 1 matriculation to medical school. Additionally, MCAT scores are considered to be a predictor of United States Medical 1 Licensing Examination (USMLE ) Step 1 performance, and therefore, they should be included in statistical analysis (Donnon et al., 2007; Zhao, 2010). To assess individual learning styles, the VARK questionnaire (Fleming, 2011) was administered to students via a password-protected course website (Luer et al., 2010). The acronym VARK stands for the Visual, Aural, Read/write, and Kinesthetic sensory modalities that people use to learn information. Results of this survey can indicate a mild, strong, or very strong tendency to learn in each of the individual modalities. Similarly, when individuals show a tendency to learn using two to four of these modalities, they were identied as having a multimodal learning style. This measure of learning style was used over other instruments, such as the Learning Styles Questionnaire (LSQ; Honey and Mumford, 2006), because it directly assesses whether learners benet from visual stimuli as used in anatomy teaching (pictures, models, charts, or diagrams; Fleming and Mills, 1992). Further, the Honey and Mumfords LSQ has been found to have poor reliability and validity (Klein et al., 2007).

student teaching assistants, and fourth year medical student prosectors. Practical and written examinations are given at the end of each section of the course, yielding six examinations total. The written examination is made up of  80% multiplechoice questions and 20% ll in the blank and short answer questions. The written examination includes a blend of clinical, functional, and identication questions. Students abilities to learn anatomical spatial relationships were assessed by their success in answering practical examination questions. The practical examination questions require students to mentally rotate structures from various views to identify anatomical structures. For example, a question may ask for identication of bony landmarks on articulated or disarticulated skeletons, structures within cadavers, structures on organs removed from the cadaver, and structures on specimens randomly positioned on a table. Each examination was graded out of 100%, and the overall percentage of questions answered correctly was used in this study.

Data Analysis
We began by summarizing student characteristics with mean values for continuous variables and percent or frequencies for dichotomous or categorical variables. We then divided the MRT scores into quartiles (Quartile 4 included those students with the highest MRT scores) and dichotomized all examinations at 90%, which was considered a level of prociency or true understanding of the material. To assess the relationship between MRT scores and examination performance, we used logistic regression with generalized estimating equations (to account for the correlation between examination scores within the same subject) while adjusting for students individual background characteristics that were confounding 1 (MCAT , VARK learning preference, gender, prior radiology experience, and path to medical school matriculation). The performance of students with MRT scores in Quartiles 2, 3, and 4 was compared to the performance of students with MRT scores in Quartile 1 (reference group). We additionally performed analyses keeping examination scores as continuous variables (not dichotomizing at 90%) and used analysis of covariance (ANCOVA) to determine the adjusted mean examination score in each MRT quartile. To determine if MRT scores changed over the course of the anatomy course, a paired t-test with an alpha level 0.05 was used to analyze the
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Assessment of Anatomical Knowledge

The Boston University School of Medicine medical gross anatomy course is comprised of three major sections: Back and Limbs; Thorax, Abdomen, and Pelvis; and Head and Neck. In the laboratory component of the course, eight students form a team and are assigned to a specic cadaver. The teams of eight are further divided into two groups of four students, and each group dissects during separate laboratory sessions. Each group is required to explain their dissection to the other group on their team. All students dissected their assigned cadaver with assistance from faculty, graduate
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Table 1.
Confounding Characteristics of Medical Students Enrolled in the Medical Gross Anatomy Course at Boston University School of Medicine, 2008 and 2009

Students characteristics Total number of students Male Female Previous radiology experience Matriculated directly from undergraduate institution MCAT score, mean (6SD) Total students tested for learning style (VARK method) Visual Auditory Read/write Kinesthetic Other
a
1

N 352 166 186 47 212 352 285 21 19 26 41 178

Percentages 100.0a 47.2 52.8 13.4 60.2 31.9 (63.82)b 100.0c 7.4 6.7 9.1 14.4 62.4

Values are expressed as percentage of total number of students. 1 MCAT performance is expressed in scores and standard deviation. c Values are expressed as percentage for total number of students tested for different learning styles with (VARK method).
b

performed additional analyses including the three written examinations into the model to determine, if there was an association between visualspatial ability and all gross anatomy examinations, and we found similar results. Looking at the written examinations alone, the odds ratio was 2.0 (95% CI 1.0 and 4.1) for the highest quartile, indicating that the visualspatial ability has a slightly increased effect on written examination performance. Finally, the odds ratio for scoring greater than 90% as a nal score in gross anatomy for students who scored in the highest quartile on the MRT was 2.5 (95% CI 1.3, 4.9) compared to those in the lowest quartile. ANCOVA results showed that those students who scored in the highest quartile on the MRT had a signicantly higher mean practical examination score (85.5%) than students who scored in the lowest quartile on the MRT (81.1%, P 5 0.03). Results of the MRT are summarized in Table 3. No students opted out, however, 97 students were lost for followup. Therefore, statistical analyses comparing initial and nal MRT scores were performed on data from the remaining 255 students, because we had complete data sets for these students. The paired t-test showed signicant increases between initial and nal mean MRT scores (t 5 217.42, P < 0.0001). There were also signicant gender-specic increases for both males and females (t 5 29.33, P < 0.0001; t 5 215.44, P < 0.0001, respectively). Males scored signicantly higher than females on the initial (N 5 352, t 5 29.82, P < 0.0001) and nal MRT (N 5 255, t 5 26.31, P < 0.0001). Due to the apparent gender differences in MRT scores, we analyzed the gender variable within the examination regression models to determine the effect of gender on examination performance. ANCOVA results showed that female students were 1.5 (95% CI 1.0, 2.2) times as likely as male students to score greater than 90% on all practical examinations. There were no signicant gender effects, however, on written examination performance [odd ratio (OR) 1.1, 95% CI 0.7, 1.8].

mean difference between initial and nal MRT scores and to assess gender-specic differences. To assess gender differences at each of the time points, for each initial MRT and nal MRT, a Students t-test with an alpha level 0.05 was used. Analyses were performed using SAS statistical software, version 9.1 (SAS Institute, Cary, NC).

DISCUSSION
The overall objective of this study was to determine the relationship between visualspatial ability, as measured by the MRT, and performance in medical gross anatomy, with an emphasis on determining whether students visualspatial abilities changed during the medical gross anatomy course. Specically, we investigated the relationship between students visualspatial abilities and performance on questions that required students to identify anatomical structures on practical examinations. We also examined the effect of participating in the gross anatomy course on students visualspatial abilities.

RESULTS
Three hundred and fty-two students were included in this study, and no students opted out of the study. Student background variables that were confounding and included in statistical analyses can be seen in Table 1 (gender, previous radiology experience, path to medical school matriculation, 1 VARK, and MCAT scores). All regression analyses were performed using complete data sets of students initial MRT scores and background variables and therefore included data from 285 students. The mean initial MRT score was 26.1, with the lowest quartile ranging from 2 to 19 and the highest ranging from 34 to 40. Overall 39.0% (415/1065) of practical examination scores were 90% or greater. Students who scored in the highest quartile of the MRT were 2.2 (95% CI 1.2, 3.8) times as likely as students who scored in the lowest quartile to score greater than 90% on all practical examinations, when adjusted for confounding variables (Table 2). We
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VisualSpatial Ability and Performance in Gross Anatomy

Our results indicate that students who scored in the highest quartile of the MRT perform better on spatially complex questions than do students in the lowest quartile of the MRT. This nding was expected, because practical examinations include identication of bony landmarks on articulated and disarticulated skeletons, as well as structures tagged on cadavers, cross-sections, and radiographic images. Cadavers are placed in multiple positions, and organ systems are removed from the cadavers and intentionally not placed in
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Table 2.
ORs Representing the Relationship Between Students Mental Rotation Test (MRT) Scores and Scoring Greater than 90% on the Outcome Measures, Adjusted for Confounding Variables, Boston University School of Medicine, 2008 and 2009

Quartile 1

Quartile 2

Quartile 3

Quartile 4

P value for trend

MRT MRT range Number of students All practical examinations Students scoring >90 (%) Adjusted OR (95% CI) Adjusted mean (95% CI) 34.9 1.00 (reference) 81.08b (78.52, 83.63) 44.4 1.90 (1.13, 3.18) 84.78 (82.25, 7.20) 37.9 1.54 (0.94, 2.52) 83.47 (81.20, 85.73) 39.6 2.16 (1.23, 3.81) 85.48b (83.18, 87.79) 0.0005a 0.004a 219 88 2026 87 2733 87 3440 90

Adjusted means examination scores for students in each MRT quartile. The column containing P value for trend indicates whether there is a signicant linear trend between students MRT scores as a continuous variable and the outcome measure. a A signicant linear trend at P < 0.05. b Signicantly different at P 5 0.03.

anatomical position. Therefore, students had to be able to mentally manipulate and rotate these structures, to correctly identify the 3D conformation of each structure. This nding also validates the results of Rochford on the predictive validity of a battery of spatial exercises on practical examination scores (Rochford, 1985). The agreement of our study with the only other study to examine this relationship suggests that testing student visualspatial abilities can identify weaknesses on practical examinations and potentially failing students. The MRT used in this study, however, would be a more efcient choice of performance predictor because of its ease of use and short time allotment ( 15 min). An understanding of ones MRT score may also benet students in their future careers in medicine, because visualspatial ability may inuence their performance in specialties such as surgery and radiology that rely on the ability to understand 2D and 3D spatial relationships. For example, as surgery has moved toward minimally invasive techniques such as laparoscopy, visualspatial skills have become even more important to both the surgeon and the patient. An unexpected result in this study is that students who scored in the highest quartile on the MRT performed better on all examinations, including practical and written examinations. This was unexpected, because we initially hypothesized that visualspatial abilities would be related only to success on questions that require mental manipulation of 3D objects. This is contrary to a previous study, which showed that students performed equally well on nonspatial multiple-choice questions, regardless of their performance on a battery of geometrical spatial exercises (Rochford, 1985). Written examination questions include a mix of clinically oriented questions and structure location questions, both of which may involve spatial orientation knowledge or memorization. Our data suggest that students may visualize anatomical structures
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related to the written examination questions and may mentally manipulate the structures to identify relationships and structural features while answering multiple-choice questions. However, further neuropsychological evaluation would be necessary to truly evaluate this phenomenon. In this study, visualspatial ability may be used as a predictor of success in medical gross anatomy. Anatomy educators can use the MRT as a pretest to evaluate students visualspatial ability and thereby identify those who may struggle in the course, so that early interventions with extra resources and tutoring can be implemented from the begin-

Table 3.
Initial and Final Mean Medical Students Mental Rotation Test (MRT) Scores and Gender-Specic Scores at Boston University School of Medicine in 2008 and 2009

MRT Initial MRT Male (N 5 166) Female (N 5 186) Final MRT Male (N 5 112) Female (N 5 143)

Mean score (SD) 26.1a (68.67) 30.3a (66.90) 22.3a (68.35) 31.6a (67.48) 34.7a (65.86) 29.3a (67.63)

Maximum score for MRT is 40 points. a P < 0.0001.

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ning of the course. The relationship between visualspatial ability and academic success is interesting and requires further research on visualspatial abilities and performance in other disciplines within medical education.

Changes in Students VisualSpatial Ability

Our study demonstrates that both males and females experience signicant visualspatial benets during participation in the medical gross anatomy course. Previous research has shown that spatial abilities can improve with experience. Both test-specic practice (retaking the same test over set intervals of time) and training in spatial activities not specic to the test improve performance on spatial ability tests (Baenninger and Newcombe, 1989; Hoyek et al., 2009). Hoyek et al. (2009) found signicant improvements in undergraduate MRT scores after students practiced mental rotation exercises. Our observation that students visualspatial ability increased during the anatomy course leads to speculation about what may have caused this improvement. Terlecki et al. (2008) have shown that videogame training can increase MRT scores. Most interestingly, videogame training was found to have larger transfer effects to other tests of visualspatial ability than repeated testing alone, indicating that the ability to improve ones innate visualspatial ability may be possible. Studies performed specically to address differences in visualspatial ability have retrospectively linked activities such as sports, classes, building models, and designing to subjects ability (Newcombe et al., 1983). Terlecki et al. (2008) even ventured to conclude that girls should become more involved in activities such as videogames to attempt to close the gender gap in visualspatial ability. The increases in visualspatial ability that occurred with our students during gross anatomy could be a result of active participation in dissection of a 3D cadaver in concert with studying 2D representations of anatomy such as textbooks and radiographs. Regardless of what contributed to the increases in MRT scores, we have conrmed that students exhibit a wide range of visualspatial abilities, and these abilities should be considered as a factor contributing to performance in a gross anatomy course (Langlois et al., 2009). Although practice effects caused by repeatedly taking the MRT have been shown (Stericker and LeVesconte, 1982; Terlecki et al., 2008), we were not concerned with this phenomenon during this study. Peters et al. (1995) demonstrated that when the MRT was given once weekly for four weeks, extensive practice resulted in minimal performance improvements. Therefore, taking the second MRT approximately four months after the initial test is unlikely to have demonstrated a signicant improvement in score due to a practice effect.

students on written examination performance (Peplow, 1998). It is difcult to directly compare these studies, because there are obvious curriculum differences, therefore investigation of the effects of gender on performance in anatomy should be considered in future studies. This also further demonstrates the necessity for controlling for variables such as gender or visualspatial abilities in anatomy education studies, depending on the predictor and outcome variables.

Limitations
The strengths of this study are that it was prospectively designed and that we controlled for the effects of confound1 ing variables, specically MCAT scores. There are always variables that are either logistically impossible or not available to include in statistical analysis. For example, further analysis of performance on specic types of questions on the written examination by individual students would have been interesting, however, this was not possible, as it was not part of the original protocol admitted by the IRB and would have involved identiable data. Age has been related to visualspatial ability in the past (Peters et al., 2007), however, this population of students was relatively homogeneous with respect to age, as determined by the path to medical school matriculation covariate. Previous videogame experience would also be an intriguing variable to include in all analyses, as this variable has been linked to visualspatial ability. Additional educational variables, such as students use of resources outside of the course requirements, may also affect the outcome variables. Time studying in the laboratory and practice practical examinations were also considered as variables that may affect the results of this study, however, logistically, this information could not be gathered. It should be acknowledged that as in most educational studies, our data were subject to ceiling effect that must be taken into consideration. The distributions of the scores in our data were skewed toward higher grades, however, this is to be expected considering the population. A limitation of this study is the loss of students for follow-up testing. MRT testing was performed during course lecture time, and the 97 students who did not complete the nal MRT were not present in lecture on the day that it was administered. Finally, the lack of a control group is a limitation to the design of this study. It is not possible within the curriculum at Boston University School of Medicine to form a control group consisting of rst year medical students who do not take the Medical Gross Anatomy course. However, this issue was addressed in part by gathering possible confounding variables and adjusting for them in statistical analysis.

Gender Effects
The signicant relationship of gender and MRT scores was not unexpected, as it is well known throughout the literature that males have higher innate visualspatial abilities than females (DeFries et al., 1976; Bouchard and McGee, 1977; McGee, 1979; Peters et al., 2006, 2007). However, it is interesting that female students are more procient than male students on practical examinations considering females scored signicantly lower than males on the MRT. Further, a previous study found that females score signicantly higher than males on written examinations in anatomy, however, we did not nd any signicant differences between male and female
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FUTURE DIRECTIONS AND CONCLUSIONS

A study further investigating relationships among the variables gathered in this study is currently underway using a different student population. Analysis of the roles of covariates in this study has been kept to a minimum for this reason. Future studies should be executed on different populations to better understand the role of visualspatial abilities in learning. In doing so, we could identify, develop, and implement pedagogical techniques to help students with visualspatial decits. Pedagogical techniques could include mental rotation exercises, such as those used by Hoyek et al. (2009), to
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fundamentally increase ones visualspatial abilities. These types of exercises could be taken one step further to include anatomical models and structures rotated in space. As technology continues to inltrate medical education, educators may want to consider the variability of spatial abilities among students. Providing extra resources, such as tutoring, to students with visualspatial decits may augment classroom and laboratory learning.

NOTES ON CONTRIBUTORS
REBECCA S. LUFLER, Ph.D., is a lecturer in the Department of Anatomy and Cellular Biology at Tufts University School of Medicine, Boston, Massachusetts. She received her doctoral degree from Boston University School of Medicine, where research presented in this report was part of her doctoral dissertation. ANN C. ZUMWALT, Ph.D., is an assistant professor in the Department of Anatomy and Neurobiology at Boston University School of Medicine, Boston, Massachusetts. She teaches medical gross anatomy and clinical anatomy courses to medical students, and she is the faculty advisor for the Anatomical Sciences Interest Group. CARLA A. ROMNEY, D.Sc., is an associate professor and Chair of Science and Engineering Program at Boston University Metropolitan College and assistant dean of Graduate Medical Sciences at Boston University School of Medicine, Boston, Massachusetts. She is responsible for the design and evaluation of K-12, undergraduate, and medical education initiatives. TODD M. HOAGLAND, Ph.D., is an associate professor in the Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin. He is teaching gross anatomy to medical students and serves as director for Clinical Human Anatomy and Advanced Clinical Anatomy courses.
LITERATURE CITED
Anastakis DJ, Hamstra SJ, Matsumoto ED. 2000. Visualspatial abilities in surgical training. Am J Surg 179:469471. Baenninger MA, Newcombe N. 1989. The role of experience in spatial test performance: A meta-analysis. Sex Roles 20:327344. Boom-Saad Z, Langenecker SA, Bieliauskas LA, Graver CJ, ONeill JR, Caveney AF, Greeneld LJ, Minter RM. 2008. Surgeons outperform normative controls on neuropsychologic tests, but age-related decay of skills persists. Am J Surg 195:205209. Bouchard TJ Jr, McGee MG. 1977. Sex differences in human spatial ability: Not an X-linked recessive gene effect. Soc Biol 24:332335. DeFries JC, Ashton GC, Johnson RC, Kuse AR, McClearn GE, Mi MP, Rashad MN, Vandenberg SC, Wilson JR. 1976. Parent-offspring resemblance for specic cognitive abilities in two ethnic groups. Nature 261:131133. Donnon T, Paolucci EO, Violato C. 2007. The predictive validity of the MCAT for medical school performance and medical board licensing examinations: A meta-analysis of the published research. Acad Med 82:100106. Fernandez R, Dror IE, Smith C. 2011. Spatial abilities of expert clinical anatomists: Comparison of abilities between novices, intermediates, and experts in anatomy. Anat Sci Educ 4:18. Fleming ND. 2011. VARK: A Guide to Learning Styles. Christchurch, New Zealand: Neil D. Fleming. URL: http://www.vark-learn.com/english/page. asp?p5questionnaire [accessed 9 June 2011]. Fleming ND, Mills C. 1992. Not another inventory, rather a catalyst for reection. Improv Acad 11:137155. Garg AX, Norman G, Sperotable L. 2001. How medical students learn spatial anatomy. Lancet 357:363364.

Guillot A, Champely S, Batier C, Thiriet P, Collet C. 2007. Relationship between spatial abilities, mental rotation and functional anatomy learning. Adv Health Sci Educ Theory Pract 12:491507. Guillot A, Collet C, Nguyen VA, Malouin F, Richards C, Doyon J. 2009. Brain activity during visual versus kinesthetic imagery: An fMRI study. Hum Brain Mapp 30:21572172. Hegarty M, Keehner M, Khooshabeh P, Montello DR. 2009. How spatial abilities enhance, and are enhanced by, dental education. Learn Indiv Differ 19:6170. Hegarty M, Kozhevnikov M. 1999. Types of visualspatial representation and mathematical problem solving. J Educ Psychol 91:684689. Honey P, Mumford A. 2006. The Learning Styles Questionnaire 40-Item Version. 1st Ed. Maidenhead, UK: Peter Honey Publications Ltd. 54 p. Hoyek N, Collet C, Rastello O, Fargier P, Thiriet P, Guillot A. 2009. Enhancement of mental rotation abilities and its effect on anatomy learning. Teach Learn Med 21:201206. Klein B, McCall L, Austin D, Piterman L. 2007. A psychometric evaluation of the learning styles questionnaire: 40-item version. Br J Educ Tech 38:2332. Kozhevnikov M, Kosslyn S, Shephard J. 2005. Spatial versus object visualizers: A new characterization of visual cognitive style. Mem Cognit 33:710726. Langlois J, Wells GA, Lecourtois M, Bergeron G, Yetisir E, Martin M. 2009. Spatial abilities in an elective course of applied anatomy after a problem-based learning curriculum. Anat Sci Educ 2:107112. Linn MC, Petersen AC. 1985. Emergence and characterization of sex differences in spatial ability: A meta-analysis. Child Dev 56:14791498. Luer RS, Zumwalt AC, Romney CA, Hoagland TM. 2010. Incorporating radiology into medical gross anatomy: Does the use of cadaver CT scans improve students academic performance in anatomy? Anat Sci Educ 3:5663. McGee MG. 1979. Human spatial abilities: Psychometric studies and environmental, genetic, hormonal, and neurological inuences. Psychol Bull 86:889 918. Newcombe N, Bandura MM, Taylor DC. 1983. Sex differences in spatial ability and spatial activities. Sex Roles 9:377386. Peplow PV. 1998. Attitudes and examination performance of female and male medical students in an active, case-based learning programme in anatomy. Med Teach 20:349355. Peters M. 2005. Sex differences and the factor of time in solving Vandenberg and Kuse mental rotation problems. Brain Cognit 57:176184. Peters M, Battista C. 2008. Applications of mental rotation gures of the Shepard and Metzler type and description of a mental rotation stimulus library. Brain Cognit 66:260264. Peters M, Laeng B, Latham K, Jackson M, Zaiyouna R, Richardson C. 1995. A redrawn Vandenberg and Kuse mental rotations test: Different versions and factors that affect performance. Brain Cognit 28:3958. Peters M, Manning JT, Reimers S. 2007. The effects of sex, sexual orientation, and digit ratio (2D:4D) on mental rotation performance. Arch Sex Behav 36:251260. Peters M, Reimers S, Manning JT. 2006. Hand preference for writing and associations with selected demographic and behavioral variables in 255,100 subjects: The BBC internet study. Brain Cognit 62:177189. Provo J, Lamar C, Newby T. 2002. Using a cross-section to train veterinary students to visualize anatomical structures in three dimensions. J Res Sci Teach 39:1034. Rochford K. 1985. Spatial learning disabilities and underachievement among university anatomy students. Med Educ 19:1326. Stericker A, LeVesconte S. 1982. Effect of brief training on sex-related differences in visualspatial skill. J Pers Soc Pyschol 43:10181029. Terlecki MS, Newcombe NS, Little M. 2008. Durable and generalized effects of spatial experience on mental rotation: Gender differences in growth patterns. Appl Cognit Psychol 22:9961013. Vandenberg SG, Kuse AR. 1978. Mental rotations, a group test of three-dimensional spatial visualization. Percept Mot Skills 47:599604. Voyer D, Voyer S, Bryden MP. 1995. Magnitude of sex differences in spatial abilities: A meta-analysis and consideration of critical variables. Psychol Bull 117:250270. Wanzel KR, Hamstra SJ, Anastakis DJ, Matsumoto ED, Cusimano MD. 2002. Effect of visualspatial ability on learning of spatially-complex surgical skills. Lancet 359:230231. Wanzel KR, Hamstra SJ, Caminiti MF, Anastakis DJ, Grober ED, Reznick RK. 2003. Visualspatial ability correlates with efciency of hand motion and successful surgical performance. Surgery 134:750757. Zhao X, Oppler S, Dunleavy D, Kroopnick M. 2010. Validity of four approaches of using repeaters MCAT scores in medical school admissions to predict USMLE Step 1 total scores. Acad Med 85:S64S67.

Anatomical Sciences Education

JANUARY/FEBRUARY 2012