the development of interactive online learning tools for the study of

2008; 30: e260–e271

WEB PAPER

The development of interactive online learningtools for the study of Anatomy

PATRICK J O’BYRNE, ANNE PATRY & JACQUELINE A CARNEGIE

University of Ottawa, Ottawa, Canada

Abstract

Background: The study of human anatomy is a core component of health science programs. However large student enrolments

and the content-packed curricula associated with these programs have made it difficult for students to have regular access to

cadaver laboratories.

Methods: Adobe Flash MXTM was used with cadaver digital photographs and textbook-derived illustrations to develop interactive

anatomy images that were made available to undergraduate health science students enrolled in first-year combined anatomy and

physiology (ANP) courses at the University of Ottawa. Colour coding was used to direct student attention, facilitate name-structure

association, improve visualization of structure contours, assist students in the construction of anatomical pathways, and to

reinforce functional or anatomical groupings. The ability of two-dimensional media to support the visualization of three-

dimensional structure was extended by developing the fade-through image (students use a sliding bar to move through tissues) as

well as the rotating image in which entire organs such as the skull were photographed at eight angles of rotation. Finally, students

were provided with interactive exercises that they could repeatedly try to obtain immediate feedback regarding their learning

progress.

Results: Survey data revealed that the learning and self-testing tools were used widely and that students found them relevant and

supportive of their self-learning. Interestingly, student summative examination outcomes did not differ between those students

who had access to the online tools and a corresponding student group from the previous academic year who did not.

Conclusion: Interactive learning tools can be tailored to meet program-specific learning objectives as a cost-effective means of

facilitating the study of human anatomy. Virtual interactive anatomy exercises provide learning opportunities for students outside

the lecture room that are of especial value to visual and kinesthetic learners.

Introduction

Undergraduate university students, the youngest of adult

learners, are expected to assume significant responsibility for

their educational success as they explore new concepts in

large class settings. Nevertheless, this responsibility must also

be shared by course instructors whose mandate is to provide

an organized and engaging educational environment that

addresses the diverse learning needs of large student popula-

tions. The study of human anatomy is a core component of

health science programs including medicine, nursing, human

kinetics, physiotherapy and occupational therapy (Granger

et al. 2006). However, the level of anatomical knowledge and

structural detail that is required for each body system is very

much discipline-dependent and anatomy instruction must be

tailored to meet the specific needs of each health science

discipline (Terrell 2006).

The lecture room, the cadaver laboratory and the virtual

laboratory are all appropriate venues for anatomy instruction.

While lectures afford the opportunity for the instructor to

present all learners with a package of well-organized

information developed around a series of learning objectives,

the potential exists, unfortunately, for a good deal of this

learning to be passive as students listen to the instructor while

Practice points

. Undergraduate students studying anatomy are presented

with large amounts of structural information that they

must assimilate within a fairly short period of time.

. Interactive learning exercises developed in Adobe

Flash MXTM provide opportunities for students to

pursue self-directed learning outside the laboratory.

The images developed for these exercises can be

manipulated by the student to enhance visualization

of three-dimensional anatomy and have value for

kinesthetic, visual and read/write learners.

. The content (level of detail) in these exercises can be

modified to meet the specific learning objectives of

various health science programs.

. Interactive self-testing exercises allow students to

practice applying new knowledge and to obtain

valuable feedback on their progress in learning before

summative examinations.

. The delivery of learning and self-testing tools online is

cost-efficient, allows repeated practice at each student’s

convenience and addresses learning challenges asso-

ciated with large class sizes.

Correspondence: Jacqueline A Carnegie, PhD, MEd., Faculty of Medicine, Department of Cellular and Molecular Medicine, University of Ottawa,

451 Smyth Road, Ottawa, Ontario K1H8M5. Tel: 613.562.5800� 8072; fax: 613.562.5434; email: [email protected]

e260 ISSN 0142–159X print/ISSN 1466–187X online/08/080260–12 � 2008 Informa UK Ltd.

DOI: 10.1080/01421590802232818

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they look at projected slides showing labeled images of body

anatomy. Interactive laboratory sessions are helpful in that

they provide some opportunity for students to manipulate

body structures so that they can appreciate their three-

dimensional form and visualize their interrelationships with

surrounding tissues and organs. However, anatomy laboratory

sessions require significant investments of time, space and

resources (Rizzolo & Stewart 2006), are usually of limited

duration, and often involve group sessions in which a student’s

view and/or ability to manipulate the cadaver is restricted.

Furthermore, a challenge facing a number of health science

programs, including those offered at the University of Ottawa,

is that many of these programs have such large student

enrolments and/or such information-dense curricula that it is

simply not possible to offer weekly anatomy laboratories as

part of the core curriculum (Granger et al. 2006; Rizzolo &

Stewart 2006). Hence, the challenge exists for anatomy

instructors to develop cost-effective, student-friendly learning

resources that target program-specific anatomical

learning objectives and are able to either replace or extend

the learning environment of the cadaver laboratory

(Clark 1994; Granger et al. 2006).

The learning characteristics of adult students have been

extensively studied and numerous theories have been

proposed. For example, in his widely-read theory of andra-

gogy, Knowles described adult students as self-directed

learners whose knowledge acquisition occurs best when it is

exploratory and task-oriented, rather than via rote memoriza-

tion (Knowles et al. 1984; Pratt 1993). Simply defined, learning

involves the reorganization and transfer of new information

from the limited confines of working memory to the limitless

repository of long term memory (Kirschner 2002; Kirschner

et al. 2006). Working memory, or what we can consider

as conscious memory, is characterized by storage durations

(5–20 sec if not readdressed) as well as content capacities

(3–7 new elements at a time, depending on information

complexity) that are both very limited (Miller 1956; Sweller

et al. 1998; Kirschner 2002; Kirschner et al. 2006; Terrell 2006).

Long term memory, on the other hand, encompasses our

repository of accumulated knowledge and, therefore, has a

capacity that is theoretically boundless (Terrell 2006). Indeed,

the challenge facing each learner is to organize new

information, as it is added to this repository, so that it can be

successively retrieved and applied in a timely fashion when

needed (Sweller et al. 1998; Kirschner 2002, Kirschner et al.

2006; Terrell 2006). With that in mind, a challenge facing

anatomy educators is to effectively guide learning so as to

maximize the efficiency with which new knowledge is

encoded in long-term memory (Kirschner et al. 2006).

This paper describes the development and implementation

of program-tailored online anatomy learning and self-testing

tools for undergraduate Faculty of Health Science students

enrolled in first-year combined anatomy and physiology (ANP)

courses at the University of Ottawa. These tools were made

available to students via supplementary WebCTTM-based

course web sites. When designing these online exercises,

care was taken to apply instructional design principles such as

cognitive load theory (Moreno & Mayer 2000; Kirschner 2002,

Heo & Chow 2005; Terrell 2006) and Gagne’s Nine Events of

Instruction (Gagne et al. 1992) so that extraneous cognitive

load (defined as the ineffective cognitive load that reduces

ease of student learning), would be minimized and the ability

of these tools to capture student attention and promote

interactive, effective learning could be maximized. As an

important first step, and as recommended by Robert Gagne’s

second (inform learners of objectives) and fifth (provide

guidance) events of instruction (Gagne et al. 1992), the online

exercises were embedded within a framework of carefully

organized course learning objectives so that students would try

each activity in order and at the most appropriate stage in their

learning. Students began with worked examples (Heo & Chow

2005; Kirschner et al. 2006) of textbook diagrams and cadaver

images in which all relevant information was made available to

them, step by step. Then, and in compliance with Robert

Gagne’s sixth event of instruction (provide opportunities for

practice; Gagne et al. 1992), students were provided with

many opportunities to practice applying their new knowledge

via unlimited access to the self-testing exercises. These

exercises resembled very closely the types of questions

students were subsequently asked on summative examinations

and assessed student learning at two rather basic levels of

competence (anatomy-based knowledge is largely factual with

minimal opportunities for higher forms of knowledge applica-

tion such as synthesis or analysis), but still at increasing levels

of difficulty (van Merrienboer & Sweller 2005). They began

with the easier drag-and-drop labeling activities that were then

followed by the more challenging type-in-labeling exercises.

Formative assessment of the anatomy tools was conducted

using student surveys. Furthermore, student performance on

summative examinations was compared between students

who had access to the online learning tools and a comparable

student population previous academic year) that did not have

access to the supplementary course web sites.

Materials and methods

Materials

Adobe Flash MXTM was used to create a number of different

types of interactive online images, as described below.

Interactive self-learning images

The roll-over image. The basic roll-over image uses colour

coding to allow the learner to visually link an anatomical

structure with its corresponding label. Whenever possible,

unlabeled textbook illustrations (Marieb 2001) were paired

with cadaver images (dissections and photography courtesy of

S. Goodwin, U. Ottawa) photographed at the same orientation

so as to facilitate comparison of structure location and

morphology between the textbook diagram and the in situ

photograph (Figure 1). To create interactivity, and as directed

by the course learning objectives, a finite number of labels was

added to each set of paired images in the form of mouse-

operated buttons. Next, each of the labeled anatomical

structures was outlined and filled with a bright and contrasting

colour, keeping the fill partially transparent so that the visibility

of the underlying structure was maintained at the same time

Interactive anatomy images

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that its shape was being clearly delineated and its proximity to

nearby body components revealed.

Within the roll-over images, the selective use of color and

the ability to add additional highlighted components to an

initial starting structure allows student attention to be directed

along an anatomical pathway, such as the pathway of arterial

blood flow down the abdominal aorta and into the left and

right common iliac arteries (Figure 2). Similarly, the pathway of

arterial blood flow through the axillary, brachial and radial

arteries as it flows down the upper limb toward the wrist

can be followed as each pathway component is highlighted

in succession (Figure 3). While this pathway appears artificially

simple when the vessels are shown in relative isolation

in a textbook drawing (Figure 3a), students are made aware

that the anatomy of the upper limb is actually considerably

more complex and that these arteries must travel in between

and around nerves, muscles and veins to reach their

destinations (Figure 3b).

Variations on the roll-over image. The simple roll-over

image does not address the pedagogical issue that three-

dimensional anatomy is being studied using two-dimensional

learning tools. Hence, variations such as the multi-angle

rotation and the fade-through image (Macromedia 2006)

were developed to encourage students to make associations

between structures linked by location and/or function.

Figure 1. Matching (a) textbook (From Marieb EN: Human Anatomy & Physiology, San Francisco, 2001, Benjamin Cummings,

used by permission of Pearson Education, Inc.) and (b) cadaver roll-over images of the location of the heart in the mediastinum of

the thorax showing the aorta. A comparison of (a) and (b) shows that the ‘empty spaces’ that are frequently included between

structures for clarity in textbook drawings do not actually exist in the body and that structures are often less perfect in shape when

seen in situ.

P. J. O’Byrne et al.

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Figure 2. Cadaver image dissected to reveal the major abdominal arteries. (a) Roll-over highlight of abdominal aorta. (b) Roll-

over highlight with the abdominal aorta still emphasized but now adding in two branches, the common iliac arteries.


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(a) Multi-angle rotation. For the multi-angle interactive

image, cadaver specimens were mounted on a movable

stage and photographed at eight equally-spaced angles

of rotation between 0� and 360�). Each image was then

placed within a different frame in the video function of

Flash so that the user will be able to use arrow buttons

to navigate completely around the body structure in

either direction (Figure 4). As shown with this interactive

rotational image of the skull (Figure 4a–c), students can

also highlight a single structure (e.g. the sphenoid bone)

and follow that structure through one complete revolu-

tion (Figure 4a–c).

(b) Grouping. For some roll-over images, structure labels

were organized so as to group related anatomical

components. For example, the group label ‘facial

bones’ was added to the image of the skull in such a

way that when the mouse is placed over this group

label, the labels for all of the individual facial bones as

Figure 3. Corresponding (a) textbook (From Marieb EN: Human Anatomy & Physiology, San Francisco, 2001, Benjamin

Cummings, used by permission of Pearson Education, Inc.) and (b) cadaver roll-over images of the right upper limb and thorax

highlighted to allow the arterial pathway of blood flow to the wrist to be followed.


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well as the bones themselves within the skull are

highlighted at the same time (Figure 4d). Furthermore,

by combining the grouping function with rotational

ability, students are able to follow these bones as a

complete structural unit when the skull is rotated and

appreciate their physical relationships with one another

from eight different points of view.

With this addition, colour coding as a means of facilitating

information organization and reducing extraneous cognitive

load became especially important (Kirschner 2002; Deubel

2003). Hence, care was taken to ensure that when paired

diagrams and cadaver images were used, each paired

structure-label member of the group had a unique and distinct

colour and that colour selection was consistent between

image pairs.

The fade-through image. The fade-through image allows

students to appreciate the relationship between superficial and

more deeply situated structures within an organ or body

region. A minimum of two photographs of the same structure

at different body depths were required for the construction

of each fade-through interactive image. Using Flash, the

photographs were placed directly on top of each other and a

slider-bar was created that was linked directly to the

transparency property of the top image. This gives the learner

the ability to adjust the transparency of the top image so as to

produce a range of image views extending from visualization

of exclusively the top image, degrees of simultaneous relative

visibility of both images (to identify physical relationships),

to exclusive visibility of only the bottom image. While Figure 5

shows just a single screen capture of the structure of the heart

Figure 4. Rotating roll-over image of the skull with the sphenoid bone highlighted so that it can be followed as the skull is

manipulated to be viewed at (a) 0�, (b) 45�, and (c) 90� of rotation. (d) The grouping function has been activated to allow all of the

facial bones to be viewed simultaneously at 45� of rotation.


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taken at 72% transparency of the top image, the slide bar tool

can be adjusted in very small increments between 100% and

0% transparency of the upper image so that the students

can finely control the rate at which they see a more superficial

view being replaced a deeper one. Furthermore, by moving

the slide bar back and forth, students can make repeated

and detailed comparisons to come to a greater understanding

of the three-dimensional structure of this organ and the

potentials for functional interaction between its components.

Interactive self-testing images

Drag-and-drop. Drag-and-drop labeling exercises were

created to allow self-testing at the most basic level of

knowledge, the simple recognition of a structure name when

viewing that structure (Anderson & Krathwohl 2001). For

these self-testing exercises, roll-over images were modified so

that the label lines linked to empty boxes rather than

structure names, and an alphabetical list of labels was

provided to the left of the diagram. If a label was dragged

and dropped into the correct box, it remained in place. If the

label was placed incorrectly, it would automatically return to

its original place within the label list, allowing the student

unlimited opportunities to try to associate it with the

appropriate structure.

Type-In labeling. Recognition of a structure name represents

the simplest form of learning. However, the applied use of

new knowledge in the workplace requires that a student know

and can use structure names in context rather than simply

recognizing them from a list. To promote the ability to recall

and correctly spell structure names, type-in labeling applets

were developed that required the user to key the name of a

structure into an empty text box when that structure was

highlighted on the computer screen. Students have three

chances to type in the correct name before it appears in the

box. Once the entire exercise has been successfully com-

pleted, the student is presented with a fully and accurately

labeled diagram for review.

Evaluation methods

Formative evaluation. These learning and self-testing tools

were provided online to 275 undergraduate University of

Ottawa health science students throughout the term during

which they were studying the anatomy and physiology of the

endocrine, cardiovascular and respiratory systems. Students

could use each tool as often as desired throughout the duration

of the course. The anatomy tools were combined with

interactive physiology self-tests to form a WebCT-based

course web site that supplemented the learning accomplished

in the lecture hall. At the end of the course, students were

asked to complete an anonymous questionnaire evaluating the

anatomy-based learning and self-testing components of the

course web site.

Figure 5. Fade-through textbook (From Marieb EN: Human Anatomy & Physiology, San Francisco, 2001, Benjamin Cummings,

used by permission of Pearson Education, Inc.) image of the heart with a sliding bar allowing the transparency of the more

superficial of the image components to be adjusted between 0 and 100%.


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This survey was composed of ten close-ended questions

that allowed students to provide feedback pertaining to their

ease and extent of use of each of the anatomy exploratory and

self-testing exercises as well as their assessment of the ability

of these learning tools to promote their learning and

comprehension of course content. For each type of tool

students were also provided with the option to not provide

feedback because they had chosen not to make use of that

particular tool. The final part of the survey contained open-

ended questions that asked students to identify the strengths

and weaknesses of the learning tools, so that any shortcomings

could be addressed.

Summative evaluation. Although difficult to rigorously

assess, the ultimate test of a learning tool is its ability to

enhance student knowledge retention and transfer. Student

outcomes on summative examinations were compared

between the first group of 275 students to use the interactive

web sites (LT Group) and a comparable student population

(241 students) who took this course in the absence of

supplemental learning tools during the previous academic

year (No-LT Group). Summative examinations results were

analysed by the t-test assuming unequal variances (Microsoft

Excel XP) while student groupings by letter grade were

evaluated using the Chi-square test (SPSS 8.0).

Results

In contrast to students studying medicine at the University of

Ottawa, students enrolled in most other health-science-related

programs do not have access to cadaver laboratories. All of

their anatomy learning must be accomplished through lecture

and online supplementary course web sites.

Student feedback

A response rate of 49% (136/275 students) was obtained for

the survey evaluating the online learning and self-testing tools

that were provided to undergraduate Faculty of Health

Science students studying anatomy and physiology.

Approximately two-thirds of respondents reported that they

used the interactive learning images (64%) as well as the drag-

and-drop (66%) and type-in labeling self-testing exercises

(68%) and that they found these instructional tools to be

helpful as they prepared for summative examinations. More

than 90% of respondents indicated that the interactive

exercises were relevant to course content, the supplied

directions to students were clear, and the activities themselves

were user-friendly.

Web site features that were identified by students as

particularly useful included the anatomy learning tools

themselves, the ability to test their knowledge online, and

the existence of unlimited access to the interactive exercises.

On the other hand, an important concern raised by students

was a lack of flexibility associated with the type-in labeling

self-tests. For a number of the labels, students noted that more

than one correct answer should have been recognized, due to

the existence of redundant terminology, optional use of capital

letters or hyphens and occasional confusion as to whether the

structure name should be provided in the singular or the

plural. They suggested that the answer key should be

expanded to accommodate all possible alternate responses.

Student learning outcomes

The two classes that were compared (LT vs No–LT) had similar

student compositions in that approximately 44% of each class

consisted of undergraduate nursing students while the

remaining 56% of students were enrolled in the human

kinetics program. Interestingly, the mean final grade obtained

by students did not differ (p > 0.05) between the LT (69.4%,

n¼ 275) and the No-LT groups (69.5%, n¼ 241). The two

student populations were also compared with regard to the

per cent of students attaining letter grades in the A, B, C, D and

below D (failure) ranges. In agreement with the similar class

averages, there was also no significant difference (p > 0.05) in

the distribution of marks throughout this grading scale

(Table 1).

Discussion

In this paper we describe the use Adobe Flash MX 2004TM to

create interactive images that undergraduate health science

students can use to compare the appearance of organ system

components between textbook diagrams and cadaver images,

explore three-dimensional body anatomy, develop a deeper

understanding of structural and functional grouping of

anatomical components, and obtain feedback on their

progress in learning. When inserted into course web sites as

instructive modules, these interactive images provide oppor-

tunities for self-directed study that can reinforce the learning

that students have begun when viewing body structures

presented as static images during lectures and/or manipulating

body components in the anatomy laboratory.

Cognitive load theory provides a number of strategies

which can be applied to the design of instructional tools that

will maximize student use of the limited confines of working

memory when learning (Moreno & Mayer 2000; Kirschner

2002, Heo & Chow 2005; Terrell 2006). Where applicable,

certain of these strategies were applied to the development of

the online activities described in the current paper. For

example, specific colour coding applied to paired structures

and labels within the worked examples provided an effective

discriminative tool that not only enhanced contrast and clearly

Table 1. Comparison of class distribution of final grades forstudents who had access to online learning tools (LT Group) or didnot have access to these tools (No-LT Group) throughout the

academic term.*

Letter grade LT group No-LT groupA (80–100%) 22.6 20.7

B (70–79%) 28.0 28.2

C (60–69%) 31.6 35.3

D (50–59%) 11.6 12.7

E or F** (below 50%) 6.2 2.9

n¼275 n¼241

Notes: *Data are expressed as a percent of the total student enrolment for that

class.

**A letter grade of E or F is a failure.


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delineated structure boundaries, but also helped students to

follow pathways (e.g. circulatory pathways) within a given

area of the body. Colour coding also made use of economical

pre-attentive information processing to facilitate information

organization while minimizing cognitive effort (Heo & Chow

2005). Furthermore, the placement of structure labels as

closely as possible to the structures being identified in each

of the images reduced extraneous cognitive load by applying

the spatial and temporal contiguity principles (Moreno &

Mayer 2000). To further expand the limited boundaries of

working memory, students were encouraged to mentally

package related pieces of new information (e.g. all of the

facial bones) as small chunks or schemata (Chi et al. 1982;

Kirschner 2002) through use of the Flash-associated grouping

function. Finally, by proceeding from worked examples

through drag-and-drop and then type-in labeling exercises,

students were taken through a graded series of applications

that gradually asked them to supply more and more of the

required information (van Merrienboer & Sweller 2005).

What is the value in devoting so much time and energy to

the development of these learning and self-testing tools when

interactive anatomy software [e.g. anatomy.tv (Primal

Pictures), Anatomy & Physiology Revealed (McGraw-Hill),

W3D-VBS (Temkin et al. 2006) and the Visible Human Project

(Spitzer & Scherzinger 2006)] already exists in the educational

marketplace? The commercially-available programs are indeed

excellent educational tools that pride themselves on providing

very high levels of anatomical detail. However, while they do

provide levels of instruction that are suitable for medical

students, these are levels that are often far in excess of what is

required for most other health science programs. For example,

nursing and human kinetics students would be faced with

a surfeit of information through which they must search for

those particular pieces that they need to know for summative

examinations. An important benefit of the approach described

in this paper is that effective learning is facilitated by

customizing anatomical images in order to address only the

learning needs of a particular program. This minimizes the

distraction of extraneous cognitive load (Kirschner 2002) and

allows students to concentrate on only those anatomical details

for which they are responsible.

Related to the notion of information overload is the

controversy surrounding the provision of multiple views of

anatomical structures (Garg et al. 1999; Levinson et al. 2007).

Certainly some of the anatomy software described in the

previous paragraph can overwhelm students because not only

are multiple angles of rotation provided for each body

structure, but these rotations are permitted along both the

horizontal and vertical axes and may involve a complete organ

or just a component of that organ that has been taken out of

context and is being manipulated in isolation. With regard to

the current self-learning tools, rotation was used for only

selected body components such as the skull and the heart

because these are body components that one would view as

entire discrete structures. The number of rotations was kept

low (no more than eight) and the rotations were always along

only the horizontal axis. The purpose was to mimic as closely

as possible a student’s ability, when in the lab, to turn over a

structure such as the heart to see what it looks like from the

other side. In contrast to other studies investigating the

influence of multiple views on learning (Levinson et al.

2007), the multiple views did not provide new material for

formative student assessment. Rather, they served as supple-

mentary learning tools so that a student could rotate a body

part, for example, to see how a blood vessel or a bone

continues around the periphery of that structure. Students

were informed that their summative examination questions

would be derived from only their textbook diagrams.

When given access to these online tools, the majority of

students did use them and they reported that they found the

learning and self-testing tools to be user-friendly, relevant

and helpful. However, there remained approximately one-

third of students who did not use the online tools. One

strategy that could be used to encourage students to

develop a personal schedule of regular practice application

would be to routinely assign (or at least remind them of)

specific exercises that should be done when they are

leaving at the end of a lecture. The concerns that students

raised regarding the inflexibility of the type-in labeling

exercises are indeed valid and, in an effort to minimize any

confusion associated with these self-assessments, the type-in

labeling exercises will be modified to permit alternative

correct responses. While it was not possible to demonstrate

a beneficial influence of the online anatomy exercises on

student learning outcomes, there are likely a number of

factors that contribute to this result. An initial confounding

factor was an inability to link individual student use of the

learning and self-testing exercises with student performance

on summative exams. Within the confines of WebCT, it was

simply not possible to track individual student use of each

of the learning and self-testing exercises. Furthermore,

student survey data was collected anonymously so as to

protect student privacy. Hence it was not possible to

determine if more favourable student outcomes might have

been preferentially associated with those students who

chose to make use of these additional learning and self-

assessment opportunities compared to those who did not.

Finally, given that a proportion of the summative exam

questions are changed every year, the two student popula-

tions did not write midterm and final exams that were

identical in their composition.

A more important value of these online learning tools may

be their ability to appeal to learning styles that are often not

addressed very strongly in the lecture room. Undergraduate

classrooms are composed of heterogeneous populations of

learners and these anatomy learning tools do address some

of this heterogeneity. Fleming and Mills (1992) and Fleming

& Bonwell (2001) described four types of learning prefer-

ences: visual, aural, read/write and kinesthetic and devel-

oped a simple online questionnaire (Fleming 2007) that

students can use to recognize their primary learning style(s).

Survey data collected from medical and health science

students at the University of Ottawa have shown them to

display a broad range of learning preferences and, as has

been reported for other health science students, to frequently

use two, three or even four learning approaches simulta-

neously (multimodal learner) when tackling a new situation

(Baykan & Nacar 2007; Slater et al. 2007; Carnegie 2008).


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Interestingly, kinesthetic (hands-on) learning was a popular

choice for many of these students (Carnegie 2008). By

allowing students to not only visualize anatomical structures

online, but also to manipulate them, much as they would if

they were in the laboratory, and to carry out labeling

exercises that provide feedback on their progress in learning,

these anatomy tools have very definite instructional value for

kinesthetic learners. But they have value for other learning

styles as well. The extensive use of images and colour coding

is helpful for visual learners while the type-in labeling

activities address certain strengths of the read-write learner

(Fleming & Bonwell 2001).

Figure 6. Reusable learning applets. (a) Partially completed drag-and-drop image of the heart. (b) Self-testing image of the

upper respiratory tract in which the epiglottis has been highlighted and its corresponding label correctly entered. (reprinted by

permission of Pearson Education, Inc.).


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Accessibility to learning experiences is also becoming an

increasingly important issue in undergraduate education.

Many health science programs (including those offered at

the University of Ottawa), have large undergraduate enrol-

ments, anatomy laboratory space is limited, and there are

insufficient resources to be able to afford the annual salaries

for the prosectors and lab demonstrators that are needed to

produce weekly laboratory sessions (Granger et al. 2006;

Rizzolo & Stewart 2006). Virtual anatomy laboratory modules

provide alternatives to the infrastructure-demanding cadaver

laboratories by offering limitless online opportunities for

students to view, manipulate and practice their identification

of anatomical components. There is, of course, a cost

associated with the initial development of these online

exercises and cost is an important consideration when

developing new instructional materials (Clark 1994). The

tools described in this paper were developed during the

summer by a health sciences student (POB) who had

previously taken this anatomy and physiology course and

was already familiar with Adobe Flash MXTM software. With

minimal guidance, he was able to develop interactive tools

that targeted the course learning objectives and some others

that gave special attention to those anatomical structures that

were visually challenging for students. Body anatomy does

not really change. Hence once the initial investment in a

student stipend has been made, one has now acquired a

small library of reusable learning objects that can be

incorporated into a variety of anatomy and physiology

courses year after year.

In summary, we have described the development of a

number of interactive learning and self-assessment exercises

using Flash that undergraduate students studying anatomy at

the University of Ottawa did use to promote their self-directed

learning and to allow them to self-test their progress in

learning. These tools can be custom-developed to meet

program-specific learning objectives associated with various

health sciences disciplines and allow the boundaries of the

traditional anatomy laboratory to be extended in a cost-

effective manner so that students can have unlimited access to

virtual anatomy laboratories in which they can repeatedly

explore, manipulate and evaluate their understanding of body

structure.

Acknowledgements

The authors gratefully acknowledge the provision by Ms.

Shannon Goodwin of careful and clean dissections as well as

high quality photographs of human cadavers. The authors also

thank Dr. Henri Lescault for his valued expertise regarding the

accuracy of structure boundary identification throughout the

preparation of these learning tools. The authors gratefully

acknowledge the copyright permission granted by Pearson

Education for the use of selected diagrams from E.N. Marieb:

Human Anatomy and Physiology, 5th Edition, 2001 in the

development of these online learning and self-testing tools.

Finally, the authors would like to thank the Centre for

e-Learning for their valuable assistance with the establishment

of the course web site. This research was supported in part by

a Teaching and Learning Grant (J. Carnegie) from the Centre

for University Teaching, University of Ottawa.

Declaration of interest: The authors report no conflicts of

interest. The authors alone are responsible for the content and

writing of the paper.

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the development of interactive online learning tools for the study of

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