Discussion

This study evaluated learner perceptions of a novel teaching tool in cardiac morphology. Innovative, contemporary educational material is needed to more effectively teach CHD, as current teaching is heterogenous, ^{Reference Rogers, Klein, James and FitzGerald3} learning preferences are changing, ^{Reference Rogers and Cohen9,Reference Windram, Neal and McMahon10} and use of traditional materials, such as heart specimens, is limited by location, time, and resources. ^{Reference Seslar, Shepard and Giroud11}

The use of virtual cardiac specimens, created using photogrammetry and viewed on traditional web browsers and in virtual reality, was well received. We found that participants perceived the virtual models to be more effective than textbook diagrams and equally or more effective than didactic teaching and specimen videos. When asked to compare the effectiveness of the virtual models with hands-on specimen review of the cadaveric hearts used to generate the models, responses were mixed, though a slight majority felt reviewing the cardiac specimens in person to be more effective than virtually. This is perhaps unsurprising, as the virtual models are unable to fully replace the kinetic experience of holding and manipulating a heart in one’s own hands. ^{Reference Preece, Williams, Lam and Weller12} However, our data suggest that in circumstances where cadaveric specimens are not accessible, virtual cardiac models are an excellent learning tool.

In addition to accessibility, there are many other advantages that virtual models have over cadaveric specimens. One significant advantage is that of specimen preservation. A bulk of the specimens from large cardiac collections are already over 30–40 years old. Regardless of preservation method, specimens experience wear and tear, having a finite lifespan as a teaching tool. It is estimated that, in some collections, more than half of the specimens have already been rendered useless by time and frequent handling by teachers and trainees. ^{Reference Seslar, Shepard and Giroud11} Our virtual models have the ability to preserve and share examples of cardiac pathology, including rare congenital defects, for many generations of learners to come.

Another benefit of the virtual cardiac models is that they encourage the kind of education promoted by adult learning theory – learning that is active, self-directed, and can be applied to the topic at hand. ^{Reference Knowles13} Learners have control over the pace at which they navigate the models and can access them on any device anytime for a just-in-time refresher. ^{Reference Barnett and Barnett14} Most learners in our study indicated that they would use these virtual models at home for their own self-directed learning and thought of them as an engaging educational tool. Furthermore, these virtual models may be increasingly appealing to newer generations of learners, who often prefer learning modalities that incorporate contemporary technologies. ^{Reference Eckleberry-Hunt and Tucciarone15,Reference Hopkins, Hampton and Abbott16} In our study, a higher percentage of fellows than attendings reported the virtual models to be more efficacious than each traditional teaching modality. While this data was not statistically significant, our study likely lacked the power to fully assess this trend given our small sample size. These models also have the potential to be used as supplemental material to modernise existing curricula or as the basis for the creation of new e-learning curricula.