VCOM Research Day Program Book 2023

Medical Student Research Educational

01 Pedagogical Limitations of 2-D Representations of Anatomical Structures: A Head-to-Head Analysis of Dimensional and Morphological Accuracy Comparing Prevalent Illustrations of the Lateral Ligament of the Ankle Joint

Brian Truong; Jonathan Millard Corresponding author:

Edward Via College of Osteopathic Medicine- Virginia Campus

Pedagogically, anatomy is uniquely situated among other medical sciences, specifically in terms of conveying accuracy. More stylized anatomical illustrations often attempt to convey ideas with simplicity while sacrificing natural accuracy. Other depictions attempt to communicate anatomical accuracy while surrendering more thematic elements which are usually characterized by function and/ or application. The primary aim of this research is to explore the limitation of anatomical illustrations in conveying morphological and spatial precision. Illustrations depicting lateral and posterior views of the lateral ligament of the ankle from the following publications were independently assessed and scored by two researchers for dimensional and morphological accuracy using Likert scale scoring (1=strongly disagree, 2=disagree, 3=neutral, 4=agree, 5= strongly

agree): Netter’s Atlas of Human Anatomy, 7 th ed. (Elsevier), Atlas of Anatomy, 3 rd ed. (Thieme), Gray’s Anatomy, 40 th ed. (Elsevier), Clinically Oriented Anatomy, 8 th ed. (Wolters Kluwer), and Sobotta’s Atlas of Anatomy, 15 th ed. (Elsevier). To create a standard reference, a detailed dissection of a cadaveric ankle was performed via typical dissection techniques. The dissection process was photographed through various stages of progression. To address dimensional accuracy, a Microscribe i L+ portable coordinate measuring machine was used to capture landmark coordinates of the attachments of the anterior talofibular, posterior talofibular, and calcaneofibular ligaments through inversion and eversion actions at the foot and ankle joints. Blender v.3.2 was used to visualize coordinates. After collating the four independent scores, both reviewers independently

reached the conclusion that the Atlas of Anatomy, 3 rd ed. (Thieme) was most effective at conveying spatial and morphological accuracy (scoring 19/20 for BT and JM), while Gray’s Anatomy, 40 th ed. (Elsevier) scored lowest for both reviewers (13/20 for BT and 11/20 for JM) when compared to the cadaveric specimen. Effectively communicating anatomical accuracy must be a high priority in the production of education materials; however, simplifying illustrations to facilitate functional understanding should also be a goal. The spatial and morphological sophistication of a clinician’s anatomical understanding is paramount in areas of patient care in which gross anatomy plays an important role. Limiting cadaver-based education in clinical curricula may result in incomplete or suboptimal learning outcomes.


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