Eine umfangreiche Datenbank von Studien, geordnet nach Themengebieten, finden Sie in der InterNICHE-Literatur-Datenbank. Hier sind auch Publikationen zum Bestand und der Entwicklung von humanen Lehrkonzepten aus Ländern weltweit enthalten.

Studien, die auf dem EUSAAT-Kongress 2019 zu „Alternatives on Animal Testing“ im Bereich der 3R-Prinzipien an Hochschulen vorgestellt wurden, sind im Abstractbook unter dem Stichwort „Education“ vorgestellt.
Studien, die auf dem 10. Weltkongress 2017 im Bereich der 3R-Prinzipien an Hochschulen vorgestellt wurden, sind unter Theme VI auf zusammengefasst.

A) Bestand, Entwicklung und Evaluation von Lehrmaterial
B) Situation des Tierverbrauchs in der Ausbildung
C) Juristische Publikationen
D) Kostenvergleich
E) Pädagogische Vergleichsstudien

A) Bestand, Entwicklung und Evaluation von Lehrmaterial

1. Allgemein
2. Klinische Fertigkeiten und Chirurgie
3. Morphologie und Physiologie
4. Histologie und Pathologie
5. Pharmakologie

1. Allgemein

Jukes N, Berreville O and Martinsen S (2017). Alternative tools and approaches for replacement in veterinary education and training. ALTEX WC10 Abstract Book, 2017, VI-1-517, S. 160. [Paper not available]

According to the InterNICHE Policy, replacement alternatives in veterinary medical education and training comprise non-animal tools and humane interactions with animals. Non-animal tools include software, virtual reality, models, mannekins and other training devices. Alternative approaches that involve animals include the use of ethically sourced animal cadavers, plastination and other preservation methods, and clinical learning opportunities with animal patients. Together with non-animal tools, they can replace animal experimentation, dissection of purpose-killed animals, and other instrumental animal use. This paper reviews some of the tools and approaches developed by teachers and companies for knowledge and skills acquisition in anatomy, physiology, pharmacology, surgery and other disciplines. It demonstrates the potential for full replacement of harmful animal use by providing case studies from veterinary faculties across the world, with particular emphasis on Canada and the US.

Smith A et al. (2017). Norecopa: A toolbox for the 3Rs in action. ALTEX WC10 Abstract Book, 2017, VI-2-280, S. 164. Complete presentation

The media are overflowing with material on animal care and use, much of which has not been specifically selected or peer-reviewed. The availability of so many resources makes it difficult to identify the best material for practising good science and the 3Rs. In addition, recent scientific reviews have revealed poor reproducibility of results from animal testing, indications of weak experimental design, and poor compliance with guidelines for reporting animal studies. If the situation is to improve, scientists need easy access to the best tools. Norecopa has invested considerable resources in building a website of global 3R resources, coupled to an intelligent search engine. All these are available at one site: The search engine returns hits from all Norecopa’s resources simultaneously. Filters can be applied to increase the relevance of the results. All searches and filters generate unique URLs, making it easy to document the searches which have been performed.

Balls M (2014). Animal experimentation and alternatives: time to say goodbye to the Three Rs and hello to humanity? Alternatives to laboratory animals: ATLA, 42(5), 327-333.

 I have made many after-dinner speeches, and at least one between the main course and the dessertand one between the starter and the main course. However, I don’t think I’ve ever given onebefore the dinner, with hundreds of hungry guests standing before me,  hoping  that  I’ll  finish  before  I’ve even started! I, too, would like to be sitting at a table with a glass of wonderful Moravian red wine, but I have a duty to perform. I will try to interest you and entertain you a little, and along the way, I’ll have one question for my  audience and  one  challenge.  I  will  deal  with three main topics: Prague and the Czech Republic, the Alternatives Congress Trust, and the future of the Three Rs.

 Jukes N (2014). Ethical animal use in education and training: from clinical rotations to ethically sourced cadavers. Altern Lab Anim. 2014 Mar;42(1):P9-P12.

[no abstract]

Knight A (2012). The potential of humane teaching methods within veterinary and other biomedical education. Altex Proc, 1(12), 365-75.

Both historically and in many regions today, animal use resulting in harm or death has remained prominent within veterinary and other biomedical education, in disciplines such as surgery, physiology, biochemistry, anatomy, pharmacology, and parasitology. Less well recognized are the harms that also may be experienced by students and staff who participate in such animal use. These range from hazardous exposures to toxic chemical preservatives to psychological and cognitive phenomena that may adversely affect learning and attitudes towards animal welfare. However, in recent years many non-harmful alternatives have been introduced into courses internationally. These include modernized computer simulations, high quality videos, “ethically sourced cadavers” (primarily from animals euthanized for medical reasons), permanently preserved specimens, models, mannequins, advanced surgical and clinical skills simulators, non-invasive self-experimentation, and supervised clinical experiences. Approximately 90% of published educational evaluations have demonstrated that students using humane alternatives achieve superior or equivalent learning outcomes, such as the acquisition of clinical or surgical skills or theoretical knowledge. Many educators remain unaware of the potential offered by humane teaching methods, however, or of the evidence relating to their educational efficacy. Accordingly, this paper reviews the major types of humane teaching methods and the published literature examining their efficacy.

Fischer J (Student für Soziale Arbeit an der Hochschule Fulda) (2012): Die Verbreitung der Tierrechtsidee im Bildungssystem, Referat (veganbrunch Saarbrücken)

[no abstract]

Daneshian M et al. (2011): Workshop report, A framework program for the teaching of alternative methods (replacement, reduction, refinement) to animal experimentation, ALTEX 4/11, S. 341-352,

Development of improved communication and education strategies is important to make alternatives to the use of animals, and the broad range of applications of the 3Rs concept better known and understood by different audiences. For this purpose, the Center for Alternatives to Animal Testing in Europe (CAAT-Europe) together with the Transatlantic Think Tank for Toxicology (t4) hosted a three-day workshop on “Teaching Alternative Methods to Animal Experimentation”. A compilation of the recommendations by a group of international specialists in the field is summarized in this report. Initially, the workshop participants identified the different audience groups to be addressed and also the communication media that may be used. The main outcome of the workshop was a framework for a comprehensive educational program. The modular structure of the teaching program presented here allows adaptation to different audiences with their specific needs; different time schedules can be easily accommodated on this basis. The topics cover the 3Rs principle, basic research, toxicological applications, method development and validation, regulatory aspects, case studies and ethical aspects of 3Rs approaches. This expert consortium agreed to generating teaching materials covering all modules and providing them in an open access online repository.

Hart LA et al (2011). Personalized Resources on Animal Biology in US Veterinary Medical Education. Altex Proceedings, 1/12, Proceedings of WC8

As a result of administrative support for developing technology, lobbying by students, and faculty innovations, U.S. veterinary schools have shifted toward mainstreaming alternatives that do not require animal euthanasia. These combined efforts have generated an impetus toward developing teaching alternatives and strategies that enhance student learning. New curricular approaches offer personalized learning tools and focus on facilitating opportunities for lifelong learning. The strong initiative to improve learning opportunities in veterinary education supports teaching approaches that do not involve consumptive uses of animals. Students experience immersion in clinical settings, handling and training companion animals, working with visualization and tactile resources, all of which facilitate deeper, integrated learning and problem solving. U.S. veterinary schools are shifting responsibility for learning to the students, providing an impetus toward learning from alternative resources. Teaching biology in secondary schools and to undergraduates also can evolve toward computer-assisted learning for better retention and use of the material learned.

Daneshian M, Leist M & Hartung T (2010). The Center for Alternatives to Animal Testing–Europe (CAAT-EU): a transatlantic bridge for the paradigm shift in toxicology. ALTEX-Alternatives to animal experimentation, 27(1), 63-69.

The Center for Alternatives to Animal Testing – Europe (CAAT-EU) was founded based a collaboration between the Johns Hopkins Bloomberg School of Public Health and the University of Konstanz. CAAT-EU, housed at the University of Konstanz, will coordinate transatlantic activities to promote humane science in research and education, and participate, as partner or coordinator, in publicly and privately funded European projects. Thomas Hartung will serve as program liaison representing Johns Hopkins University and Marcel Leist as the University of Konstanz liaison. CAAT-EU aims to:

  • Set up transatlantic consortia for international research projects on alternative methods
  • Establish a CAAT Europe faculty and advisory board composed of sponsor representatives and prominent academics from Europe
  • Participate in the Transatlantic Think Tank for Toxicology (t4) devoted to conceptual work for the paradigm shift in toxicology
  • Coordinate a series of information days in Europe on relevant developments in the US, similar to the 2009 series CAAT held in the US on EU issues (one on the 7th Amendment to the EU Cosmetics Directive and one on EU and US chemical regulation)
  • Support ALTEX as the official journal of CAAT and CAAT-EU
  • Develop strategic projects with sponsors to promote humane science and new toxicology, especially with CAAT faculty members
  • Develop a joint education program between Johns Hopkins and the University of Konstanz, such as e-courses and the existing Humane Science Certificate program developed by CAAT, a student exchange program, and collaboration with the International Graduate School “Cell-based Characterization of De- and Regeneration” in Konstanz

Martinsen S & Jukes N (2007). Ethically sourced animal cadavers and tissue: Considerations for education and training. In Proc. 6th World Congress on Alternatives and Animal Use in the Life Sciences, Tokyo, Japan (pp. 21-25).

This paper describes ‚ethically sourced‘ animal cadavers and tissue, as defined by the InterNICHE Policy, and addresses the importance of using cadavers and tissue only from these sources when material is needed for the purpose of education and training. The attitudes developed by students and trainees using ethically sourced material and conventional sources are compared and discussed. Examples are given where the use of ethically sourced cadavers and tissue has been successfully implemented in practical classes for anatomy and surgery. Potential use for research and testing purposes is also briefly discussed. The paper outlines the potential practical problems of such cadaver use and offers examples of how they may be overcome. The impact on veterinary colleges and society of ‚client donation programs‘ for sourcing animal cadavers is also addressed.

Dewhurst D (2006). Computer-based alternatives in higher education-past, present and future. ALTEX-Alternatives to animal experimentation, 23(3), 197-201.

Many thousands of animals are still used annually in tertiary education despite efforts by enthusiastic teachers to reduce this number by developing and making available to their colleagues a range of alternatives. Technology-based alternatives which support replacement and reduction are at the forefront of these efforts. Persuading teachers to use them is critical and strategies to raise awareness and support the integration of the alternatives into teaching are described. Many of the existing computer- based alternatives were developed in the early 1990s and rapid changes in the technologies used to deliver them have rendered them difficult to use and in some cases obsolete despite the fact that their content and educational design are still valid. A project, using a learning object approach to development, which aims to preserve the content and educational design, improve the flexibility of delivery and enable teachers to edit the content, is also described.

Balcombe, J. (2004). Medical training using simulation: Toward fewer animals and safer patients. ATLA. 2004;32(1):553-560

This paper presents the current status of computer-based simulation in medicine. Recent technological advances have enabled this field to emerge from esoteric explorations in academic laboratories to commercially available simulators designed to train users to perform medical procedures from start to finish. Today, more than a dozen companies are producing virtual reality simulators and interactive manikins for training in endoscopy, laparoscopy, anaesthesia, trauma management, angiography, and needle insertion. For many of these procedures, thousands of animals are still being used in training. Yet simulation has many advantages that can transcend scientific, ethical, economic and logistical problems that arise when using animals. The first validation studies of medical simulators began appearing in the late 1990s, and the early results indicate that these devices measure what they are intended to, and that they can improve performance relative to traditional learning methods. In addition to expanded use for new and existing minimally invasive procedures, medical simulators will probably soon be used in physician credentialing, and they may someday allow surgeons to rehearse procedures in a patient-specific operating environment. Replacing animals with simulators in medical training is limited no longer by technical feasibility but by a willingness of the medical community to embrace it.

Dewhurst D (2004). How can we encourage teachers to use computer-based alternatives: the UK higher education experience. ATLA-NOTTINGHAM-, 32, 565-568.

Computer-assisted learning (CAL) programs, which are now widely available, have the potential to make a significant contribution to reducing the use of animals in teaching, particularly in pharmacology and physiology. A number of databases exist to support teachers in finding information about potential alternatives. The evidence from a number of evaluative studies is that computer programs that provide a virtual simulation of an animal lab can achieve many of the teaching and learning objectives for many students at least as effectively as the live experience. However, the key to reducing animal use is persuading teachers to integrate the alternatives into mainstream practice. Proven strategies to facilitate this process are described.

2. Klinische Fertigkeiten und Chirurgie top

3D Systems (früher Symbionix) hat Sammlungen von klinischen Validierungsstudien zum Lap Mentor sowie RobotiX Mentor zusammengestellt.

AlAli AB (2018). Evaluating the Use of Cleft Lip and Palate 3D-Printed Models as a Teaching Aid. J Surg Educ. 2018 Jan – Feb;75(1):200-208. doi: 10.1016/j.jsurg.2017.07.023 .

OBJECTIVE: Visualization tools are essential for effective medical education, to aid students understanding of complex anatomical systems. Three dimensional (3D) printed models are showing a wide-reaching potential in the field of medical education, to aid the interpretation of 2D imaging. This study investigates the use of 3D-printed models in educational seminars on cleft lip and palate, by comparing integrated „hands-on“ student seminars, with 2D presentation seminar methods. SETTING: Cleft lip and palate models were manufactured using 3D-printing technology at the medical school. PARTICIPANTS: Sixty-seven students from two medical schools participated in the study. DESIGN: The students were randomly allocated to 2 groups. Knowledge was compared between the groups using a multiple-choice question test before and after the teaching intervention. Group 1 was the control group with a PowerPoint presentation-based educational seminar and group 2 was the test group, with the same PowerPoint presentation, but with the addition of a physical demonstration using 3D-printed models of unilateral and bilateral cleft lips and palate. RESULTS: The level of knowledge gained was established using a preseminar and postseminar assessment, in 2 different institutions, where the addition of the 3D-printed model resulted in a significant improvement in the mean percentage of knowledge gained (44.65% test group; 32.16%; control group; p = 0.038). Student experience was assessed using a postseminar survey, where students felt the 3D-printed model significantly improved the learning experience (p = 0.005) and their visualization (p = 0.001). CONCLUSIONS: This study highlights the benefits of the use of 3D-printed models as visualization tools in medical education and the potential of 3D-printing technology to become a standard and effective tool in the interpretation of 2D imaging.

Bartel T et al. (2018). Medical three-dimensional printing opens up new opportunities in cardiology and cardiac surgery. Eur Heart J. 2018 Apr 14;39(15):1246-1254. doi: 10.1093/eurheartj/ehx016 .

Advanced percutaneous and surgical procedures in structural and congenital heart disease require precise pre-procedural planning and continuous quality control. Although current imaging modalities and post-processing software assists with peri-procedural guidance, their capabilities for spatial conceptualization remain limited in two- and three-dimensional representations. In contrast, 3D printing offers not only improved visualization for procedural planning, but provides substantial information on the accuracy of surgical reconstruction and device implantations. Peri-procedural 3D printing has the potential to set standards of quality assurance and individualized healthcare in cardiovascular medicine and surgery. Nowadays, a variety of clinical applications are available showing how accurate 3D computer reformatting and physical 3D printouts of native anatomy, embedded pathology, and implants are and how they may assist in the development of innovative therapies. Accurate imaging of pathology including target region for intervention, its anatomic features and spatial relation to the surrounding structures is critical for selecting optimal approach and evaluation of procedural results. This review describes clinical applications of 3D printing, outlines current limitations, and highlights future implications for quality control, advanced medical education and training.

Colaco M (2018). The potential of 3D printing in urological research and patient care. Nat Rev Urol. 2018 Apr;15(4):213-221. doi: 10.1038/nrurol.2018.6 .

 3D printing is an evolving technology that enables the creation of unique organic and inorganic structures with high precision. In urology, the technology has demonstrated potential uses in both patient and clinician education as well as in clinical practice. The four major techniques used for 3D printing are inkjet printing, extrusion printing, laser sintering, and stereolithography. Each of these techniques can be applied to the production of models for education and surgical planning, prosthetic construction, and tissue bioengineering. Bioengineering is potentially the most important application of 3D printing, as the ability to produce functional organic constructs might, in the future, enable urologists to replicate and replace abnormal tissues with neo-organs, improving patient survival and quality of life.

Dong M et al. (2018). Development of three-dimensional brain arteriovenous malformation model for patient communication and young neurosurgeon education. British journal of neurosurgery, 1-4.

Purpose: Rapid prototyping technology is used to fabricate three-dimensional (3D) brain arteriovenous malformation (AVM) models and facilitate presurgical patient communication and medical education for young surgeons.
Methods: Two intracranial AVM cases were selected for this study. Using 3D CT angiography or 3D rotational angiography images, the brain AVM models were reconstructed on personal computer and the rapid prototyping process was completed using a 3D printer. The size and morphology of the models were compared to brain digital subtraction arteriography of the same patients. 3D brain AVM models were used for preoperative patient communication and young neurosurgeon education.
Results: Two brain AVM models were successfully produced. By neurosurgeons’ evaluation, the printed models have high fidelity with the actual brain AVM structures of the patients. The patient responded positively toward the brain AVM model specific to himself. Twenty surgical residents from residency programs tested the brain AVM models and provided positive feedback on their usefulness as educational tool and resemblance to real brain AVM structures.
Conclusions: Patient-specific 3D printed models of brain AVM can be constructed with high fidelity. 3D printed brain AVM models are proved to be helpful in preoperative patient consultation, surgical planning and resident training.

Gala SG and Crandall ML (2018). Global Collaboration to Modernize Advanced Trauma Life Support Training. J Surg Educ. 2018 Sep 20. pii: S1931-7204(18)30448-3. doi: 10.1016/j.jsurg.2018.08.011 .

BACKGROUND: Each year, thousands of surgeons and other trauma health care providers participate in the American College of Surgeon’s Advanced Trauma Life Support (ATLS) program, which historically has allowed trainees to practice cricothyroidotomy, chest tube insertion, pericardiocentesis, venous cutdown, and diagnostic peritoneal lavage on live dogs, pigs, sheep, and goats. However, more than 99% of ATLS programs in the United States and Canada have now ended animal use, driven primarily by simulation technology advancements. OBJECTIVE: This review details an international survey of animal versus simulation use in ATLS programs and summarizes the surgical training impact of a novel collaboration between the industry manufacturer of the TraumaMan human simulator, Simulab Corporation (Seattle, Washington), and an animal protection nongovernmental organization (NGO) based in Norfolk, Virginia, to replace animal use in ATLS programs with human simulators. METHODS: From 2012 through 2017, the NGO e-mailed formal surveys concerning program statistics and animal use practices to ATLS officials in various countries (N = 64). The survey response rate was 87.5% and included pre- and post-comparison surveys relative to the industry-NGO simulation collaboration. RESULTS: Eighteen ATLS programs (32.1%) initially replied that they use nonanimal training methods, whereas 38 ATLS programs (67.8%) replied that they use animals for surgical skills training and cited financial constraints as the primary barrier to adopting human simulation methods. Through the industry-NGO collaboration, the NGO donated 119 TraumaMan models valued at nearly $3million (USD) to ATLS programs in 22 countries, such that 75% of those ATLS programs surveyed by the NGO now use exclusively nonanimal simulation models. CONCLUSIONS: The industry-NGO collaboration successfully transformed the surgical skills laboratories of 22 international ATLS programs to replace animal use with nonanimal simulation models that are more anatomically realistic, cost less, and allow trainees to repeat surgical skills until proficiency.

Garcia J et al. (2018). 3D printing materials and their use in medical education: a review of current technology and trends for the future. BMJ Simulation and Technology Enhanced Learning, 2018, 4. Jg., Nr. 1, S. 27-40.

 3D printing is a new technology in constant evolution. It has rapidly expanded and is now being used in health education. Patient-specific models with anatomical fidelity created from imaging dataset have the potential to significantly improve the knowledge and skills of a new generation of surgeons. This review outlines five technical steps required to complete a printed model: They include (1) selecting the anatomical area of interest, (2) the creation of the 3D geometry, (3) the optimisation of the file for the printing and the appropriate selection of (4) the 3D printer and (5) materials. All of these steps require time, expertise and money. A thorough understanding of educational needs is therefore essential in order to optimise educational value. At present, most of the available printing materials are rigid and therefore not optimum for flexibility and elasticity unlike biological tissue. We believe that the manipuation and tuning of material properties through the creation of composites and/or blending materials will eventually allow for the creation of patient-specific models which have both anatomical and tissue fidelity.

Hu M (2018). From ancient to avant-garde: a review of traditional and modern multimodal approaches to surgical anatomy education. ANZ J Surg. 2018 Mar;88(3):146-151. doi: 10.1111/ans.14189 .

The landscape of surgical anatomy education is progressively changing. Traditional methods, such as cadaveric dissection and didacticism are being increasingly phased out in undergraduate courses for multimodal approaches incorporating problem-based learning, radiology and computer-based simulations. Although effective at clinically contextualizing and integrating anatomical information, these approaches may be a poor substitute for fostering a grasp of foundational ‚pure‘ anatomy. Dissection is ideal for this purpose and hence remains the cornerstone of anatomical education. However, novel methods and technological advancements continually give way to adjuncts such as cadaveric surgery, three-dimensional printing, virtual simulation and live surgical streaming, which have demonstrated significant efficacy alone or alongside dissection. Therefore, although divergent paradigms of ’new versus old‘ approaches have engulfed and divided the community, educators should seek to integrate the ancient and avant-garde to comprehensively satisfy all of the modern anatomy learner’s educational needs.

Kim JW et al. (2018). Clinical experience with three-dimensional printing techniques in orthopedic trauma. Journal of Orthopaedic Science, 23(2), 383-388.

Background: To report our experiences with the use of three-dimensional (3D) printing in the field of orthopedic trauma.
Methods: This retrospective study enrolled 24 patients from three university teaching hospitals in whom 3D printing technique was applied: 14 patients with acetabular fractures and 10 patients with clavicular shaft fractures. We summarized our experiences with 3D printed bone models.
Results: Three-dimensional printed acetabular models improved understanding of complex acetabular anatomy and fracture pattern to plan the optimal positioning of a reduction clamp and the trajectory of screws. Pre-bending of a reconstruction plate could reduce operative time. We also recorded fluoroscopic images of a simulated surgery for percutaneous screw fixation of the acetabular posterior column, with the optimal positioning of the guide wire determined during the simulation used as a reference during the actual operation. This surgical simulation was performed by a resident and served as a helpful training method. For fractures of the clavicle, we identified the optimal position of anatomical plates using 3D printed clavicle models.
Conclusion: In our experience, 3D printing technique provided surgeons with improved understanding of the fracture pattern and anatomy and was effectively used for preoperative planning, education of surgical trainees, and performing simulations to improve intra-operative technical outcomes.

Langridge B (2018). Systematic Review of the Use of 3-Dimensional Printing in Surgical Teaching and Assessment. J Surg Educ. 2018 Jan – Feb;75(1):209-221. doi: 10.1016/j.jsurg.2017.06.033 .

OBJECTIVE: The use of 3-dimensional (3D) printing in medicine has rapidly expanded in recent years as the technology has developed. The potential uses of 3D printing are manifold. This article provides a systematic review of the uses of 3D printing within surgical training and assessment. METHODS: A structured literature search of the major literature databases was performed in adherence to PRISMA guidelines. Articles that met predefined inclusion and exclusion criteria were appraised with respect to the key objectives of the review and sources of bias were analysed. RESULTS: Overall, 49 studies were identified for inclusion in the qualitative analysis. Heterogeneity in study design and outcome measures used prohibited meaningful meta-analysis. 3D printing has been used in surgical training across a broad range of specialities but most commonly in neurosurgery and otorhinolaryngology. Both objective and subjective outcome measures have been studied, demonstrating the usage of 3D printed models in training and education. 3D printing has also been used in anatomical education and preoperative planning, demonstrating improved outcomes when compared to traditional educational methods and improved patient outcomes, respectively. CONCLUSIONS: 3D printing technology has a broad range of potential applications within surgical education and training. Although the field is still in its relative infancy, several studies have already demonstrated its usage both instead of and in addition to traditional educational methods.

Lau I & Sun Z (2018). Three‐dimensional printing in congenital heart disease: A systematic review. Journal of medical radiation sciences.

 Three‐dimensional (3D) printing has shown great promise in medicine with increasing reports in congenital heart disease (CHD). This systematic review aims to analyse the main clinical applications and accuracy of 3D printing in CHD, as well as to provide an overview of the software tools, time and costs associated with the generation of 3D printed heart models. A search of different databases was conducted to identify studies investigating the application of 3D printing in CHD. Studies based on patient’s medical imaging datasets were included for analysis, while reports on in vitro phantom or review articles were excluded from the analysis. A total of 28 studies met selection criteria for inclusion in the review. More than half of the studies were based on isolated case reports with inclusion of 1–12 cases (61%), while 10 studies (36%) focused on the survey of opinion on the usefulness of 3D printing by healthcare professionals, patients, parents of patients and medical students, and the remaining one involved a multicentre study about the clinical value of 3D printed models in surgical planning of CHD. The analysis shows that patient‐specific 3D printed models accurately replicate complex cardiac anatomy, improve understanding and knowledge about congenital heart diseases and demonstrate value in preoperative planning and simulation of cardiac or interventional procedures, assist surgical decision‐making and intra‐operative orientation, and improve patient‐doctor communication and medical education. The cost of 3D printing ranges from USD 55 to USD 810. This systematic review shows the usefulness of 3D printed models in congenital heart disease with applications ranging from accurate replication of complex cardiac anatomy and pathology to medical education, preoperative planning and simulation. The additional cost and time required to manufacture the 3D printed models represent the limitations which need to be addressed in future studies.

Lee S (2018): Efficacy of a Three-Dimensional-Printed Training Simulator for Endoscopic Biopsy in the Stomach. Gut Liver. 2018 Mar 15;12(2):149-157. doi: 10.5009/gnl17126 .

Background/Aims: We used three-dimensional (3D) printing technology to create a new biopsy simulator for the stomach and investigated its efficacy and realism in endoscopic biopsy training.
Methods: A novel stomach biopsy simulator, with 10 biopsy sites, was produced using a 3D printer. We enrolled 26 participants, including 10 residents, six first-year fellows, five second-year fellows, and five faculty members. We recorded and reviewed five training sessions and evaluated the simulator with questionnaires using a 7-point Likert scale.
Results: The mean completion time (seconds) was 244.8±11.5 for the residents, 107.9±33.4 for the first-year fellows, 106.8±20.1 for the second-year fellows, and 103.8±19.2 for the faculty members. The completion time became shorter with repetition and was significantly lower for residents by the fifth trial (first trial, 347.0±159.5; fifth trial, 169.6±57.7; p=0.007). The faculty members strongly agreed that the simulator realistically reflected endoscopic handling and was reasonable for endoscopic training (scores of 6.2±0.8 and 6.4±0.9, respectively). Importantly, experienced endoscopists reported that the difficulty levels of the 10 biopsy sites in the simulator were a realistic match for the actual stomach.
Conclusions: This endoscopic biopsy simulator created using a 3D printer is a realistic and useful method to improve the biopsy skills of trainee endoscopists.

Li F (2018): Production of accurate skeletal models of domestic animals using three-dimensional scanning and printing technology. Anat Sci Educ. 2018 Jan;11(1):73-80. doi: 10.1002/ase.1725 .

Access to adequate anatomical specimens can be an important aspect in learning the anatomy of domestic animals. In this study, the authors utilized a structured light scanner and fused deposition modeling (FDM) printer to produce highly accurate animal skeletal models. First, various components of the bovine skeleton, including the femur, the fifth rib, and the sixth cervical (C6) vertebra were used to produce digital models. These were then used to produce 1:1 scale physical models with the FDM printer. The anatomical features of the digital models and three-dimensional (3D) printed models were then compared with those of the original skeletal specimens. The results of this study demonstrated that both digital and physical scale models of animal skeletal components could be rapidly produced using 3D printing technology. In terms of accuracy between models and original specimens, the standard deviations of the femur and the fifth rib measurements were 0.0351 and 0.0572, respectively. All of the features except the nutrient foramina on the original bone specimens could be identified in the digital and 3D printed models. Moreover, the 3D printed models could serve as a viable alternative to original bone specimens when used in anatomy education, as determined from student surveys. This study demonstrated an important example of reproducing bone models to be used in anatomy education and veterinary clinical training. Anat Sci Educ 11: 73-80.

Lichtenberger, JP et al. (2018). Using 3D Printing (Additive Manufacturing) to Produce Low-Cost Simulation Models for Medical Training. Military medicine, 183(suppl_1), 73-77.

Objectives: This work describes customized, task-specific simulation models derived from 3D printing in clinical settings and medical professional training programs.
Methods: Simulation models/task trainers have an array of purposes and desired achievements for the trainee, defining that these are the first step in the production process. After this purpose is defined, computer-aided design and 3D printing (additive manufacturing) are used to create a customized anatomical model. Simulation models then undergo initial in-house testing by medical specialists followed by a larger scale beta testing. Feedback is acquired, via surveys, to validate effectiveness and to guide or determine if any future modifications and/or improvements are necessary.
Results: Numerous custom simulation models have been successfully completed with resulting task trainers designed for procedures, including removal of ocular foreign bodies, ultrasound-guided joint injections, nerve block injections, and various suturing and reconstruction procedures. These task trainers have been frequently utilized in the delivery of simulation-based training with increasing demand.
Conclusions: 3D printing has been integral to the production of limited-quantity, low-cost simulation models across a variety of medical specialties. In general, production cost is a small fraction of a commercial, generic simulation model, if available. These simulation and training models are customized to the educational need and serve an integral role in the education of our military health professionals.

Smith CF (2018). Take away body parts! An investigation into the use of 3D‐printed anatomical models in undergraduate anatomy education. Anatomical sciences education, 11(1), 44-53.

Understanding the three‐dimensional (3D) nature of the human form is imperative for effective medical practice and the emergence of 3D printing creates numerous opportunities to enhance aspects of medical and healthcare training. A recently deceased, un‐embalmed donor was scanned through high‐resolution computed tomography. The scan data underwent segmentation and post‐processing and a range of 3D‐printed anatomical models were produced. A four‐stage mixed‐methods study was conducted to evaluate the educational value of the models in a medical program. (1) A quantitative pre/post‐test to assess change in learner knowledge following 3D‐printed model usage in a small group tutorial; (2) student focus group (3) a qualitative student questionnaire regarding personal student model usage (4) teaching faculty evaluation. The use of 3D‐printed models in small‐group anatomy teaching session resulted in a significant increase in knowledge (P = 0.0001) when compared to didactic 2D‐image based teaching methods. Student focus groups yielded six key themes regarding the use of 3D‐printed anatomical models: model properties, teaching integration, resource integration, assessment, clinical imaging, and pathology and anatomical variation. Questionnaires detailed how students used the models in the home environment and integrated them with anatomical learning resources such as textbooks and anatomy lectures. In conclusion, 3D‐printed anatomical models can be successfully produced from the CT data set of a recently deceased donor. These models can be used in anatomy education as a teaching tool in their own right, as well as a method for augmenting the curriculum and complementing established learning modalities, such as dissection‐based teaching. Anat Sci Educ 11: 44–53. © 2017 American Association of Anatomists.

Smith ML et al. (2018). Dual‐extrusion 3D printing of anatomical models for education. Anatomical sciences education, 11(1), 65-72.

Two material 3D printing is becoming increasingly popular, inexpensive and accessible. In this paper, freely available printable files and dual extrusion fused deposition modelling were combined to create a number of functional anatomical models. To represent muscle and bone FilaFlex3D flexible filament and polylactic acid (PLA) filament were extruded respectively via a single 0.4 mm nozzle using a Big Builder printer. For each filament, cubes (5 mm3) were printed and analyzed for X, Y, and Z accuracy. The PLA printed cubes resulted in errors averaging just 1.2% across all directions but for FilaFlex3D printed cubes the errors were statistically significantly greater (average of 3.2%). As an exemplar, a focus was placed on the muscles, bones and cartilage of upper airway and neck. The resulting single prints combined flexible and hard structures. A single print model of the vocal cords was constructed which permitted movement of the arytenoids on the cricoid cartilage and served to illustrate the action of intrinsic laryngeal muscles. As University libraries become increasingly engaged in offering inexpensive 3D printing services it may soon become common place for both student and educator to access websites, download free models or 3D body parts and only pay the costs of print consumables. Novel models can be manufactured as dissectible, functional multi‐layered units and offer rich possibilities for sectional and/or reduced anatomy. This approach can liberate the anatomist from constraints of inflexible hard models or plastinated specimens and engage in the design of class specific models of the future. Anat Sci Educ 11: 65–72. © 2017 American Association of Anatomists.

Crafts TD (2017). Three-dimensional printing and its applications in otorhinolaryngology–head and neck surgery. Otolaryngology–Head and Neck Surgery, 156(6), 999-1010.

Objective: Three-dimensional (3D)-printing technology is being employed in a variety of medical and surgical specialties to improve patient care and advance resident physician training. As the costs of implementing 3D printing have declined, the use of this technology has expanded, especially within surgical specialties. This article explores the types of 3D printing available, highlights the benefits and drawbacks of each methodology, provides examples of how 3D printing has been applied within the field of otolaryngology–head and neck surgery, discusses future innovations, and explores the financial impact of these advances.
Data Sources: Articles were identified from PubMed and Ovid MEDLINE.
Review Methods: PubMed and Ovid Medline were queried for English articles published between 2011 and 2016, including a few articles prior to this time as relevant examples. Search terms included 3-dimensional printing, 3D printing, otolaryngology, additive manufacturing, craniofacial, reconstruction, temporal bone, airway, sinus, cost, and anatomic models.
Conclusions: Three-dimensional printing has been used in recent years in otolaryngology for preoperative planning, education, prostheses, grafting, and reconstruction. Emerging technologies include the printing of tissue scaffolds for the auricle and nose, more realistic training models, and personalized implantable medical devices.
Implications for Practice: After the up-front costs of 3D printing are accounted for, its utilization in surgical models, patient-specific implants, and custom instruments can reduce operating room time and thus decrease costs. Educational and training models provide an opportunity to better visualize anomalies, practice surgical technique, predict problems that might arise, and improve quality by reducing mistakes.

Shi C et al. (2017). The role of three-dimensional printed models of skull in anatomy education: a randomized controlled trail. Scientific Reports, 7(1), 575.

Three-dimensional (3D) printed models represent educational tools of high quality compared with traditional teaching aids. Colored skull models were produced by 3D printing technology. A randomized controlled trial (RCT) was conducted to compare the learning efficiency of 3D printed skulls with that of cadaveric skulls and atlas. Seventy-nine medical students, who never studied anatomy, were randomized into three groups by drawing lots, using 3D printed skulls, cadaveric skulls, and atlas, respectively, to study the anatomical structures in skull through an introductory lecture and small group discussions. All students completed identical tests, which composed of a theory test and a lab test, before and after a lecture. Pre-test scores showed no differences between the three groups. In post-test, the 3D group was better than the other two groups in total score (cadaver: 29.5 [IQR: 25–33], 3D: 31.5 [IQR: 29–36], atlas: 27.75 [IQR: 24.125–32]; p = 0.044) and scores of lab test (cadaver: 14 [IQR: 10.5–18], 3D: 16.5 [IQR: 14.375–21.625], atlas: 14.5 [IQR: 10–18.125]; p = 0.049). Scores involving theory test, however, showed no difference between the three groups. In this RCT, an inexpensive, precise and rapidly-produced skull model had advantages in assisting anatomy study, especially in structure recognition, compared with traditional education materials.

Witowski JS et al. (2017). 3D printing in liver surgery: a systematic review. Telemedicine and e-Health, 23(12), 943-947.

Background: Rapid growth of three-dimensional (3D) printing in recent years has led to new applications of this technology across all medical fields. This review article presents a broad range of examples on how 3D printing is facilitating liver surgery, including models for preoperative planning, education, and simulation.
Materials and Methods: We have performed an extensive search of the medical databases Ovid/MEDLINE and PubMed/EMBASE and screened articles fitting the scope of review, following previously established exclusion criteria. Articles deemed suitable were analyzed and data on the 3D-printed models—including both technical properties and desirable application—and their impact on clinical proceedings were extracted.
Results: Fourteen articles, presenting unique utilizations of 3D models, were found suitable for data analysis. A great majority of articles (93%) discussed models used for preoperative planning and intraoperative guidance. PolyJet was the most common (43%) and, at the same time, most expensive 3D printing technology used in the development process. Many authors of reviewed articles reported that models were accurate (71%) and allowed them to understand patient’s complex anatomy and its spatial relationships.
Conclusions: Although the technology is still in its early stages, presented models are considered useful in preoperative planning and patient and student education. There are multiple factors limiting the use of 3D printing in everyday healthcare, the most important being high costs and the time-consuming process of development. Promising early results need to be verified in larger randomized trials, which will provide more statistically significant results.

Bootsma K et al. (2016). Materials Used as Tissue Phantoms in Medical Simulation. Studies in Mechanobiology, Tissue Engineering and Biomaterials. 2016.Springer, Berlin, Heidelberg

Medical simulation is a technique used to train students and professional healthcare providers to perform a variety of clinical procedures without placing patients at risk. While medical simulation has been shown to reduce medical errors and associated costs, there exists a need for more realistic tissue analogue materials that account for tissue biomechanical responses in various situations. This chapter provides an overview of materials used in medical simulation by discussing concepts used in the mechanical characterization of materials, the complex structure and mechanical properties of biological tissues, the chemical structure and mechanical properties of materials commonly used in medical simulators, the designs of medical simulation devices on the market today and those reported in literature, and the recent developments and future directions in this field.

Elnady, F. A. (2016). The Elnady Technique: An innovative, new method for tissue preservation. ALTEX-Alternatives to animal experimentation, 33(3), 237-242.

At the Faculty of Veterinary Medicine, Cairo University, there is an increasing number of students but a limited availability of animal cadavers for dissection, and student exposure to formalin is a known hazard. In order to address these challenges, a new method for tissue preservation was developed, the “Elnady Technique.” This method is a modified form of plastination, where the chemicals used are not patented, are inexpensive and locally available, and the process is performed at room temperature. The produced specimens are realistic, durable, have no offensive odor, and are dry, soft and flexible. They can be used to replace the use of animals killed for teaching basic anatomy, embryology, pathology,  parasitology  and  forensic  medicine.  They  have  great  potential  to  support  training  in  clinical  skills  and  surgery, including for clinical examination, endoscopy, surgical sutures, and obstetrics simulation.

Adams JW et al. (2015). 3D printed reproductions of orbital dissections: a novel mode of visualising anatomy for trainees in ophthalmology or optometry. Br J Ophthalmol. 2015 Sep;99(9):1162-7. doi: 10.1136/bjophthalmol-2014-306189 .

BACKGROUND: The teaching of human head, neck and orbital anatomy forms a critical part of undergraduate and postgraduate medical and allied health professional training, including optometry. While still largely grounded in cadaveric dissection, this method of instruction is constrained in some countries and regional areas by access to real human cadavers, costs of cadaver bequest programmes, health and safety of students and staff and the shortage of adequate time in modern curricula. Many candidates choosing a postgraduate pathway in ophthalmological training, such as those accepted into the Royal Colleges of Ophthalmology in the UK, Australia and New Zealand programmes and the American Academy of Ophthalmologists in the USA, are compelled as adult learners to revise or revisit human orbital anatomy, ocular anatomy and select areas of head and neck anatomy. These candidates are often then faced with the issue of accessing facilities with dissected human cadaveric material. METHODS: In light of these difficulties, we developed a novel means of creating high-resolution reproductions of prosected human cadaver orbits suitable for education and training. RESULTS: 3D printed copies of cadaveric orbital dissections (superior, lateral and medial views) showing a range of anatomical features were created. DISCUSSION: These 3D prints offer many advantages over plastinated specimens as they are suitable for rapid reproduction and as they are not human tissue they avoid cultural and ethical issues associated with viewing cadaver specimens. In addition, they are suitable for use in the office, home, laboratory or clinical setting in any part of the world for patient and doctor education.

de Souza, MCI & Matera JM (2015). Bleeding simulation in embalmed cadavers: bridging the gap between simulation and live surgery. ALTEX-Alternatives to animal experimentation, 32(1), 59-63.

In veterinary medicine, surgical education and training require the development of abilities that can be acquired in practical classes using currently available models such as cadaver training. Limited availability of cadavers, undesirable changes in tissue texture and the absence of bleeding are the main disadvantages of cadaver-based training compared to training in live animals. This study proposes a chemical cadaver preservation method aimed at overcoming the aforementioned limitations. Blood circulation could be reproduced in preserved cadavers, thereby enabling satisfactory simulation-based training of several surgical procedures, from incision to suture and including hemostatic techniques. The model in this study introduces a high-fidelity simulation training alternative to prepare students for the practice of surgery. In this manner, surgical interventions would be restricted to surgical cases and healthy animals would not be submitted to surgical procedures exclusively for learning purposes.

Elnady F et al. (2015). Training of upper respiratory endoscopy in the horse using preserved head and neck. ALTEX-Alternatives to animal experimentation, 32(4), 384-387.

 Endoscopy of the upper respiratory tract (URT) is one of the minimally invasive techniques used for diagnosis and treatment of diseases in horses. Training in the use of an endoscope follows an apprenticeship approach, with extensive practice needed to help achieve effective skills acquisition. The use of live animals for training presents the risk of injury to both the animal and the trainee. The increased number of students and practitioners, a shortage of facilities and limited time available from expert clinicians add more challenges to the training process. In this work, we focused on the development of a preserved head and neck model that can be used as an effective training tool for training novices in the basics of URT endoscopy. The aim of the training is to become familiar with handling the endoscope and identification of the endoscopic depictions of normal anatomical structures encountered in the URT. Using the model, anatomical structures were clearly visible, recognized by their shape, architecture and topographical location. The model solved many of the aforementioned practical challenges and has great potential as a replacement alternative to the use of live animals. There are opportunities for the application of such models in training other clinical skills and for a variety of species.

Akhtar KS (2014). The role of simulation in developing surgical skills.

Surgical training has followed the master-apprentice model for centuries but is currently undergoing a paradigm shift. The traditional model is inefficient with no guarantee of case mix, quality, or quantity. There is a growing focus on competency-based medical education in response to restrictions on doctors’ working hours and the traditional mantra of “see one, do one, teach one” is being increasingly questioned. The medical profession is subject to more scrutiny than ever before and is facing mounting financial, clinical, and political pressures. Simulation may be a means of addressing these challenges. It provides a way for trainees to practice technical tasks in a protected environment without putting patients at risk and helps to shorten the learning curve. The evidence for simulation-based training in orthopedic surgery using synthetic models, cadavers, and virtual reality simulators is constantly developing, though further work is needed to ensure the transfer of skills to the operating theatre.

Crochet P et al. (2014). Current and future use of surgical skills simulation in gynecologic resident education: a French national survey. Journal de gynecologie, obstetrique et biologie de la reproduction, 43(5), 379-386.

OBJECTIVES: Simulation is a promising method to enhance surgical education in gynecology. The purpose of this study was to provide baseline information on the current use of simulators across French academic schools. MATERIALS AND METHODS: Two questionnaires were created, one specifically for residents and one for professors. Main issues included the type of simulators used and the kind of use made for training purposes. Opinions and agreement about the use of simulators were also asked. RESULTS: Twenty-six percent of residents (258/998) and 24% of professors (29/122) answered the questionnaire. Sixty-five percent of residents (167/258) had experienced simulators. Laparoscopic pelvic-trainers (84%) and sessions on alive pigs (63%) were most commonly used. Residents reported access to simulators most commonly during introductory sessions (51%) and days of academic workshops (38%). Residents believed simulators very useful for training. Professors agreed that simulators should become a required part of residency training, but were less enthusiastic regarding simulation becoming a part of certification for practice. CONCLUSION: Surgical skills simulators are already experienced by a majority of French gynecologic residents. However, the use of these educational tools varies among surgical schools and remains occasional for the majority of residents. There was a strong agreement that simulation technology should be a component of training.

McMenamin PG et al. (2014). The production of anatomical teaching resources using three‐dimensional (3D) printing technology. Anatomical sciences education, 7(6), 479-486.

The teaching of anatomy has consistently been the subject of societal controversy, especially in the context of employing cadaveric materials in professional medical and allied health professional training. The reduction in dissection‐based teaching in medical and allied health professional training programs has been in part due to the financial considerations involved in maintaining bequest programs, accessing human cadavers and concerns with health and safety considerations for students and staff exposed to formalin‐containing embalming fluids. This report details how additive manufacturing or three‐dimensional (3D) printing allows the creation of reproductions of prosected human cadaver and other anatomical specimens that obviates many of the above issues. These 3D prints are high resolution, accurate color reproductions of prosections based on data acquired by surface scanning or CT imaging. The application of 3D printing to produce models of negative spaces, contrast CT radiographic data using segmentation software is illustrated. The accuracy of printed specimens is compared with original specimens. This alternative approach to producing anatomically accurate reproductions offers many advantages over plastination as it allows rapid production of multiple copies of any dissected specimen, at any size scale and should be suitable for any teaching facility in any country, thereby avoiding some of the cultural and ethical issues associated with cadaver specimens either in an embalmed or plastinated form. Anat Sci Educ 7: 479–486. © 2014 American Association of Anatomists.

Paramasivam S et al. (2014). Silicone models as basic training and research aid in endovascular neurointervention—a single-center experience and review of the literature. Neurosurgical review, 37(2), 331-337.

The rapid development and wider use of neurointerventional procedures have increased the demand for a comprehensive training program for the trainees, in order to safely and efficiently perform these procedures. Artificial vascular models are one of the dynamic ways to train the new generation of neurointerventionists to acquire the basic skills of material handling, tool manipulation through the vasculature, and development of hand-eye coordination. Herein, the authors present their experience regarding a long-established training program and review the available literature on the advantages and disadvantages of vascular silicone model training. Additionally, they present the current research applications of silicone replicas in the neurointerventional arena.

Waran V et al. (2014). Utility of multimaterial 3D printers in creating models with pathological entities to enhance the training experience of neurosurgeons. Journal of neurosurgery, 120(2), 489-492.

The advent of multimaterial 3D printers allows the creation of neurosurgical models of a more realistic nature, mimicking real tissues. The authors used the latest generation of 3D printer to create a model, with an inbuilt pathological entity, of varying consistency and density. Using this model the authors were able to take trainees through the basic steps, from navigation and planning of skin flap to performing initial steps in a craniotomy and simple tumor excision. As the technology advances, models of this nature may be able to supplement the training of neurosurgeons in a simulated operating theater environment, thus improving the training experience.

Keegan R, Henderson T & Brown G (2009). Use of the virtual ventilator, a screen-based computer simulation, to teach the principles of mechanical ventilation. Journal of veterinary medical education, 36(4), 436-443.

Examination scores from 109 students enrolled in the professional veterinary program at Washington State University were evaluated to determine the effectiveness and utility of the Virtual Ventilator computer simulation for teaching the principles of mechanical ventilation in an anesthesia course. Students were randomly assigned to either a live-animal mechanical ventilation laboratory (LIVE-1st) or a computer laboratory using the mechanical ventilation simulation (SIM-1st) in week 1. During week 2, students in the LIVE-1st group participated in the ventilation simulation while students in the SIM-1st group participated in the live-animal laboratory. Student knowledge was evaluated using two similar written quizzes administered following each laboratory. Student opinions concerning the value of the simulation were assessed using an online survey. Differences in quiz scores within and between groups were compared using t-tests while survey results were tabulated. A p value of less than 0.05 was considered significant. Within the LIVE-1st group, scores for the second quiz, which was taken after the students had completed the simulation exercise, were significantly higher than those obtained from the first quiz. Accordingly, the Virtual Ventilator simulation was at least equivalent to the live-animal laboratory in the ability to present information that was subsequently tested for on the quizzes. Students in the SIM-1st group reported that use of the simulation prior to a live-animal ventilation laboratory enhanced their understanding of and ability to provide mechanical ventilation to anesthetized patients. The Virtual Ventilator simulation appears to be a useful and well-received teaching tool.

Schoffl H et al. (2008). Strategies for the reduction of live animal use in microsurgical training and education. ATLA-Alternatives to Laboratory Animals, 36(2), 153.

Education and training in microsurgical techniques have historically relied on the use of live animal models. Due to an increase in the numbers of microsurgical operations in recent times, the number of trainees in this highly-specialised surgical field has continued to grow. However, strict legislation, greater public awareness, and an increasing sensitivity toward the ethical aspects of scientific research and medical education, emphatically demand a significant reduction in the numbers of animals used in surgical and academic education. Hence, a growing number of articles are reporting on the use of alternatives to live animals in microsurgical education and training. In this review, we report on the current trends in the development and use of microsurgical training models, and on their potential to reduce the number of live animals used for this purpose. We also share our experiences in this field, resulting from our performance of numerous microsurgical courses each year, over more than ten years. The porcine heart, in microvascular surgery training, and the fresh chicken leg, in microneurosurgical and microvascular surgery training, are excellent models for the teaching of basic techniques to the microsurgical novice. Depending on the selected level of expertise of the trainee, these alternative models are capable of reducing the numbers of live animals used by 80-100%. For an even more enhanced, „closer-to-real-life“ scenario, these non-animated vessels can be perfused by a pulsatile pump. Thus, it is currently possible to provide excellent and in-depth training in microsurgical techniques, even when the number of live animals used is reduced to a minimum. With these new and innovative techniques, trainees are able to learn and prepare themselves for the clinical situation, with the sacrifice of considerably fewer laboratory animals than would have occurred previously.

De Brugerolle, A. (2007). SkinEthic laboratories, a company devoted to develop and produce in vitro alternative methods to the animal use. ALTEX-Alternatives to animal experimentation, 24(3), 167-171.

SkinEthic Laboratories is a France-based biotechnology company recognised as the world leader in tissue engineering. SkinEthic is devoted to develop and produce reliable and robust in vitro alternative methods to animal use in cosmetic, chemical and pharmaceutical industries. SkinEthic models provide relevant tools for efficacy and safety screening tests in order to support an integrated decision-making during research and development phases. Some screening tests are referenced and validated as alternatives to animal use (Episkin), others are in the process of validation under ECVAM and OECD guidelines. SkinEthic laboratories provide a unique and joined experience of more than 20 years from Episkin SNC and SkinEthic SA. Their unique cell culture process allows in vitro reconstructed human tissues with well characterized histology, functionality and ultrastructure features to be mass produced. Our product line includes skin models: a reconstructed human epidermis with a collagen layer, Episkin, reconstructed human epidermis without or with melanocytes (with a tanning degree from phototype II to VI) and a reconstructed human epithelium, i.e. cornea, and other mucosa, i.e. oral, gingival, oesophageal and vaginal. Our philosophy is based on 3 main commitments: to support our customers by providing robust and reliable models, to ensure training and education in using validated protocols, allowing a large array of raw materials, active ingredients and finished products in solid, liquid, powder, cream or gel form to be screened, and, to provide a dedicated service to our partners.

3. Morphologie und Physiologie top

Schoenfeld-Tacher RM et al. (2017). Evaluation of 3D Additively Manufactured Canine Brain Models for Teaching Veterinary Neuroanatomy. Journal of veterinary medical education, 44(4), 612-619.

 Physical specimens are essential to the teaching of veterinary anatomy. While fresh and fixed cadavers have long been the medium of choice, plastinated specimens have gained widespread acceptance as adjuncts to dissection materials. Even though the plastination process increases the durability of specimens, these are still derived from animal tissues and require periodic replacement if used by students on a regular basis. This study investigated the use of three-dimensional additively manufactured (3D AM) models (colloquially referred to as 3D-printed models) of the canine brain as a replacement for plastinated or formalin-fixed brains. The models investigated were built based on a micro-MRI of a single canine brain and have numerous practical advantages, such as durability, lower cost over time, and reduction of animal use. The effectiveness of the models was assessed by comparing performance among students who were instructed using either plastinated brains or 3D AM models. This study used propensity score matching to generate similar pairs of students. Pairings were based on gender and initial anatomy performance across two consecutive classes of first-year veterinary students. Students‘ performance on a practical neuroanatomy exam was compared, and no significant differences were found in scores based on the type of material (3D AM models or plastinated specimens) used for instruction. Students in both groups were equally able to identify neuroanatomical structures on cadaveric material, as well as respond to questions involving application of neuroanatomy knowledge. Therefore, we postulate that 3D AM canine brain models are an acceptable alternative to plastinated specimens in teaching veterinary neuroanatomy.

Li L (2016). Integrating Medical Simulation Into the Physician Assistant Physiology Curriculum. J Physician Assist Educ. 2016 Dec;27(4):156-161.

PURPOSE: Medical simulation has recently been used in medical education, and evidence indicates that it is a valuable tool for teaching and evaluation. Very few studies have evaluated the integration of medical simulation in medical physiology education, particularly in PA programs. This study was designed to assess the value of integrating medical simulation into the PA physiology curriculum. METHODS: Seventy-five students from the PA program at Central Michigan University participated in this study. Mannequin-based simulation was used to simulate a patient with hemorrhagic shock and congestive heart failure to demonstrate the Frank-Starling force and cardiac function curve. Before and after the medical simulation, students completed a questionnaire as a self-assessment. A knowledge test was also delivered after the simulation. RESULTS: Our study demonstrated a significant improvement in student confidence in understanding congestive heart failure, hemorrhagic shock, and the Frank-Starling curve after the simulation. CONCLUSIONS: Medical simulation may be an effective way to enhance basic science learning experiences for students and an ideal supplement to traditional, lecture-based teaching in PA education.

da Silva RR, Bissaco MAS & Goroso DG (2015). MioLab, a rat cardiac contractile force simulator: Applications to teaching cardiac cell physiology and biophysics. Computer methods and programs in biomedicine, 122(3), 480-490.

 Introduction: Understanding the basic concepts of physiology and biophysics of cardiac cells can be improved by virtual experiments that illustrate the complex excitation–contraction coupling process in cardiac cells. The aim of this study is to propose a rat cardiac myocyte simulator, with which calcium dynamics in excitation–contraction coupling of an isolated cell can be observed. This model has been used in the course “Mathematical Modeling and Simulation of Biological Systems”. In this paper we present the didactic utility of the simulator MioLab®.
Methods: The simulator enables virtual experiments that can help studying inhibitors and activators in the sarcoplasmic reticulum sodium–calcium exchanger, thus corroborating a better understanding of the effects of medications, which are used to treat arrhythmias, on these compartments. The graphical interfaces were developed not only to facilitate the use of the simulator, but also to promote a constructive learning on the subject, since there are animations and videos for each stage of the simulation. The effectiveness of the simulator was tested by a group of graduate students.
Results: Some examples of simulations were presented in order to describe the overall structure of the simulator. Part of these virtual experiments became an activity for Biomedical Engineering graduate students, who evaluated the simulator based on its didactic quality. As a result, students answered a questionnaire on the usability and functionality of the simulator as a teaching tool. All students performed the proposed activities and classified the simulator as an optimal or good learning tool. In their written questions, students indicated as negative characteristics some problems with visualizing graphs; as positive characteristics, they indicated the simulator’s didactic function, especially tutorials and videos on the topic of this study.
Conclusions: The results show that the simulator complements the study of the physiology and biophysics of the cardiac cell.

Dewhurst DG & Kojic ZZ (2011). Replacing animal use in physiology and pharmacology teaching in selected universities in Eastern Europe–charting a way forward. Alternatives to laboratory animals: ATLA, 39(1), 15-22.

 The aims of this study were to explore the use of animals in teaching and the implementation of innovative technology-based teaching practices across a small sample of universities in Eastern Europe. The research methods used were a questionnaire circulated four weeks before a workshop took place (in October 2009, in Belgrade, Serbia), as well as focused, face-to-face group discussions, led by one of the authors during the workshop. Twenty-two faculty (physiologists and pharmacologists), from 13 Eastern European countries, attended the meeting. Fourteen of the eighteen schools represented at the workshop were making use of animals, in some instances in quite large numbers, for their teaching. For example, a single department at a Romanian university used over 250 animals per annum, and at least 1130 animals were used, per annum, across all of the institutions. The species used in largest numbers were the rat (34%), frog/toad (29%), mouse (22%), rabbit (10%), guinea-pig (4%) and dog (1%). None of the universities sampled had implemented institution-wide virtual learning environments (VLEs), although there were isolated instances of local use of VLEs. There was relatively little current use of technology-based teaching and learning resources, but there was considerable enthusiasm to modernise teaching and to introduce innovative learning and teaching methods. The major perceived barrier to the introduction of replacement alternatives was the lack of versions in local languages. There was a consensus view that developing local language exemplars and evaluating their usefulness was likely to have the greatest impact on animal use, at least in the short-term.

Kofranek J et al. (2011). The Atlas of Physiology and Pathophysiology: Web-based multimedia enabled interactive simulations. Computer methods and programs in biomedicine, 104(2), 143-153.

The paper is a presentation of the current state of development for the Atlas of Physiology and Pathophysiology (Atlas). Our main aim is to provide a novel interactive multimedia application that can be used for biomedical education where (a) simulations are combined with tutorials and (b) the presentation layer is simplified while the underlying complexity of the model is retained. The development of the Atlas required the cooperation of many professionals including teachers, system analysts, artists, and programmers. During the design of the Atlas, tools were developed that allow for component-based creation of simulation models, creation of interactive multimedia and their final coordination into a compact unit based on the given design. The Atlas is a freely available online application, which can help to explain the function of individual physiological systems and the causes and symptoms of their disorders.

Delp SL et al. (2007). OpenSim: open-source software to create and analyze dynamic simulations of movement. IEEE transactions on biomedical engineering, 54(11), 1940-1950.

Dynamic simulations of movement allow one to study neuromuscular coordination, analyze athletic performance, and estimate internal loading of the musculoskeletal system. Simulations can also be used to identify the sources of pathological movement and establish a scientific basis for treatment planning. We have developed a freely available, open-source software system (OpenSim) that lets users develop models of musculoskeletal structures and create dynamic simulations of a wide variety of movements. We are using this system to simulate the dynamics of individuals with pathological gait and to explore the biomechanical effects of treatments. OpenSim provides a platform on which the biomechanics community can build a library of simulations that can be exchanged, tested, analyzed, and improved through a multi-institutional collaboration. Developing software that enables a concerted effort from many investigators poses technical and sociological challenges. Meeting those challenges will accelerate the discovery of principles that govern movement control and improve treatments for individuals with movement pathologies.

Dewhurst D (2004). Computer-based alternatives to using animals in teaching physiology and pharmacology to undergraduate students. ATLA-NOTTINGHAM-, 32, 517-520.

In the UK, the majority of animals used for undergraduate education are for laboratory practical classes (wet labs) in pharmacology and physiology. Computer simulations, which are now widely available at relatively low cost, can provide a dry lab experience that may fulfil some, but not all, of the objectives of the animal labs and may be particularly appropriate where the animal lab is costly to run or requires a high level of technical expertise. Broadly, the computer simulations fall into two categories, each having design features in line with achieving slightly different learning objectives. Most of the available evidence suggests that where computer simulations are used as alternatives, they can fulfil many of the learning objectives of wet labs, though clearly they are not effective in teaching animal handling, surgical/dissection and laboratory skills.

4. Histologie und Pathologie top

Neel A et al. (2007). Introduction and evaluation of virtual microscopy in teaching veterinary cytopathology. Journal of veterinary medical education, 34(4), 437-444.

Virtual microscopy (VM) uses a computer to view digitized slides and is comparable to using a microscope to view glass slides. This technology has been assessed in human medical education for teaching histology and histopathology, but, to the authors’ knowledge, no one has evaluated its use in teaching cytopathology in veterinary medical education. We hypothesize that students will respond positively to the use of VM for viewing cytopathology preparations and that the technology can be successfully used for student assessment. To test this hypothesis, we surveyed students regarding their level of satisfaction with features of the VM system, their preference for use of VM in the curriculum, and the potential influence virtual slides may have on student study habits; student performance on a traditional cytopathology practical examination and a similar exam using VM was evaluated. Our results show that student perception of the VM system is generally very positive, with some concerns about resolution and the need for continued exposure to traditional microscopy. Within the curriculum, students indicated a preference for the option of using virtual slides for studying and take-home exercises. Overwhelmingly, students wanted either hybrid laboratory sessions or sessions using glass slides with virtual slides available for study and review. Students identified many VM test-taking features as advantageous compared with traditional glass-slide practical exams as traditionally administered. However, students indicated a strong preference for continued use of traditional microscopy for graded practical exams. Students may be more likely to study slides in preparation for practical examinations if virtual slides are available. Results also indicate that VM can be used successfully for assessment purposes, but students should receive training in using virtual slides if the technology will be used for assessment.

5. Pharmakologie top

Dewhurst D and Ward R (2017). The Virtual Pharmacology Lab – An online repository of free educational alternatives for practical pharmacology teaching. ALTEX WC10 Abstract Book, 2017, VI-4-364, S. 167. Complete Article (2014)

An  online  repository  of  free-to-use  (educational  Creative  Commons license)  “alternatives”  learning  objects  (LOs)  has  been  developed  to  assist  university  faculty  in  teaching  pharmacology  practical  classes  that  frequently  use  live  animal  preparations.  The  650+  metadata-tagged  LOs  were  acquired  by  disaggregating  existing  multimedia  simulations developed by the authors ( and include:  data  traces  from  experiments;  (HTML)  text  descriptions;  images,  diagrams;  video;  interactive  student  tasks;  self-assessments.
Users browse or use a keyword search facility to find individual LOs each  of  which  has  associated  descriptive  text,  a  web  link  (url),  the  code to embed them into webpages/online content, and a preview (e.g. image, animation). The granularity of the LOs enables faculty to tailor the content of their teaching materials more readily. Summary website usage  statistics  will  be  presented  together  with  examples  of  teacher-created e-books illustrating how the LOs may be used.

Sambuy Y et al. (2017). From Cells to QSAR: Alternative predictive models in toxicology. ALTERNATIVES TO ANIMAL EXPERIMENTATION, 34(1), 168-171.

Meeting report
The  Italian  Association  for  In  Vitro  Toxicology  CELLTOX  in  collaboration  with  the  Laboratory  of  Analysis  and  research  in  Physiopathology  (LARF),  Department  of  Experimental  Medicine (DIMES) of the University of Genova, in April 2016 organized a three-day course on alternative predictive models in toxicology. The course was also supported by ESTIV, The European Society of Toxicology In Vitro.

Raveendran R (2017). ExPharm Pro – A computer assisted learning software for undergraduate students. ALTEX WC10 Abstract Book, 2017, VI-4-189, S. 167.

ExPharm  Pro  is  an  online  software  package  for  simulating  animal  experiments in pharmacology. It consists of five experiments namely the effect of drugs on frog heart, dog blood pressure-heart rate, frog esophagus and rabbit eye and bioassay of histamine using guinea pig ileum. These experiments are available in two modes namely tutorial and examination modes. The tutorial mode includes detailed instructions. The animal tissue/whole animal along with the equipment setup is displayed on the screen for testing the drug effects. On application of drugs, the responses appear on the screen in realistic animated sequences. The data obtained by the student can be recorded in a table and a few questions will be displayed for the students to answer. The data and the answers are stored on the server and managed by an inbuilt  students’  management  system.  The  examination  mode  displays  tasks to be carried out by the student by choosing and doing an appropriate experiment. The answers and the steps carried out will be stored on the server for the teacher to evaluate the same. This software which is  widely  used  in  India  has  many  more  features  and  will  be  demonstrated to the delegates.

Badyal DK, Desai C (2014). Animal use in pharmacology education and research: The changing scenario. Indian Journal of Pharmacology. 2014;46(3):257-265. doi:10.4103/0253-7613.132153 .

 The use of animals in research and education dates back to the period when humans started to look for ways to prevent and cure ailments. Most of present day’s drug discoveries were possible because of the use of animals in research. The dilemma to continue animal experiments in education and research continues with varied and confusing guidelines. However, the animal use and their handling vary in each laboratory and educational institution. It has been reported that the animals are being subjected to painful procedures in education and training unnecessarily. The extensive use of animals in toxicity studies and testing dermatological preparations has raised concerns about the ways animals are sacrificed for these “irrelevant experiments”. On the other side of the coin are scientists who advocate the relevant and judicious use of animals in research so that new discoveries can continue. In this review, we discuss the evolution of the use of animals in education and research and how these have been affected in recent times owing to concerns from animal lovers and government regulations. A number of computer simulation and other models have been recommended for use as alternatives to use of animals for pharmacology education. In this review we also discuss some of these alternatives.

Gabrielsson J et al. (2014). Maxsim2—Real-time interactive simulations for computer-assisted teaching of pharmacokinetics and pharmacodynamics. Computer methods and programs in biomedicine, 113(3), 815-829.

 We developed a computer program for use in undergraduate and graduate courses in pharmacology, pharmacokinetics and pharmacodynamics. This program can also be used in environmental and toxicological studies and preclinical simulation, to facilitate communication between modeling pharmacokineticists and project leaders or other decision-makers in the pharmaceutical industry. The program simulates the drug delivery and transport by means of (I) a six-compartment physiological pharmacokinetic flow model, (II) a system of traditional compartment models, or (III) a target-mediated drug disposition system. The program also can be used to simulate instantaneous equilibria between concentration and pharmacodynamic response, or as temporal delays between concentration and response. The latter is done by means of turnover models (indirect response models). Drug absorption, distribution, and elimination are represented by differential equations, which are described by organ and tissue volumes or other volumes of distribution, blood flows, clearance terms, and tissue-to-blood partition coefficients. The user can control and adjust these parameters by means of a slider in real time. By interactively changing the parameter values and simultaneously displaying the resulting concentration–time and/or response–time profiles, users can understand the major mechanisms that govern the disposition or the pharmacological response of the drug in the organism in real time. Schedule dependence is typically seen in clinical practice with a non-linear concentration–response relationship, and is difficult to communicate except via simulations. Here, we sought to illustrate the potential advantages of this approach in teaching pharmacology, pharmacokinetics, and pharmacodynamics to undergraduate pharmacy-, veterinary-, and medical students or to project teams in drug discovery/development.

Babanli A, Gunes A & Ozturk Y (2011). A computer experiment model to investigate the effects of drug dosage in animals, for use in pharmacological education and research. Alternatives to Laboratory Animals-ATLA, 39(6), 519.

 The ACD-IDEA database, which was originally developed by the authors in 2004, is an ongoing compilation of existing data on the in vivo doses of compounds at which various responses in certain animal species have been observed. It can provide an infrastructure for various research/educational efforts, and creates a synergy for new applications. In this paper, some of these applications are described. Specific interfaces within the database are designed for users who are not computer specialists. Users can search the database to find the answer to a query, or they can design a simple virtual animal experiment. In the second case, the interface is used to undertake a dialogue with the system, in order to test the user’s knowledge regarding an experiment under consideration, and to allow the user to glean additional information on better experimental planning. The use of this virtual experimental tool should lead to savings in time, animals, materials, and monetary costs, while the effective learning outcomes of pharmacological experiments are maintained or enhanced.

Dewhurst DG & Kojic ZZ (2011). Replacing animal use in physiology and pharmacology teaching in selected universities in Eastern Europe–charting a way forward. Alternatives to laboratory animals: ATLA, 39(1), 15-22.

 The aims of this study were to explore the use of animals in teaching and the implementation of innovative technology-based teaching practices across a small sample of universities in Eastern Europe. The research methods used were a questionnaire circulated four weeks before a workshop took place (in October 2009, in Belgrade, Serbia), as well as focused, face-to-face group discussions, led by one of the authors during the workshop. Twenty-two faculty (physiologists and pharmacologists), from 13 Eastern European countries, attended the meeting. Fourteen of the eighteen schools represented at the workshop were making use of animals, in some instances in quite large numbers, for their teaching. For example, a single department at a Romanian university used over 250 animals per annum, and at least 1130 animals were used, per annum, across all of the institutions. The species used in largest numbers were the rat (34%), frog/toad (29%), mouse (22%), rabbit (10%), guinea-pig (4%) and dog (1%). None of the universities sampled had implemented institution-wide virtual learning environments (VLEs), although there were isolated instances of local use of VLEs. There was relatively little current use of technology-based teaching and learning resources, but there was considerable enthusiasm to modernise teaching and to introduce innovative learning and teaching methods. The major perceived barrier to the introduction of replacement alternatives was the lack of versions in local languages. There was a consensus view that developing local language exemplars and evaluating their usefulness was likely to have the greatest impact on animal use, at least in the short-term.

Badyal DK, Modgill V & Kaur J (2009). Computer simulation models are implementable as replacements for animal experiments. Alternatives to laboratory animals: ATLA, 37(2), 191-195.

It has become increasingly difficult to perform animal experiments, because of issues related to the procurement of animals, and strict regulations and ethical issues related to their use. As a result, it is felt that the teaching of pharmacology should be more clinically oriented and that unnecessary animal experimentation should be avoided. Although a number of computer simulation models (CSMs) are available, they are not being widely used. Interactive demonstrations were conducted to encourage the departmental faculty to use CSMs. Four different animal experiments were selected, that dealt with actions of autonomic drugs. The students observed demonstrations of animal experiments involving conventional methods and the use of CSMs. This was followed by hands-on experience of the same experiment, but using CSMs in small groups, instead of hands-on experience with the animal procedures. Test scores and feedback showed that there was better understanding of the mechanisms of action of the drugs, gained in a shorter time. The majority of the students found the teaching programme used to be good to excellent. CSMs can be used repeatedly and independently by students, and this avoids unnecessary experimentation and also causing pain and trauma to animals. The CSM programme can be implemented in existing teaching schedules for pharmacology undergraduate teaching with basic infrastructure support, and is readily adaptable for use by other institutes.

Hartung T, Blaauboer B & Leist M (2009). Food for thought… on education in alternative methods in toxicology. ALTEX-Alternatives to animal experimentation, 26(4), 255-263.

[no abstract]

Dewhurst D (2004). Computer-based alternatives to using animals in teaching physiology and pharmacology to undergraduate students. ATLA-NOTTINGHAM-, 32, 517-520.

In the UK, the majority of animals used for undergraduate education are for laboratory practical classes (wet labs) in pharmacology and physiology. Computer simulations, which are now widely available at relatively low cost, can provide a dry lab experience that may fulfil some, but not all, of the objectives of the animal labs and may be particularly appropriate where the animal lab is costly to run or requires a high level of technical expertise. Broadly, the computer simulations fall into two categories, each having design features in line with achieving slightly different learning objectives. Most of the available evidence suggests that where computer simulations are used as alternatives, they can fulfil many of the learning objectives of wet labs, though clearly they are not effective in teaching animal handling, surgical/dissection and laboratory skills.

B) Situation des Tierverbrauchs in der Ausbildung top

BMEL (2019). Verwendung von Versuchstieren im Jahr 2018. Daten zur Verwendung von Versuchstieren im Jahr 2018 (PDF). Zu „Education“ siehe Fig. 3 and 6, Tab. 9 and 22

[no abstract]

Schmidt, Astrid; Hohensee, Christiane; Teichgräber, Ute, and André Schmidt (2011): SATIS ethics ranking of universities in Germany regarding animal use in education, ALTEX 3/11, S. 243-244.

Der Artikel steht im Altex-Archiv zur Verfügung (NCBI-Eintrag).

Ducceschi, Laura; Green, Nicole and Crystal Miller-Spiegel (2010): Dying to learn: the supply and use of companion animals in U.S. colleges and universities, ALTEX 4/10. Der Artikel steht im Altex-Archiv zur Verfügung.

Americans consider dogs and cats as household pets, but many are harmed and killed for teaching and training purposes, despite the availability of alternatives. A review of 92 U.S. public college and university Institutional Animal Care and Use Committee (IACUC) 2005-2007 records indicates that 52% are using live and dead dogs and cats, and 26% are using live dogs and cats in harmful teaching exercises in undergraduate life science, veterinary, and medical education. In specific cases, IACUCs are failing to minimize animal use and suffering in education as required by the Animal Welfare Act (AWA). Sources of dogs and cats for education include Class A and Class B dealers, and United States Department of Agriculture (USDA) 2005-2007 inspections reveal repeated violations and inhumane treatment. Regardless, dealers continue to sell thousands of dogs and cats, many whom were former pets, annually to universities for use in education. A growing number of universities, however, are changing their policies and replacing harmful animal use with pedagogically sound alternatives.

C) Juristische Publikationen top

Alzmann N (2016). Zur Beurteilung der ethischen Vertretbarkeit von Tierversuchen (Vol. 6). Narr Francke Attempto Verlag. Link

[no abstract]

Hirt A, Maisack C, Moritz J (2015). Tierschutzgesetz: TierSchG, Kommentar 3. Auflage, Verlag Franz Vahlen

[no abstract]

Cirsovius T (2002): Die Verwendung von Tieren zu Lehrzwecken, Historische, verfassungs- und verwaltungsrechtliche Untersuchung, Dissertation, 264 S., Broschiert, ISBN 978-3-7890-7760-9 .

[not available]

Kuthz, Martina (1998): Möglichkeiten und Probleme beim Vollzug tierschutzrechtlicher Bestimmungen, Dissertation.

[no abstract]

D) Kostenvergleich top

Animalearn (2016): Animal Dissection vs. Non-Animal Alternatives: A Cost Comparison.

Non-animal methods of teaching anatomy and physiology have many benefits, including a reduction in costs. As this chart outlines, alternatives cost less than animal dissections and can often times be used for a substantially longer period of time, once the initial purchase has been made. The following analysis is based on the needs of a typical biology department over a three-year period. Four of the most commonly dissected species -the cat, fetal pig, dogfish shark, and frog- are given as examples. For this chart, we assume a school has three biology classes comprising of 30 students each or 90 students total. If the school chooses to use animal specimens to teach anatomy/physiology, we assume that a pair of students will dissect the specimen. So, there would be: 45 cats, 45 fetal pigs, 45 dogfish, and 45 frogs needed annually, or 135 (45×3) of each over a three-year period.  If the school chooses to use alternative methods to teach anatomy/physiology, we assume that a pair of students will perform a virtual dissection or 45 students/year. The alternative methods used would be software and a model.

Singh M et al. (2014). Development of a five-day basic microsurgery simulation training course: a cost analysis. Archives of plastic surgery, 41(3), 213.

The widespread use of microsurgery in numerous surgical fields has increased the need for basic microsurgical training outside of the operating room. The traditional start of microsurgical training has been in undertaking a 5-day basic microsurgery course. In an era characterised by financial constraints in academic and healthcare institutions as well as increasing emphasis on patient safety, there has been a shift in microsurgery training to simulation environments. This paper reviews the stepwise framework of microsurgical skill acquisition providing a cost analysis of basic microsurgery courses in order to aid planning and dissemination of microsurgical training worldwide.

Digital (2013). Comparison to Real Dissection and Other Virtual Dissection Software. (2010). Digital Frog International. Retrieved June 5, 2013, from

[no abstract]

Sakezles C (2009). Synthetic human tissue models can reduce the cost of device development. Med Device Technol, 20, 32-34.

Synthetic  human  tissues  and  body  parts  that  closely  resemble  the  live  human environment   have  been  developed  for  use   in  medical   device  verification  and validation studies.  This  article  discusses  how  they  can save  developers time  and money while improving quality and accuracy.

Knight A (2007). The effectiveness of humane teaching methods in veterinary education. ALTEX-Alternatives to animal experimentation, 24(2), 91-109.
Hier ist auch der Kostenvorteil enthalten

Animal use resulting in harm or death has historically played an integral role in veterinary education, in disciplines such as surgery, physiology, biochemistry, anatomy, pharmacology, and parasitology. However, many non-harmful alternatives now exist, including computer simulations, high quality videos, “ethically-sourced cadavers,” such as from animals euthanased for medical reasons, preserved specimens, models and surgical simulators, non-invasive self-experimentation, and supervised clinical experiences. Veterinary students seeking to use such methods often face strong opposition from faculty members, who usually cite concerns about their teaching efficacy. Consequently, studies of veterinary students were reviewed comparing learning outcomes generated by non-harmful teaching methods with those achieved by harmful animal use. Of eleven published from 1989 to 2006, nine assessed surgical training – historically the discipline involving greatest harmful animal use. 45.5% (5/11) demonstrated superior learning outcomes using more humane alternatives. Another 45.5% (5/11) demonstrated equivalent learning outcomes, and 9.1% (1/11) demonstrated inferior learning outcomes. Twenty one studies of non-veterinary students in related academic disciplines were also published from 1968 to 2004. 38.1% (8/21) demonstrated superior, 52.4% (11/21) demonstrated equivalent, and 9.5% (2/21) demonstrated inferior learning outcomes using humane alternatives. Twenty nine papers in which comparison with harmful animal use did not occur illustrated additional benefits of humane teaching methods in veterinary education, including: time and cost savings, enhanced potential for customisation and repeatability of the learning exercise, increased student confidence and satisfaction, increased compliance with animal use legislation, elimination of objections to the use of purpose-killed animals, and integration of clinical perspectives and ethics early in the curriculum. The evidence demonstrates that veterinary educators can best serve their students and animals, while minimising financial and time burdens, by introducing well-designed teaching methods not reliant on harmful animal use.

Animalearn (2002). A Cost Comparison Between Animal Dissection and Humane Educational Alternatives. Download auf

[no abstract]

E) Pädagogische Vergleichsstudien top

Lim KHA et al. (2016). Use of 3D printed models in medical education: a randomized control trial comparing 3D prints versus cadaveric materials for learning external cardiac anatomy. Anatomical sciences education, 9(3), 213-221.

Three‐dimensional (3D) printing is an emerging technology capable of readily producing accurate anatomical models, however, evidence for the use of 3D prints in medical education remains limited. A study was performed to assess their effectiveness against cadaveric materials for learning external cardiac anatomy. A double blind randomized controlled trial was undertaken on undergraduate medical students without prior formal cardiac anatomy teaching. Following a pre‐test examining baseline external cardiac anatomy knowledge, participants were randomly assigned to three groups who underwent self‐directed learning sessions using either cadaveric materials, 3D prints, or a combination of cadaveric materials/3D prints (combined materials). Participants were then subjected to a post‐test written by a third party. Fifty‐two participants completed the trial; 18 using cadaveric materials, 16 using 3D models, and 18 using combined materials. Age and time since completion of high school were equally distributed between groups. Pre‐test scores were not significantly different (P = 0.231), however, post‐test scores were significantly higher for 3D prints group compared to the cadaveric materials or combined materials groups (mean of 60.83% vs. 44.81% and 44.62%, P = 0.010, adjusted P = 0.012). A significant improvement in test scores was detected for the 3D prints group (P = 0.003) but not for the other two groups. The finding of this pilot study suggests that use of 3D prints do not disadvantage students relative to cadaveric materials; maximally, results suggest that 3D may confer certain benefits to anatomy learning and supports their use and ongoing evaluation as supplements to cadaver‐based curriculums.

Hochman JB et al. (2015). Comparison of cadaveric and isomorphic three‐dimensional printed models in temporal bone education. The Laryngoscope, 125(10), 2353-2357.

Objectives/Hypothesis: Current three‐dimensional (3D) printed simulations are complicated by insufficient void spaces and inconsistent density. We describe a novel simulation with focus on internal anatomic fidelity and evaluate against template/identical cadaveric education.
Study Design: Research ethics board‐approved prospective cohort study.
Methods: Generation of a 3D printed temporal bone was performed using a proprietary algorithm that deconstructs the digital model into slices prior to printing. This supplemental process facilitates removal of residual material from air‐containing spaces and permits requisite infiltrative access to the all regions of the model. Ten otolaryngology trainees dissected a cadaveric temporal bone (CTB) followed by a matched/isomorphic 3D printed bone model (PBM), based on derivative micro‐computed tomography data. Participants rated 1) physical characteristics, 2) specific anatomic constructs, 3) usefulness in skill development, and 4) perceived educational value. The survey instrument employed a seven‐point Likert scale.
Results: Trainees felt physical characteristics of the PBM were quite similar to CTB, with highly ranked cortical (5.5 ± 1.5) and trabecular (5.2 ± 1.3) bone drill quality. The overall model was considered comparable to CTB (5.9 ± 0.74), with respectable air cell reproduction (6.1 ± 1.1). Internal constructs were rated as satisfactory (range, 4.9–6.2). The simulation was considered a beneficial training tool for all types of mastoidectomy (range, 5.9–6.6), posterior tympanotomy (6.5 ± 0.71), and skull base approaches (range, 6–6.5). Participants believed the model to be an effective training instrument (6.7 ± 0.68), which should be incorporated into the temporal bone lab (7.0 ± 0.0). The PBM was thought to improve confidence (6.7 ± 0.68) and operative performance (6.7 ± 0.48).
Conclusions: Study participants found the PBM to be an effective platform that compared favorably to CTB. The model was considered a valuable adjunctive training tool with both realistic mechanical and visual character.

Nickel F et al. (2015). Virtual reality training versus blended learning of laparoscopic cholecystectomy: a randomized controlled trial with laparoscopic novices. Medicine, 94(20).

This study compared virtual reality (VR) training with low cost-blended learning (BL) in a structured training program. Training of laparoscopic skills outside the operating room is mandatory to reduce operative times and risks.
Laparoscopy-naïve medical students were randomized in 2 groups stratified for sex. The BL group (n = 42) used E-learning for laparoscopic cholecystectomy (LC) and practiced basic skills with box trainers. The VR group (n = 42) trained basic skills and LC on the LAP Mentor II (Simbionix, Cleveland, OH). Each group trained 3 × 4 hours followed by a knowledge test concerning LC. Blinded raters assessed the operative performance of cadaveric porcine LC using the Objective Structured Assessment of Technical Skills (OSATS). The LC was discontinued when it was not completed within 80 min. Students evaluated their training modality with questionnaires.
The VR group completed the LC significantly faster and more often within 80 min than BL (45% v 21%, P = .02). The BL group scored higher than the VR group in the knowledge test (13.3 ± 1.3 vs 11.0 ± 1.7, P < 0.001). Both groups showed equal operative performance of LC in the OSATS score (49.4 ± 10.5 vs 49.7 ± 12.0, P = 0.90). Students generally liked training and felt well prepared for assisting in laparoscopic surgery. The efficiency of the training was judged higher by the VR group than by the BL group.
VR and BL can both be applied for training the basics of LC. Multimodality training programs should be developed that combine the advantages of both approaches.

Savage EC et al. (2015) A comparison of live tissue training and high-fidelity patient simulator: A pilot study in battlefield trauma training. J Trauma Acute Care Surg. 2015 Oct;79(4 Suppl 2).

BACKGROUND: Trauma procedural and management skills are often learned on live tissue. However, there is increasing pressure to use simulators because their fidelity improves and as ethical concerns increase. We randomized military medical technicians (medics) to training on either simulators or live tissue to learn combat casualty care skills to determine if the choice of modality was associated with differences in skill uptake.
METHODS: Twenty medics were randomized to trauma training using either simulators or live tissue. Medics were trained to perform five combat casualty care tasks (surgical airway, needle decompression, tourniquet application, wound packing, and intraosseous line insertion). We measured skill uptake using a structured assessment tool. The medics also completed exit questionnaires and interviews to determine which modality they preferred.
RESULTS: We found no difference between groups trained with live tissue versus simulators in how they completed each combat casualty care skill. However, we did find that the modality of assessment affected the assessment score. Finally, we found that medics preferred trauma training on live tissue because of the fidelity of tissue handling in live tissue models. However, they also felt that training on simulators also provided additional training value.
CONCLUSION: We found no difference in performance between medics trained on simulators versus live tissue models. Even so, medics preferred live tissue training over simulation. However, more studies are required, and future studies need to address the measurement bias of measuring outcomes in the same model on which the study participants are trained.
LEVEL OF EVIDENCE: Therapeutic/care management study, level II.

Lombardi SA, Hicks RE, Thompson KV, Marbach-Ad G. (2014): Are all hands-on activities equally effective? Effect of using plastic models, organ dissections, and virtual dissections on student learning and perceptions. Adv Physiol Educ. 2014 Mar;38(1):80-6.

This study investigated the impact of three commonly used cardiovascular model-assisted activities on student learning and student attitudes and perspectives about science. College students enrolled in a Human Anatomy and Physiology course were randomly assigned to one of three experimental groups (organ dissections, virtual dissections, or plastic models). Each group received a 15-min lecture followed by a 45-min activity with one of the treatments. Immediately after the lesson and then 2 mo later, students were tested on anatomy and physiology knowledge and completed an attitude survey. Students who used plastic models achieved significantly higher overall scores on both the initial and followup exams than students who performed organ or virtual dissections. On the initial exam, students in the plastic model and organ dissection treatments scored higher on anatomy questions than students who performed virtual dissections. Students in the plastic model group scored higher than students who performed organ dissections on physiology questions. On the followup exam, when asked anatomy questions, students in the plastic model group scored higher than dissection students and virtual dissection students. On attitude surveys, organ dissections had higher perceived value and were requested for inclusion in curricula twice as often as any other activity. Students who performed organ dissections were more likely than the other treatment groups to agree with the statement that „science is fun,“ suggesting that organ dissections may promote positive attitudes toward science. The findings of this study provide evidence for the importance of multiple types of hands-on activities in anatomy laboratory courses.

Andrew B. Hall, Ramon Riojas, Danny Sharon (2014): Comparison of Self-Efficacy and Its Improvement After Artificial Simulator or Live Animal Model Emergency Procedure Training, Military Medicine, Volume 179, Issue 3, Pages 320–323

The objective of this study is to compare post-training self-efficacy between artificial simulators and live animal training for the performance of emergency medical procedures. Volunteer airmen of the 81st Medical Group, without prior medical procedure training, were randomly assigned to two experimental arms consisting of identical lectures and training of diagnostic peritoneal lavage, thoracostomy (chest tube), and cricothyroidotomy on either the TraumaMan (Simulab Corp., Seattle, Washington) artificial simulator or a live pig (Sus scrofa domestica) model. Volunteers were given a postlecture and postskills training assessment of self-efficacy. Twenty-seven volunteers that initially performed artificial simulator training subsequently underwent live animal training and provided assessments comparing both modalities. The results were first, postskills training self-efficacy scores were significantly higher than postlecture scores for either training mode and for all procedures (p < 0.0001). Second, post-training self-efficacy scores were not statistically different between live animal and artificial simulator training for diagnostic peritoneal lavage (p = 0.555), chest tube (p = 0.486), and cricothyroidotomy (p = 0.329). Finally, volunteers undergoing both training modalities indicated preference for live animal training (p < 0.0001). We conclude that artificial simulator and live animal training produce equivalent levels of self-efficacy after initial training, but there is a preference in using a live animal model to achieve those skills.

Jameel Ali, Anne Sorvari, and Anand Pandya (2012): Teaching Emergency Surgical Skills for Trauma Resuscitation-Mechanical Simulator versus Animal Model, ISRN Emergency Medicine, vol. 2012, Article ID 259864, 6 pages,

Background. Traditionally, surgical skills in trauma resuscitation have been taught using animal models in the advanced trauma life support (ATLS) course. We compare one mechanical model (TraumaMan simulator) as an alternative teaching tool for these skills. Method. Eighteen providers and 14 instructors performed four surgical procedures on TraumaMan and compared educational effectiveness with the porcine model. Evaluation was conducted (Likert system 1: very poor to 5: excellent). The participants indicated if TraumaMan was a suitable (scale 1: not suitable to 4: excellent) ATLS teaching model considering cost, animal ethics concerns, and other factors. Comments were solicited for both models. Results. Overall ratings for educational effectiveness of the 4 skills ranged from 3.58 to 4.36 for the porcine and 3.48 to 4.29 for the TraumaMan model. TraumaMan suitability was rated 3-4 (mean 3.38) by 84% participants. TraumaMan as a substitute for the porcine model was recommended by 85% participants. With no ethical or cost concerns, 44% students and 71% instructors preferred TraumaMan. Considering all factors, TraumaMan was preferred by 78% students and 93% instructors. Conclusions. TraumaMan is a suitable alternative to the porcine model and considering all factors it may be the preferred method for teaching ATLS emergency trauma surgical skills.

DeHoff ME, Clark KL, & Meganathan K (2011). Learning outcomes and student-perceived value of clay modeling and cat dissection in undergraduate human anatomy and physiology. Advances in physiology education, 35(1), 68-75.

Alternatives and/or supplements to animal dissection are being explored by educators of human anatomy at different academic levels. Clay modeling is one such alternative that provides a kinesthetic, three-dimensional, constructive, and sensory approach to learning human anatomy. The present study compared two laboratory techniques, clay modeling of human anatomy and dissection of preserved cat specimens, in the instruction of muscles, peripheral nerves, and blood vessels. Specifically, we examined the effect of each technique on student performance on low-order and high-order questions related to each body system as well as the student-perceived value of each technique. Students who modeled anatomic structures in clay scored significantly higher on low-order questions related to peripheral nerves; scores were comparable between groups for high-order questions on peripheral nerves and for questions on muscles and blood vessels. Likert-scale surveys were used to measure student responses to statements about each laboratory technique. A significantly greater percentage of students in the clay modeling group “agreed” or “strongly agreed” with positive statements about their respective technique. These results indicate that clay modeling and cat dissection are equally effective in achieving student learning outcomes for certain systems in undergraduate human anatomy. Furthermore, clay modeling appears to be the preferred technique based on students‘ subjective perceptions of value to their learning experience.

Waters JR et al. (2011). Human clay models versus cat dissection: How the similarity between the classroom and the exam affects student performance. Advances in Physiology Education, 35(2), 227-236.

This study examined the effect of different anatomic representations on student learning in a human anatomy class studying the muscular system. Specifically, we examined the efficacy of using dissected cats (with and without handouts) compared with clay sculpting of human structures. Ten undergraduate laboratory sections were assigned to three treatment groups: cat dissection only, cat dissection with handouts, and human clay sculpting with handouts. Exams included higher-order questions that presented novel anatomic images and scenarios that the students did not practice in class. The higher-order anatomy exam questions varied the degree to which students in the different treatments had to transform the anatomic representation studied during laboratory activities to match the representation used in the exam questions. In this respect, exam questions manipulated the similarity between the surface features of the anatomic representations used in the classroom versus the exam. When identifying anatomic structures presented in a photograph or diagram, student performance improved significantly when transformation demands decreased, i.e., students in the human clay sculpting treatment group performed best on human anatomy questions and students in the cat dissection treatment group performed better on cat anatomy questions (independent of the use of handouts). There were similar, but nonsignificant, trends when students were asked functional anatomy questions presented in human and cat contexts. On survey questions designed to measure student attitudes about dissection versus nonanimal alternatives, students typically preferred the method used in their treatment group, suggesting that student preference is too fluid to factor into curricular decisions. When designing curricula, instructors must choose anatomic representations that support their course goals. Human representations are most effective when teaching the human muscular system.

Yuza Steve C. (2010): Science Laboratory Depth of Learning: Interactive Multimedia Simulation and Virtual Dissection Software. ProQuest LLC, Ph.D. Dissertation, Capella University

The purpose of this study was to determine the effects of interactive multimedia simulations and virtual dissection software on depth of learning among students participating in biology and chemistry laboratory courses. By understanding more about how simulation and virtual dissection software changes depth of learning, educators will have the ability to add these modalities to their current instructional design. The research problems for this study were designed to answer two questions: first, what effect does the use of interactive multimedia simulation software have on the depth of learning within science laboratories? and second, what effect does the use of virtual dissection software have on the depth of learning within science laboratories? A comparative methodology was utilized to collect pretest and posttest data to assess depth of learning for four sampling periods in Introduction to Chemistry and General Biology laboratories. Pretest and posttest statistical comparison was completed via paired „t“ tests, independent sample „t“ tests, and analysis of variance. Statistical findings showed significant differences between participants in their depth of learning after utilizing interactive multimedia simulations in introduction to chemistry. No significant differences were found within general biology participants after utilizing the interactive multimedia simulations. Statistical findings showed significant differences between participants in their depth of learning after utilizing virtual dissection software. These results indicate that participants changed their depth of learning after completing simulation and virtual dissection software when compared to „wet“ laboratories learning environments. The research study findings will allow for an instructional design to establish and to use specific simulation and virtual dissection software as components of a science laboratory learning environment. Overall, the use of simulation and virtual dissection software in coordination with any instructional design model will allow science educators to create a learning environment that promotes an increase in depth of learning.

Motoike HK, O’Kane RL, Lenchner E, Haspel C. (2009): Clay modeling as a method to learn human muscles: A community college study. Anat Sci Educ. 2009 Jan-Feb;2(1):19-23

The efficacy of clay modeling compared with cat dissection for human muscle identification was examined over two semesters at LaGuardia Community College in Queens, NY. The 181 students in 10 sections in this study were randomly distributed into control (cat dissection) and experimental (clay modeling) groups, and the results of the muscle practical examination were analyzed. The clay-modeling group was significantly better at identifying human muscles on human models than the cat-dissection group, and was as good at identifying muscles on their self-made clay mannequins as the cat-dissection group was at identifying cat muscle on their specimens. This study demonstrated that clay modeling is more effective than cat dissection for learning human muscles at the community college level.

Animalearn (2008). Analysis of Studies Comparing the Use of Animals in Science Education to the Use of Humane Educational Methods.

[no abstract]

Knight A (2008). Humane teaching methods demonstrate efficacy in veterinary education. Responsibilities–The 4 th R, 119.

Animal use resulting in harm or death has historically played an integral role in veterinary education, in disciplines such as   surgery,   physiology,   biochemistry,   anatomy,   pharmacology   and   parasitology.   However,   many   non-harmful alternatives now exist, including computer simulations, high quality  videos,  ‘ethically-sourced  cadavers’  such  as  from  animals  euthanased  for  medical  reasons,  preserved  specimens,  models  and  surgical  simulators,  non-invasive  self-experimentation  and  supervised  clinical  experiences.  Complaints  by  veterinary  students  in  Australia,  the  US  and  elsewhere  have  shown  that  many  veterinary  academics  remain  opposed  to  their  introduction,  usually  citing  concerns  about  teaching  efficacy.  Consequently,  studies  of  veterinary  students  were  reviewed  comparing  learning  outcomes  generated by non-harmful teaching methods with those achieved by harmful animal use. Of eleven published from 1989 to 2006, nine assessed surgical training—historically the discipline involving greatest harmful animal use. 45.5% (5/11) demonstrated  superior  learning  outcomes  using  more  humane  alternatives.  Another  45.5%  (5/11)  demonstrated  equivalent  learning  outcomes  and  one  (9.1%)  demonstrated  inferior  learning  outcomes.  Twenty  nine  papers  in  which  comparison  with  harmful  animal  use  did  not  occur  illustrated  additional  benefits  of  humane  teaching  methods,  including:  time  and  cost  savings,  enhanced  potential  for  customisation  and  repeatability  of  the  learning  exercise,  increased  student  confidence  and  satisfaction,  increased  compliance  with  animal  use  legislation,  elimination  of  objections  to  the  use  of  purpose-killed  animals,  and  integration  of  clinical  perspectives  and  ethics  early  in  the  curriculum.  The  evidence  emonstrates  that  veterinary  educators  can  best  serve  their  students  and  animals,  while  minimising  financial  and  time  burdens,  by  introducing  well-designed  teaching  methods  not  reliant  on  harmful  animal  use. However, due to their lack of support for the concept, too many Australian veterinary educators remain among the world’s worst teachers of humane veterinary surgical courses. Instead, they should aim to be among the best. Such an achievement is within their ability; it simply requires a fundamental change in attitude.

Knight A (2007). The effectiveness of humane teaching methods in veterinary education. ALTEX-Alternatives to animal experimentation, 24(2), 91-109.

Animal use resulting in harm or death has historically played an integral role in veterinary education, in disciplines such as surgery, physiology, biochemistry, anatomy, pharmacology, and parasitology. However, many non-harmful alternatives now exist, including computer simulations, high quality videos, “ethically-sourced cadavers,” such as from animals euthanased for medical reasons, preserved specimens, models and surgical simulators, non-invasive self-experimentation, and supervised clinical experiences. Veterinary students seeking to use such methods often face strong opposition from faculty members, who usually cite concerns about their teaching efficacy. Consequently, studies of veterinary students were reviewed comparing learning outcomes generated by non-harmful teaching methods with those achieved by harmful animal use. Of eleven published from 1989 to 2006, nine assessed surgical training – historically the discipline involving greatest harmful animal use. 45.5% (5/11) demonstrated superior learning outcomes using more humane alternatives. Another 45.5% (5/11) demonstrated equivalent learning outcomes, and 9.1% (1/11) demonstrated inferior learning outcomes. Twenty one studies of non-veterinary students in related academic disciplines were also published from 1968 to 2004. 38.1% (8/21) demonstrated superior, 52.4% (11/21) demonstrated equivalent, and 9.5% (2/21) demonstrated inferior learning outcomes using humane alternatives. Twenty nine papers in which comparison with harmful animal use did not occur illustrated additional benefits of humane teaching methods in veterinary education, including: time and cost savings, enhanced potential for customisation and repeatability of the learning exercise, increased student confidence and satisfaction, increased compliance with animal use legislation, elimination of objections to the use of purpose-killed animals, and integration of clinical perspectives and ethics early in the curriculum. The evidence demonstrates that veterinary educators can best serve their students and animals, while minimising financial and time burdens, by introducing well-designed teaching methods not reliant on harmful animal use.

Patronek GJ and Rauch A (2007). Systematic review of comparative studies examining alternatives to the harmful use of animals in biomedical education. Journal of the American Veterinary Medical Association 230(1), 37-43.

Objective—To systematically review the published literature for controlled studies comparing learning outcomes of traditional methods that require the terminal use of animals (eg, dissection, live-animal surgery, and live-animal laboratory demonstrations) with outcomes obtained with alternative teaching methods.
Design—Systematic review.Study Population—Controlled studies published between 1996 and 2004.
Procedures—PubMed was searched with the following keywords, used alone and in combination: educational alternatives, nonlethal teaching methods, veterinary alternatives, medical education, and nonterminal animal use. Cited references of retrieved reports were reviewed to identify additional reports. Reports were selected for review only if a comparison group was included.
Results—17 studies that were randomized controlled trials or nonrandomized trials that included a comparison group were identified. Five involved veterinary students, 3 involved medical students, 6 involved university undergraduate students, and 3 involved high school biology students. Sample size ranged from 14 to 283 students. Eleven studies appeared to be randomized, parallel-group trials, 4 involved comparative groups to which participants were not randomly assigned or for which the randomization process was not clear, 1 was a 2-period crossover study, and 1 involved a retrospective review of grades. In all 17 studies reviewed, results associated with the alternative method of instruction were not significantly different from or superior to results associated with the conventional method.
Conclusions and Clinical Relevance—Although the number of controlled studies identified was small, the results seem to support more widespread adoption of alternative teaching methods in biomedical education.

Aggarwal R, Ward J, Balasundaram I, Sains P, Athanasiou T, Darzi A. (2007): Proving the effectiveness of virtual reality simulation for training in laparoscopic surgery. Ann Surg. 2007 Nov;246(5):771-9.

Objective: The aim of this study was to compare learning curves for laparoscopic cholecystectomy (LC) after training on a proficiency based virtual reality (VR) curriculum with that of a traditionally trained group. Summary background data: Simulator-based training has been shown to improve technical performance during real laparoscopic procedures, although research to date has not proven the persistence of this effect over subsequent cases. Material and methods: Twenty novice surgeons underwent baseline laparoscopic skills testing followed by a 1-day didactic training session. Control subjects (n = 10) performed 5 cadaveric porcine LCs each; VR-trained subjects (n = 10) completed a VR training curriculum followed by 3 porcine LCs each. A further 10 experienced laparoscopic surgeons (>100 LCs) performed 2 porcine LCs each to define benchmark levels. Technical skill assessment was by motion analysis and video-based global rating scores (out of 35). Results: There were no intergroup differences in baseline skill. The first LC revealed significant differences between control and VR groups for time (median 4590 seconds vs. 2165 seconds, P = 0.038), path length (169.2 meters vs. 86.8 meters, P = 0.009), number of movements (2446 vs. 1029, P = 0.009), and video scores (17 vs. 25, P = 0.001). The VR group, although not a control, achieved video and dexterity scores equivalent to expert levels of performance. Conclusions: A proficiency based VR training curriculum shortens the learning curve on real laparoscopic procedures when compared with traditional training methods. This may be a more cost- and time-effective approach, and supports the need for simulator-based practice to be integrated into surgical training programs.

Waters JR et al. (2005). Cat dissection vs. sculpting human structures in clay: An analysis of two approaches to undergraduate human anatomy laboratory education. Advances in Physiology Education, 29 (1), 27-34.

Many human anatomy courses are taught using cat dissection. Alternatives are available, but information regarding learning outcomes is incomplete. In 2003, ∼120 undergraduates enrolled in a human anatomy course were assigned to one of two treatment groups. In the control group, students performed cat dissections (emphasizing isolation and identification) of the muscular, digestive, and cardiovascular systems. In the experimental treatment group, students built clay sculptures of each human body system. Student learning was evaluated by using both low- and high-difficulty questions. On pre- and postexperiment control exams, there were no significant differences in student performance. On exams after a cat dissection vs. a human-clay sculpting experience, the students in the human-clay sculpting treatment group scored significantly higher than their classmates in the cat dissection group on both the low- and high-difficulty questions. Student attitudes toward dissection and taking future human anatomy courses were also measured. There were no differences in student attitudes at the beginning of the experiment; afterward, students exposed to a cat dissection experience viewed dissection more favorably than students in the human-clay sculpting treatment group. There were no treatment effects on student willingness to take future human anatomy courses. The experimental design makes it difficult to conclude precisely why students assigned to the human-clay sculpting experience performed better on exams, but as each method was performed in this particular human anatomy course, our data indicate that human-clay sculpting may be a viable alternative to cat dissection in an anatomy course in which the students focus on human anatomy.