3D Embryonic Heart Goes Mobile: Efficacy of Mobile Application in Congenital Cardiac Embryology Education.

Mastery of embryonic heart development is challenging but critical for medical professionals due to the frequency and variety of congenital cardiac defects that arise when the process goes awry. Unfortunately, teaching and learning cardiac embryology is difficult due to a lack of accurate and effective visual resources that depict this complex spatiotemporal event. To that end, an interactive mobile application named Embryonic Virtual Heart Application (EVHA) was developed as an accessible and interactive learner platform featuring a set of anatomically accurate 3D embryonic heart models with and without congenital cardiac defects (Figure 1). The project aims to assess whether the EVHA usage leads to measurable learning outcomes for first-year medical students in the absence of a traditional lecture on cardiac embryology and congenital cardiac defects. In a COMIRB exempt study (#21-4827), as a part of an optional pre-work activity prior to the cardiac embryology class, 172 first-year medical students were given access to a pre-quiz (Q1) on cardiac embryology before interacting with the EVHA. After the EVHA usage, a post-quiz (Q2) comprised of a set of matched, but different, questions than the Q1 was provided. During the class, students' retention on this topic was assessed by a set of clinically oriented questions (Q3). Lastly, students completed an optional survey on their perceived value of the EVHA after the class. The learning outcomes from the EVHA usage were assessed by a one-way ANOVA to compare Q1, Q2, and Q3 performances. To analyze the survey results, the frequency of each Likert scale score was averaged while thematic analysis was performed on the comments. The learning outcomes analysis revealed a significant increase in quiz performance between Q1 (22% ± 19%) and Q2 (65% ± 24%) with a 43% increase in the score (p<0.001; d=0.7; n=21). In-class performance (Q3) average (61%; n=61) for all participants was not significantly different from Q2 (p>0.05), however those students who completed all optional prework (Q1, EVHA, Q2) had a significantly higher Q3 performance (79%; p <0.05; n=9). Survey analysis indicates that students perceive EVHA as an effective learning tool with its greatest strength being the interactive 3D virtual models of the congenital cardiac defects. Despite the limitations and confounds in this project, these results indicate that the EVHA may be an effective tool contributing to significant learning outcomes independent from a formal class and can further enhance learning in the classroom and on higher-order assessments. The impact of this project is its contribution of an accessible, portable and visually-oriented learning resource on cardiac embryology with clinical emphasis. Based on the learning outcomes data, the project also demonstrates the potential of educational mobile applications in medical curricula in which contact hours are limited.