Applying Augmented Reality to Convey Medical Knowledge on Osteoclasts to Users of a Serious Game: Vignette Experiment

Abstract

Background: Visualization technology is enhancing interactive learning by merging digital content with real-world environments, offering immersive experiences through augmented reality (AR) in fields like medical education. AR is being increasingly used in medicine and dental education to improve student learning, particularly in understanding complex concepts such as bone remodeling. Active learning strategies, supported by AR, boost student autonomy, reduce cognitive load, and improve learning outcomes across various disciplines. AR is gaining popularity in higher education as it enhances active learning, reduces cognitive load, and improves cognitive, meta-cognitive, and affective outcomes, particularly in medical and nursing education. The effectiveness of immersive AR in enhancing understanding of complex physiological processes is still unclear, with a lack of rigorous studies on its impact and how to effectively convert academic content into AR.

Objective: We assess the capacity of AR-enhanced content for learning medical knowledge with a state-of-the-art AR game published along with a modern cell atlas of the oral cavity. To assess AR-enhanced content for learning, we formulated hypotheses on the general impact on learning (H1), specific improvements in learning (H2), and long-term retention (H3).

Methods: An AR serious game was developed to represent current knowledge on osteoclasts for classroom use. The game was evaluated in an unblinded face-to-face vignette experiment (39 participants). Learning outcomes on "Osteoclasts" were compared between the AR game (17 participants) and a textbook-only option (20 participants) conveying the same content. Participants were randomly assigned and learning success was measured at three time-points, immediately after the experiment session, 1 week later, and 1 month later, via web-based surveys.

Results: The AR serious game elicited strong interest in the topic (perceived relevance in Attention, Relevance, Confidence, and Satisfaction [ARCS], W=10,417; P<.001) and motivated students by increasing self-efficacy (confidence in ARCS, W=11,882.5; P=.02) and satisfaction (in ARCS, W=4561; P<.001). The learning outcomes were comparable to text-based self-learning (t=2.0103; PBonferroni=.095). Furthermore, curious students benefited more from interactive learning methods compared with text-only methods and had higher learning success (t=-2.518; P=.02).

Conclusions: Introducing new technology such as AR into teaching requires technological investment, updated curricula, and careful application of learning paradigms. We found support for improved motivation (H1) and some evidence of AR's baseline effectiveness (H2a). While we could not confirm AR's impact on visual tasks overall (H2b), we noted an interesting interaction between curiosity and visual task outcomes (H2c), as well as how game design influences student perception of the material (H2d). Due to attrition, long-term learning outcomes (H3) could not be assessed. AR-based learning may particularly benefit curious students, who often struggle with text-heavy methods. As students are increasingly accustomed to brief, engaging content, teaching approaches must adapt.

Keywords: augmented reality; communication; educational game; medical student; oral cavity; osteoclasts; serious game; tablet-based augmented reality; user study; vignette experiment.

Figure 1.. The augmented reality osteoclast serious game being played in a lecture hall.

Figure 2.. Protocol for the student learning experiment. Students were randomly assigned to the text-only group (blue) and the AR experience (red). The AR content (bottom images) included 6 short interactions covering osteoclast differentiation, lacuna formation, and osteoblast differentiation (Multimedia Appendix 1). Demographic information was collected before the experiment, and learning outcomes were measured at 3 points to assess long-term knowledge retention. ARI: augmented reality immersion; BMP: Bone Morphogenetic Protein; CEI-II: Curiosity and Exploratory Inventory-II; IMMS: Instructional Materials Motivation Survey; UEQ-S: User Experience Questionnaire – Short; VEGF: Vascular Endothelial Growth Factor.

Figure 3.. Evaluating the Instructional Materials Motivation Survey responses based on the ARCS construct with 95% CIs, we found no significant difference in Attention (W=18,619; P=.08) between the learning scenarios. However, participants reported increased Confidence (W=11,882.5; P=.02) , greater perceived Relevance (W=10,417; P<.001) of the material, and higher Satisfaction (W=4561; P<.001) with the learning experience. AR: augmented reality; ARCS: Attention, Relevance, Confidence, and Satisfaction.

Figure 4.. A simple slope analysis of our model revealed a strong inverse relationship between reading and curiosity in the students (1.4% decrease in correct responses, t₂₄=−2.518, P=.02). For students who were curious, this could be offset by experiencing the information in AR. AR: augmented reality; CEI-II: Curiosity and Exploratory Inventory-II.

Figure 5.. Topic prevalence by treatment. Negative values indicate an increased prevalence to appear in the AR-enhanced treatment, while positive values indicate an increased prevalence to appear in the text-only treatment. When the dashed line is crossed, no significant prevalence for either treatment is detected. AR: augmented reality; RANK: Receptor Activator of NF-κB; RANKL: Receptor Activator of NF-κB Ligand.