Tracing-based drawing method enhances anatomy learning outcomes and proportional awareness: a randomized cross-over study

Freehand drawing can support active anatomy learning but may be challenging for beginners, particularly when reproducing complex anatomical structures and proportions. The Tracing-Based Drawing Method (TBDM) combines standardized 1:1 cranial templates with transparent tracing to provide structured support during anatomy drawing practice. In this randomized cross-over study, 60 first-year medical students were assigned to two randomized method sequences ( n = 30 each). At T1, Group A used TBDM and Group B used the Traditional Memory-Based Method (TMBM) to draw the anterior skull view. At T2, the methods were crossed over and both groups drew the lateral skull view. One week later, participants repeated the anterior and lateral drawing tasks at T3 and T4, respectively. Six blinded evaluators assessed structural completeness, proportional accuracy, adjacency accuracy, and artistic quality. Drawing outcomes were analyzed using linear mixed-effects models accounting for repeated measurements, assessment occasion, and randomized group/sequence. TBDM was associated with a higher total drawing score than TMBM, with an adjusted mean difference of 11.96 points (95% CI, 11.42 to 12.51; p < 0.0001). In the timing/view sensitivity analysis, the estimated TBDM-minus-TMBM difference was 14.17 points at the immediate assessment (95% CI, 13.54 to 14.80) and 9.75 points at the one-week delayed assessment (95% CI, 9.12 to 10.38; both p < 0.0001). Learner-reported ratings also favored TBDM, with an adjusted mean difference of 0.55 points on a five-point scale (95% CI, 0.49 to 0.62; p < 0.0001). TBDM was associated with higher drawing performance and more positive learner ratings than TMBM. A positive method contrast was observed at both the immediate and one-week delayed assessments, although the difference was smaller at the delayed assessment. TBDM may provide a low-cost, structured complement to existing anatomy-learning methods. Its longer-term and transferable educational effects require further investigation.