Painting or tattooing? A comparative study of body painting and temporary tattoos for learning surface anatomy in an intensive undergraduate anatomy course

Body painting (BP) is a well-established active learning strategy in anatomy education that promotes engagement and spatial understanding of surface anatomy. However, it is time-intensive and may disadvantage students with limited artistic confidence. Temporary tattoos (TT) may offer a faster, standardized alternative. An intensive undergraduate anatomy course included four weekly surface anatomy sessions (face/neck, arm/forearm, hand, leg). Participants were randomly assigned to BP or TT for each session and participated in both modalities twice. Quiz scores and time-on-task were recorded after each session. Control scores were derived from regions not associated with either modality. Statistical analyses included Friedman tests and Wilcoxon signed-rank tests. Per-participant costs were calculated for both modalities. Learning condition significantly affected quiz performance (Q(2) = 6.595, p = 0.037). Median scores were 78% [IQR: 72-84] for control regions, 85% [80-89] for BP, and 84% [79-88] for TT. Both BP and TT significantly outperformed control regions (ΔBP, p < 0.0001; ΔTT, p = 0.019). Absolute quiz scores did not differ between BP and TT (p = 0.657), but TT yielded significantly larger relative gains within-subjects (ΔTT - ΔBP, p < 0.0001). BP required more time than TT (26.5 vs. 15.0 min; p < 0.0001). Per-participant costs were comparable (BP: USD$8.92; TT: USD$9.64). Both modalities enhanced surface anatomy learning. TT produced larger relative gains while requiring less time, suggesting a more time-efficient alternative to BP without compromising learning outcomes.