Students’ Learning Outcomes in a Virtual Microscopic Online and Face-to-Face Anatomy Course: Cross-Over Comparative Study

Abstract Background Since 2021, the histology of organs in the microscopic anatomy course at the Department of Anatomy II of the Ludwig-Maximilians-Universität Munich has been held as a hybrid course using a 3D virtual microscopy system. Evidence comparing synchronous online versus face-to-face instruction using an advanced 3D virtual slide system remains limited. In particular, it is unclear whether learning outcomes are equivalent across instructional modes, and whether individual student characteristics influence learning outcomes under these conditions. Objective This study systematically (1) compares the learning outcomes of preclinic students attending a microscopic anatomy course either face-to-face or synchronously online using a 3D virtual microscopy slide box generated from fully scanned histological glass slides previously used in a traditional course, and (2) investigates whether selected demographic characteristics and personal skills predict learning outcomes in either instructional mode. We hypothesized that learning outcomes would not differ between online and face-to-face participation when instructional conditions are identical. Methods The students attended 2 consecutive course days on 2 topics (kidney and liver) in a crossover design. Half of the students attended the first day face-to-face, and the second day online, while the other half attended in the reverse order. Demographic characteristics (eg, self-organization and affinity for technology interaction) and learning outcomes were collected via survey and simulated examination on the day after the second course day. To minimize potential confounding factors (eg, learning by means of external resources) and to ensure that the results reflected the learning outcomes within the scope of this study, 2 particularly challenging course days were intentionally selected, and the time interval before the simulated examination was kept short. Learning outcomes were analyzed using a linear mixed-effects model, and potential predictors were explored using stepwise linear regression. Results Overall, 740 student questionnaires and examinations (740/864, 86% of the total student cohort) were used to assess the items' quality of the simulated examination. Inferential analyses included data from 415 students who completed the crossover design as intended. No significant main effect of participation mode on learning outcomes was found ( F 1, 413 =0.16; P =.69). Although a significant effect of examination topic was observed ( F 1, 413 =25.56; P <.001), there was no significant interaction between participation mode and examination topic ( F 1, 413 =0.13; P =.72). Regression analyses showed low predictive power overall ( R 2 ≥0.12), with self-organization emerging as a weak but consistent predictor across both instructional modes. Conclusions The results of this study suggest that the microscopic anatomy learning outcomes of students under controlled short-term conditions are comparable in synchronous online and face-to-face teaching. However, it should be noted that the study was limited to 2 topics and 2 consecutive course days. Further research should address additional topics, long-term learning outcomes, and broader student populations.