be argued that the HVOD method helps students gain and retain knowledge in the short term , and quite possibly , long term ( see Figure 6 ). This is not only directly expressed in the questionnaires , but also subtly indicated in the mental image of the hammer and humerus that many students have reported . Achieving a mental representation of the anatomical structures can be evidence of conceptualised knowledge that is likely to enhance memory ( van Kesteren et al ., 2014 ). Keeping in mind that the humerus was not first introduced during the workshop and was only re-studied using the HVOD method , the HVOD method could , at least , allow students the opportunity to build on former knowledge established by other educational means . Consequently , principles of the HVOD method can effectively support anatomy learning in topics where it is applicable . Another value raised by students was establishing an understanding of anatomical relationships . This is also part of the ‘ big picture ’ achievable by haptico-visual observation . The HVOD method places great emphasis on multisensory observation , but also encourages a global exploration of the structure . As a result , the parts of the observed structure are not examined in isolation of each other , but in a sequential manner to build a global representation of the object where an understanding of the relationship of all object features can be understood . It is noteworthy that the mental images of under-examined parts of the humerus were reported to be less vivid “ I think if we had more time or had drawn the entire humerus the same could have been said for the rest of it , but as we only were focusing on the head and neck it is only this part that is clearer for me ”.
By closely examining the responses , a few suggested facilitators of learning can be readily identified . Haptic exploration enabled students to gather distinct information about the humerus . Where large details could be registered by vision “ I think that the roundness of the head of the humerus could be appreciated through visual observation ”, surface details , in particular , were appreciated through touch “ The haptic observation allowed me to appreciate the head of the humerus ' s grooves and dainty points the most .”. This is supported by the strong agreement on the importance of touch in learning ( see Figure 6 ). Moreover , introducing an additional sensory input has been shown to reduce the cognitive load on students ( Zacharia , 2015 ), which could enhance learning . A further advantage of haptic observation is that it allows the understanding of multiple aspects of an object concurrently , whereas only a single aspect of the structure can be observed at a time using sight ( Klatzky and Lederman , 2011 ). Learning by drawing also contributed to student understanding . Drawing has been found effective in supporting the learning process ( Alsaid and Bertrand , 2016 ; Borrelli et al ., 2018 ; Na et al ., n . d .). In this study , many students believed that their experience was enriched by the drawing component “ The drawing part was great . But by the use of touch and drawing we were able to get a 3-dimensional aspect to it ”. Specifically , the emphasis on producing well observed , but not necessarily aesthetically pleasing drawings , focused the participants ’ attention on observing and describing the form and details of the objects . Where the humerus was under-represented by the marks made on paper , this indicated ineffective observation , and the need to re-explore specific areas of the bone , helping students bridge the gaps in their observation and learning . Although hapticovisual observation is fundamental to the process , students raised concerns of feasibility in typical laboratory teaching . A few students assumed that the learning effects were due to mere prolonged observation “ I don ' t think this change is due to using the method , but to the fact that I got the chance to look at the humerus at home for 3 hours .”, which may not be appropriate for a content-dense curriculum . Such a distinction can be established by studies comparing free observation with the haptico-visual observation in the context of anatomy learning .
Further qualitative analysis suggests that the HVOD method may require a few adjustments to be appropriately incorporated into anatomy curriculums . While many students believed that haptico-visual observation was effective , they raised the issue of time constraints and unfeasibility in learning with a university programme given the other workloads ( Smith et al ., 2014 ).
A customised HVOD approach tailored for course and student-specific needs is likely to be included realistically into curriculum schedule . Having learned the principles , we can assume that students can apply the approach in a more flexible fashion . Another concern observed was the limited content for which this approach is suitable . Most students advocated its use for osteological structures , given that the approach involves the physical manipulation of structures . But the approach – in student opinions – appears less applicable to soft and small structures . Given the limited scope of the