IMAGE-BASED AUGMENTED REALITY: REINFORCING LEARNING IN MEDICAL SCHOOL EDUCATION A Project Presented to the Faculty of California State Polytechnic University, Pomona In Partial Fulfillment Of the Requirements for the Degree Master of Arts In Education By Joseph S. Marilo 2017 SIGNATURE PAGE PROJECT: IMAGE-BASED AUGMENTED REALITY: REINFORCING LEARNING IN MEDICAL SCHOOL EDUCATION AUTHOR: Joseph S. Marilo DATE SUBMITTED: Spring 2017 Education Department Shahnaz Lotfipour, Ph. D. _______________________________________ Project Committee Chair Professor of Education Jerry Kellogg, MA _______________________________________ Senior Consultant Creative Edge ii ACKNOWLEDGEMENTS I am forever appreciative of my parents for the sacrifices they made toward my scholastic pursuits. They did not have the same educational opportunities back in their respective countries, and I know that I would not be the person I am today without their love and support. To my wife, Christy, for her tireless encouragement despite the challenges. At one point, we were both in school – she completed her Doctorate last year! We will be breathing a sigh of relief very soon...again! This project would not have been possible without the assistance of my work colleagues. The team members in Instructional Technology and Distributed Learning provided technical expertise and guidance that kept the project on track. The generous support of the administration, post-doctoral teaching fellows, and staff of the NMM/OMM department was invaluable as was the support of the administration in the College of Osteopathic Medicine. To my classmates in my cohort who inspire and exemplify the selfless act of imparting knowledge. I’m grateful for your friendship and generosity. And lastly, a very special thank you to my faculty advisor, Dr. Shahnaz Lotfipour. I always left our project meetings buoyed by her encouragement, enthusiasm, and guidance. iii ABSTRACT Medical school education is a rigorous endeavor where students undergo hundreds of hours of lecture and laboratory instruction during their pre-clinical years alone (Smith, Peterson, Degenhardt, & Johnson, 2007). Additionally, it is not uncommon for the courses to be at times demanding, abstract, and conceptual (Smith et al., 2007). Augmented reality (AR) is an up-and-coming technology that may aid the learner in comprehending abstract and difficult concepts. Augmented reality is the process where computer-generated information is layered upon a real-world view, thus adding to – or augmenting – the information presented (Azuma, 1997; Caudell & Mizell, 1992). The technology surrounding augmented reality has its origins in World War II (Vaughan-Nichols, 2009). However, AR has since diffused from the military to other sectors including manufacturing, marketing, and entertainment (Carmigniani et al., 2011; Vaughan-Nichols, 2009; Yuen, Yaoyuneyong, & Johnson, 2011). While augmented reality is not new, it is still considered emergent in the field of education (Bacca, Baldiris, Fabregat, Graf, & Kinshuk, 2014; Billinghurst & Duenser, 2012). Bacca et al. (2014) and Thornton et al. (2012) have suggested that the subjects of science, engineering and mathematics are well suited for augmented reality. AR has the potential of clarifying complex and abstract theories and relationships, increasing engagement and comprehension, all while placing the student in a safe environment (Cuendet, Bonnard, Do-Lenh, & Dillenbourg, 2013). The purpose of this research project was to create image-based augmented reality experiences for medical students enrolled in The Expanding Osteopathic Concept (EOC), iv a five-day intensive cranial course taught to second-year osteopathic medical students. Accompanying this course is The Expanding Osteopathic Concept Manual, a 170-page spiral-bound workbook. AR experiences were embedded in specific sections of this workbook as a means of clarifying concepts, all while reinforcing and engaging the medical student. Three hundred forty-six second-year osteopathic medical students were invited to take part in this study via an email invitation. Of those, 82 participated in the study and completed the survey. The study involved students accessing the study website, viewing augmented reality-enhanced illustrations, and taking a short, anonymous survey. The survey was comprised of twelve questions: ten multiple choice, and two open-ended. In the analysis of the data, participants’ attitudes and perceptions of augmented reality have been largely favorable. Perceived comprehension, retention, and engagement scored an average of 4.41, 4.32, and 4.8 out of 5 respectively. According to participant feedback, addressing technical limitations of image stabilization and device compatibility is of high priority and paramount in creating a successful user experience. Continued research in this field will aid in augmented reality’s development and in the potential impact on student outcomes. Further studies are needed to measure AR’s effectiveness and viability beyond student perception and into measured, academic results. v TABLE OF CONTENTS Signature Page .................................................................................................................... ii Acknowledgements ............................................................................................................ iii Abstract .............................................................................................................................. iv List of Tables ..................................................................................................................... ix List of Figures ..................................................................................................................... x Chapter One: Introduction .................................................................................................. 1 Background of the Problem ............................................................................................ 2 Statement of the Problem ................................................................................................ 4 Purpose of the Project ..................................................................................................... 5 Assumptions .................................................................................................................... 6 Limitations ...................................................................................................................... 6 Delimitations ................................................................................................................... 7 Definition of Terms......................................................................................................... 7 Chapter Two: Literature Review ...................................................................................... 12 What is Augmented Reality? ........................................................................................ 14 History of Augmented Reality ...................................................................................... 16 How does Augmented Reality Work? .......................................................................... 18 Augmented Reality in Current Use ............................................................................... 19 Manufacturing ....................................................................................................... 20 vi Marketing and Commerce..................................................................................... 20 Entertainment and Informational .......................................................................... 21 Medicine ............................................................................................................... 23 Education .............................................................................................................. 26 Augmented Reality and Education ............................................................................... 26 The Future of Augmented Reality ................................................................................ 28 Summary ....................................................................................................................... 29 Chapter Three: Methodology ............................................................................................ 31 Content Development ................................................................................................... 32 Analysis Phase ...................................................................................................... 32 Design Phase ......................................................................................................... 33 Program Development .................................................................................................. 35 Field Testing Procedure ................................................................................................ 37 Implementation Phase ........................................................................................... 37 Evaluation Phase ................................................................................................... 38 Chapter Four: Summary, Conclusions, and Recommendations ....................................... 40 Summary ....................................................................................................................... 40 Conclusions ..................................................................................................................