Role of spatial ability, motivation and anxiety in learning neuroanatomy


  • Hamish Newman School of Allied Health, Health Professions Education, The University of Western Australia, Perth, Western Australia
  • Sandra Carr School of Allied Health, Health Professions Education, The University of Western Australia, Perth, Western Australia
  • Amanda Meyer School of Human Sciences, The University of Western Australia, Perth, Western Australia



neuroanatomy, learning, motivation, spatial ability, anxiety, education


Introduction: In the last decade, medical student neuroanatomy knowledge has been below an acceptable level. Teaching interventions targeted towards factors relevant to learning neuroanatomy, such as spatial ability or motivation, may be developed to improve knowledge acquisition and long-term retention. This paper seeks to characterise the relationship between spatial ability, motivation and anxiety on learning neuroanatomy. Methods: Students (n = 131) enrolled in a neuroanatomy course (males n = 53; females n = 78; age = 22±6 [mean ± SD] years) completed a mental rotations test (MRT), condensed Motivated Strategies for Learning Questionnaire (MSLQ) and Depression, Anxiety and Stress Scales (DASS-21) survey to assess spatial ability, motivation and anxiety, respectively. Spearman correlations were calculated between students’ scores on these tools and examination/unit results. Results: Final unit score and perceived task value were weakly positively correlated (rs = 0.22, p = 0.016, n = 112), whereas final unit score and anxiety were weakly negatively correlated (rs = -0.22, p = 0.04, n = 82). There was a weak positive correlation between spatial ability and spatial MCQ results (rs = 0.232, p = 0.016, n = 108) but no other assessment modality.  Conclusions: Targeting interventions to increase students’ perceptions of the value of learning neuroanatomy and to reduce anxiety will further improve student performance in this subject. Data from this report may guide the development of personalised educational techniques with the aim of improving knowledge acquisition. Future research into devising these interventions and characterising their effect on neuroanatomy learning would be beneficial. 


Abdel Meguid, E. M., & Khalil, M. K. (2017). Measuring medical students' motivation to learning anatomy by cadaveric dissection. Anatomical Sciences Education, 10(4), 363–371.

Abulaban, A. A., Obeid, T. H., Algahtani, H. A., Kojan, S. M., Al-Khathaami, A. M., Abulaban, A. A., Bokhari, M. F., Merdad, A. A., & Radi, S. A. (2015). Neurophobia among medical students. Neurosciences, 20(1), 37–40.

Abushouk, A. I., & Duc, N. M. (2016). Curing neurophobia in medical schools: Evidence-based strategies. Medical Education Online, 21(1), Article 32476.

AlHindi, M., Rashed, B., & AlOtaibi, N. (2016). Failure rate of inferior alveolar nerve block among dental students and interns. Saudi Medical Journal, 37(1), 84–89.

Allen, L. K., Eagleson, R., & de Ribaupierre, S. (2016). Evaluation of an online three‐dimensional interactive resource for undergraduate neuroanatomy education. Anatomical Sciences Education, 9(5), 431–439.

Anwar, K., Shaikh, A. A., Sajid, M. R., Cahusac, P., Alarifi, N. A., & Al Shedoukhy, A. (2015). Tackling student neurophobia in neurosciences block with team-based learning. Medical Education Online, 20(1), Article 28461.

Arantes, M., Arantes, J., & Ferreira, M. (2018). Tools and resources for neuroanatomy education: A systematic review. BMC Medical Education, 18(1), 94.

Bernhardt, V., Rothkötter, H. J., & Kasten, E. (2012). Psychological stress in first year medical students in response to the dissection of a human corpse. GMS Zeitschrift für Medizinische Ausbildung, 29(1), Article 12.

Bloom, B. S. (1956). Taxonomy of educational objectives, Handbook 1: Cognitive domain. McKay.

Bradley, A., Khan, K., Madurska, M., Riddell, A., & Saldanha, J. (2015). From cadavers to clinical practice: The anatomy of lifelong learning. Scottish Medical Journal, 60(4), 161–163.

Brewer, D. N., Wilson, T. D., Eagleson, R., & de Ribaupierre, S. (2012). Evaluation of neuroanatomical training using a 3D visual reality model. Studies in Health Technology and Informatics, 173, 85–91.

Carter, A. G., Creedy, D. K., & Sidebotham, M. (2017). Critical thinking skills in midwifery practice: Development of a self-assessment tool for students. Midwifery, 50, 184–192.

Cassady, J. C., & Johnson, R. E. (2002). Cognitive test anxiety and academic performance. Contemporary Educational Psychology, 27(2), 270–295.

Chhetri, S. K. (2017). E-learning in neurology education: Principles, opportunities and challenges in combating neurophobia. Journal of Clinical Neuroscience, 44, 80–83.

Clark, L. A., & Watson, D. (1991). Tripartite model of anxiety and depression: Psychometric evidence and taxonomic implications. Journal of Abnormal Psychology, 100(3), 316–336.

Crawford, J., Cayley, C., Lovibond, P. F., Wilson, P. H., & Hartley, C. (2011). Percentile norms and accompanying interval estimates from an Australian general adult population sample for self‐report mood scales (BAI, BDI, CRSD, CES‐D, DASS, DASS‐21, STAI‐X, STAI‐Y, SRDS, and SRAS). Australian Psychologist, 46(1), 3–14.

Dewar, B., Day, G. S., & Shamy, M. C. (2020). Overcoming neurophobia with the help of Peruvian talking bears. JAMA Neurology, 77(3), 291–292.

Ekstrand, C., Jamal, A., Nguyen, R., Kudryk, A., Mann, J., & Mendez, I. (2018). Immersive and interactive virtual reality to improve learning and retention of neuroanatomy in medical students: A randomized controlled study. CMAJ Open, 6(1), E103–E109.

Ferguson, E., James, D., & Madeley, L. (2002). Factors associated with success in medical school: Systematic review of the literature. BMJ, 324(7343), 952–957.

Fox, J., & Bouchet-Valat, M. (2017). Rcmdr: R Commander. In R package version (Version 3.2).

Giles, J. (2010). Clinical neuroscience attachments: A student’s view of "neurophobia". The Clinical Teacher, 7(1), 9–13.

Gonzales, R. A., Ferns, G., Vorstenbosch, M. A., & Smith, C. F. (2020). Does spatial awareness training affect anatomy learning in medical students? Anatomical Sciences Education, 13(6), 707–720.

Guimarães, B., Firmino‐Machado, J., Tsisar, S., Viana, B., Pinto‐Sousa, M., Vieira‐Marques, P., Cruz-Correia, R., & Ferreira, M. A. (2019). The role of anatomy computer‐assisted learning on spatial abilities of medical students. Anatomical Sciences Education, 12(2), 138–153.

Guraya, S. Y., Guraya, S. S., Habib, F., AlQuiliti, K. W., & Khoshhal, K. I. (2018). Medical students' perception of test anxiety triggered by different assessment modalities. Medical Teacher, 40(Suppl. 1), S49–S55.

Henry, J. D., & Crawford, J. R. (2005). The short‐form version of the Depression Anxiety Stress Scales (DASS‐21): Construct validity and normative data in a large non‐clinical sample. British Journal of Clinical Psychology, 44(2), 227–239.

Henssen, D. J. H. A., van den Heuvel, L., de Jong, G., Vorstenbosch, M. A. T. M., Cappellen van Walsum, A.-M., Van den Hurk, M. M., Kooloos, J. G. M., & Bartels, R. H. M. A. (2019). Neuroanatomy learning: Augmented reality vs. cross-sections. Anatomical Sciences Education, 13(3), 353–365.

Javaid, M. A., Chakraborty, S., Cryan, J. F., Schellekens, H., & Toulouse, A. (2018). Understanding neurophobia: Reasons behind impaired understanding and learning of neuroanatomy in cross‐disciplinary healthcare students. Anatomical Sciences Education, 11(1), 81–93.

Jozefowicz, R. F. (1994). Neurophobia: The fear of neurology among medical students. Archives of Neurology, 51(4), 328–329.

Kam, K., Tan, G., Tan, K., Lim, E., Koh, N. Y., & Tan, N. (2013). Neurophobia in medical students and junior doctors: Blame the GIK. Annals of the Academy of Medicine, Singapore, 42(11), 559–566.

Kusurkar, R., Ten Cate, T. J., Van Asperen, M., & Croiset, G. (2011). Motivation as an independent and a dependent variable in medical education: A review of the literature. Medical Teacher, 33(5), e242–e262.

Langlois, J., Bellemare, C., Toulouse, J., & Wells, G. A. (2019). Spatial abilities training in anatomy education: A systematic review. Anatomical Sciences Education, 13(1), 71–79.

Loftus, A. M., Wade, C., & McCarron, M. O. (2016). Primary care perceptions of neurology and neurology services. Postgraduate Medical Journal, 92(1088), 318–321.

Lufler, R. S., Zumwalt, A. C., Romney, C. A., & Hoagland, T. M. (2012). Effect of visual–spatial ability on medical students' performance in a gross anatomy course. Anatomical Sciences Education, 5(1), 3–9.

McBride, J. M., & Drake, R. L. (2018). National survey on anatomical sciences in medical education. Anatomical Sciences Education, 11(1), 7–14.

McCarron, M. O., Stevenson, M., Loftus, A. M., & McKeown, P. (2014). Neurophobia among general practice trainees: The evidence, perceived causes and solutions. Clinical Neurology and Neurosurgery, 122, 124–128.

McKeown, P. P., Heylings, D. J. A., Stevenson, M., McKelvey, K. J., Nixon, J. R., & McCluskey, D. R. (2003). The impact of curricular change on medical students' knowledge of anatomy. Medical Education, 37(11), 954–961.

Meguid, E. M. A., Smith, C. F., & Meyer, A. J. (2019). Examining the motivation of health profession students to study human anatomy. Anatomical Sciences Education, 13(3), 343–352.

Moeller, J. J., Kurniawan, J., Gubitz, G. J., Ross, J. A., & Bhan, V. (2008). Diagnostic accuracy of neurological problems in the emergency department. Canadian Journal of Neurological Sciences, 35(3), 335–341.

Moore, F. G. (2020). A diverse specialty: What students teach us about neurology and “neurophobia”. Canadian Journal of Neurological Sciences, 47(5), 675–680.

Moro, C., Štromberga, Z., Raikos, A., & Stirling, A. (2017). The effectiveness of virtual and augmented reality in health sciences and medical anatomy. Anatomical Sciences Education, 10(6), 549–559.

Moxham, B., McHanwell, S., Plaisant, O., & Pais, D. (2015). A core syllabus for the teaching of neuroanatomy to medical students. Clinical Anatomy, 28(6), 706–716.

Newman, H. J., Meyer, A. J., & Carr, S. E. (2021). Neuroanatomy teaching in Australian and New Zealand medical schools. World Neurosurgery, 149, e217–e224.

Pedersen, K., Wilson, T. D., & De Ribaupierre, S. (2013). An interactive program to conceptualize the anatomy of the internal brainstem in 3D. Studies in Health Technology and Informatics, 184, 319–323.

Peters, M., Laeng, B., Latham, K., Jackson, M., Zaiyouna, R., & Richardson, C. (1995). A redrawn Vandenberg and Kuse mental rotations test: Different versions and factors that affect performance. Brain and Cognition, 28(1), 39–58.

Pintrich, P. R., Smith, D. A., Garcia, T., & McKeachie, W. J. (1991). A manual for the use of the Motivated Strategies for Learning Questionnaire (MSLQ) (ED338122). ERIC.

Pintrich, P. R., Smith, D. A., Garcia, T., & McKeachie, W. J. (1993). Reliability and predictive validity of the Motivated Strategies for Learning Questionnaire (MSLQ). Educational and Psychological Measurement, 53(3), 801–813.

Pizzimenti, M. A., & Axelson, R. D. (2015). Assessing student engagement and self‐regulated learning in a medical gross anatomy course. Anatomical Sciences Education, 8(2), 104–110.

Plumley, L., Armstrong, R., De Ribaupierre, S., & Eagleson, R. (2013). Spatial ability and training in virtual neuroanatomy. Studies in Health Technology and Informatics, 184(20), 324–329.

Powell, D. H. (2004). Behavioral treatment of debilitating test anxiety among medical students. Journal of Clinical Psychology, 60(8), 853–865.

Prince, K. J., Scherpbier, A. J., Van Mameren, H., Drukker, J., & Van Der Vleuten, C. P. (2005). Do students have sufficient knowledge of clinical anatomy? Medical Education, 39(3), 326–332.

Ramirez, G., & Beilock, S. L. (2011). Writing about testing worries boosts exam performance in the classroom. Science, 331(6014), 211–213.

Roach, V. A., Mi, M., Mussell, J. C., Van Nuland, S. E., Lufler, R. S., DeVeau, K. M., Dunham, S. M., Husmann, P. R., Herriott, H. L., Edwards, D. N., Doubleday, A. F., Wilson, B. M., & Wilson, A. B. (2020). A systematic review of spatial ability & anatomy performance: It’s time for a metaanalysis. The FASEB Journal, 34(S1), 1–1.

Salamonson, Y., Everett, B., Koch, J., Wilson, I., & Davidson, P. M. (2009). Learning strategies of first year nursing and medical students: A comparative study. International Journal of Nursing Studies, 46(12), 1541–1547.

Sandrone, S., Berthaud, J. V., Chuquilin, M., Cios, J., Ghosh, P., Gottlieb-Smith, R. J., Kushlaf, H., Mantri, S., Masangkay, N., Menkes, D. L., Nevel, K. S., Sarva, H., & Schneider, L. D. (2019). Neurologic and neuroscience education: Mitigating neurophobia to mentor health care providers. Neurology, 92(4), 174–179.

Schon, F., Hart, P., & Fernandez, C. (2002). Is clinical neurology really so difficult? Journal of Neurology, Neurosurgery & Psychiatry, 72(5), 557–559.

Shelley, B. P., Chacko, T. V., & Nair, B. R. (2018). Preventing “neurophobia”: Remodeling neurology education for 21st-century medical students through effective pedagogical strategies for “neurophilia”. Annals of Indian Academy of Neurology, 21(1), 9–18.

Shepard, R. N., & Metzler, J. (1971). Mental rotation of three-dimensional objects. Science, 171(3972), 701–703.

Soemantri, D., Mccoll, G., & Dodds, A. (2018). Measuring medical students’ reflection on their learning: Modification and validation of the motivated strategies for learning questionnaire (MSLQ). BMC Medical Education, 18(1), Article 274.

Sorby, S. A., & Baartmans, B. J. (2000). The development and assessment of a course for enhancing the 3‐D spatial visualization skills of first year engineering students. Journal of Engineering Education, 89(3), 301–307.

Sotgiu, M. A., Mazzarello, V., Bandiera, P., Madeddu, R., Montella, A., & Moxham, B. (2019). Neuroanatomy, the Achille’s heel of medical students: A systematic analysis of educational strategies for the teaching of neuroanatomy. Anatomical Sciences Education, 13(1), 107–116.

Tarolli, C. G., & Józefowicz, R. F. (2018). Managing neurophobia: How can we meet the current and future needs of our students? Seminars in Neurology, 38(4), 407–412.

Thompson, A. R., & O'Loughlin, V. D. (2015). The Blooming Anatomy Tool (BAT): A discipline‐specific rubric for utilizing Bloom's taxonomy in the design and evaluation of assessments in the anatomical sciences. Anatomical Sciences Education, 8(6), 493–501.

Vandenberg, S. G., & Kuse, A. R. (1978). Mental rotations, a group test of three-dimensional spatial visualization. Perceptual and Motor Skills, 47(2), 599–604.

Vorstenbosch, M. A., Klaassen, T. P., Donders, A., Kooloos, J. G., Bolhuis, S. M., & Laan, R. F. (2013). Learning anatomy enhances spatial ability. Anatomical Sciences Education, 6(4), 257–262.

Voyer, D., Voyer, S., & Bryden, M. P. (1995). Magnitude of sex differences in spatial abilities: A meta-analysis and consideration of critical variables. Psychological Bulletin, 117(2), 250–270.

Waterston, S. W., & Stewart, I. J. (2005). Survey of clinicians' attitudes to the anatomical teaching and knowledge of medical students. Clinical Anatomy, 18(5), 380–384.

Watson, D., Clark, L. A., & Carey, G. (1988). Positive and negative affectivity and their relation to anxiety and depressive disorders. Journal of Abnormal Psychology, 97(3), 346–353.

Yeager, D. S., & Walton, G. M. (2011). Social-psychological interventions in education: They’re not magic. Review of Educational Research, 81(2), 267–301.

Youssef, F. F. (2009). Neurophobia and its implications: Evidence from a Caribbean medical school. BMC Medical Education, 9(1), Article 39.

Zimmerman, B. J. (1989). A social cognitive view of self-regulated academic learning. Journal of Educational Psychology, 81(3), 329–339.

Zinchuk, A. V., Flanagan, E. P., Tubridy, N. J., Miller, W. A., & McCullough, L. D. (2010). Attitudes of US medical trainees towards neurology education: "Neurophobia"—a global issue. BMC Medical Education, 10(1), Article 49.