Nursing students' perceptions of image-based anatomical self-assessment in undergraduate education

Human anatomy is a core subject in undergraduate nursing education but is often perceived as challenging due to its conceptual complexity and visual-spatial demands. Digital self-assessment tools may support active learning and reinforce anatomical identification through repeated engagement with visual content.

To evaluate first-year nursing students' perceptions of the educational value, acceptability, and satisfaction associated with an image-based anatomy self-assessment activity designed to reinforce anatomical identification across the full syllabus under real educational conditions.

A cross-sectional descriptive study was conducted among first-year nursing students enrolled in a Human Anatomy module. The activity comprised 266 image-based identification and ordering questions delivered online as part of continuous assessment. Student perceptions were collected through a post-activity questionnaire with a Net Promoter Score (NPS) item and an open-ended question. Demographic and academic variables were recorded. Analyses included descriptive statistics, non-parametric tests, and k-means clustering; qualitative comments were examined through content-based analysis.

A total of 159 students completed the activity and questionnaire (93.0%). Satisfaction was high (mean NPS 7.97; NPS index +27), with 49.1% classified as Promoters. Performance scores showed a ceiling effect (median 8.8/10; 98.1% pass rate). No significant differences in satisfaction or performance were observed across demographic or academic subgroups. Qualitative feedback highlighted perceived utility as the most frequent theme, with concerns focused on image quality, technical issues, and workload. Cluster analysis identified three student profiles, indicating that satisfaction varied mainly by experiential rather than demographic factors.

The image-based self-assessment activity was well accepted and perceived as educationally valuable, supporting anatomical identification across student subgroups. Improving image clarity, technical stability, and workload may further enhance learning. Findings support integrating structured image-based self-assessment as a complementary tool in nursing anatomy education.