Evaluation of the Relationship Between Finger Morphometry, Hand Motor Skills, and Practical Anatomy Exam Performance Among First-Year Medical Students

Evaluation of the Relationship Between Finger Morphometry, Hand Motor Skills, and Practical Anatomy Exam Performance Among First-Year Medical Students | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluation of the Relationship Between Finger Morphometry, Hand Motor Skills, and Practical Anatomy Exam Performance Among First-Year Medical Students Abdullah Örs, Hamza Atalar This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7104950/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 19 Jan, 2026 Read the published version in BMC Medical Education → Version 1 posted 10 You are reading this latest preprint version Abstract Background This study aimed to investigate the relationship between finger morphometric characteristics (2D:4D ratio) and hand motor skills (Nine-Hole Peg Test duration) with practical anatomy exam performance among first-year medical students. Methods This cross-sectional study included voluntary first-year medical students at Kocaeli University Faculty of Medicine. The lengths of the second (2D) and fourth (4D) fingers of the right hand were measured using a digital caliper, and the 2D:4D ratio was calculated. Hand motor performance was evaluated using the Nine-Hole Peg Test (NHPT). Practical anatomy exam scores were used to determine academic achievement. Students with an average score above 65 were classified as successful. Results Regression analysis showed no significant association between 2D:4D ratio and anatomy exam performance (p = 0.771). However, there was a significant negative relationship between NHPT duration and academic performance (B = -1.63; p = 0.036). Successful students completed the test in significantly shorter time than their peers (p = 0.016). Conclusion Hand motor performance appears to be a significant predictor of anatomy exam success, whereas the 2D:4D ratio does not show such predictive power. These findings emphasize the importance of integrating psychomotor skills into medical education strategies. Anatomy education Academic achievement 2D:4D ratio Nine-Hole Peg Test Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Anatomy education is a fundamental component of medical curricula and plays a critical role in shaping the professional development of future physicians. Its instruction requires comprehension of three-dimensional structures, spatial perception, visual memory, and higher-order cognitive processes [ 1 – 3 ]. Practical anatomy exams aim to assess students’ abilities to localize, identify, and interpret the function of morphological structures. In this process, individual differences in attention, memory, and psychomotor competence may significantly influence student success [ 4 ]. The 2D:4D ratio—the proportion between the lengths of the second and fourth fingers—has been proposed as a biological marker of prenatal androgen exposure. It has been linked to various cognitive, behavioral, and physical traits [ 5 – 7 ]. Several studies have examined the relationship between the 2D:4D ratio and academic performance, mathematical reasoning, musical ability, leadership, and risk-taking behavior [ 8 – 10 ]. However, consistent results in educational contexts remain elusive. The Nine-Hole Peg Test (NHPT) is widely used to assess hand–eye coordination and fine motor skills. It is a standard tool for evaluating upper extremity function, particularly in the diagnosis and monitoring of neurological conditions [ 11 , 12 ]. Recently, it has also been applied to assess psychomotor performance in medical education [ 13 , 14 ]. Its ease of administration and reproducibility make it a practical tool in academic settings. This study aimed to evaluate the relationship between the 2D:4D digit ratio and hand motor performance with anatomy exam success among first-year medical students. By assessing morphometric and psychomotor variables together, this study sought to identify potential predictors of practical anatomy performance, ultimately contributing to personalized educational strategies and academic guidance. Methods This cross-sectional study was conducted at XXX University Faculty of Medicine among first-year medical students who voluntarily participated. The relationship between students’ anatomy exam performance and their finger morphometric characteristics and hand motor skills was investigated. Academic performance was assessed using two practical anatomy exams (the 5th and 6th module exams), each consisting of five stations with two questions per station. Each station included anatomical specimens with flagged pins marking specific structures, and students were given 50 seconds per station. Finger morphometry was evaluated by measuring the lengths of the second (index) and fourth (ring) fingers of the right hand using a digital caliper with 0.001 mm precision. Measurements were taken from the proximal palmar crease to the fingertip, and the 2D:4D ratio was calculated. Hand motor performance was assessed using the Nine-Hole Peg Test. Participants were asked to place nine pegs into nine holes on a test board and remove them as quickly as possible, following a specific order. The duration to complete the task was recorded in seconds using a stopwatch. Students with a practical exam average score above 65 were classified as “successful,” while those scoring below 65 were categorized as “unsuccessful.” Statistical Analysis All statistical analyses were performed using SPSS version 26.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics were presented as mean ± standard deviation (Std). The normality of data distribution was assessed using the Shapiro-Wilk test. For comparisons between groups (e.g., by sex or academic success), independent samples t-test or Mann–Whitney U test was applied based on distribution characteristics. The relationship between anatomy exam performance and independent variables (2D:4D ratio and Nine-Hole Peg Test duration) was evaluated using linear regression analysis. The significance level was set at p < 0.05 for all tests. Results A total of 94 students participated in the study, including both male and female students. The mean age was 19.04 ± 1.10 years. Male students had significantly higher height, weight, and body mass index (BMI) compared to female students (p < 0.001) (Table 1 ). Table 1 Descriptive characteristics of participants by sex Variable Female (n = 30) Mean ± Std Male (n = 64) Mean ± Std Total (n = 94) Mean ± Std p-value Age 19.27 ± 1.23 18.94 ± 1.03 19.04 ± 1.10 *0.238 Height (cm) 166.43 ± 5.25 179.67 ± 6.83 175.40 ± 8.88 < 0.001 Weight (kg) 59.63 ± 10.00 79.43 ± 14.70 73.04 ± 16.24 *<0.001 BMI (kg/m²) 21.49 ± 3.07 24.56 ± 3.95 23.57 ± 3.95 *<0.001 2D length (mm) 63.83 ± 5.05 70.64 ± 4.72 68.44 ± 5.77 < 0.001 4D length (mm) 64.31 ± 5.12 71.11 ± 4.62 68.92 ± 5.73 < 0.001 2D:4D ratio 0.99 ± 0.03 0.98 ± 0.02 0.98 ± 0.02 *0.026 Anatomy exam score (0–100) 69.25 ± 20.33 59.80 ± 21.33 62.85 ± 21.37 0.044 NHPT duration (sec) 18.78 ± 2.30 20.06 ± 3.02 19.65 ± 2.86 *0.080 Std: Standard deviation; BMI: Body mass index; NHPT: Nine-Hole Peg Test Student's t-test was used. * Mann-Whitney U test was used. Finger length measurements indicated that males had significantly longer 2D and 4D digits compared to females (p < 0.001). The mean 2D:4D ratio was 0.99 ± 0.03 for females and 0.98 ± 0.02 for males, a difference that was statistically significant (p = 0.026). In terms of academic success, male students had significantly higher average practical exam scores than female students (p = 0.044). NHPT durations were shorter in the successful group compared to the unsuccessful group, indicating better hand motor performance among higher-performing students (p = 0.016) (Table 2 , Fig. 2 ). Table 2 Comparison of 2D:4D ratio and NHPT duration by academic performance Variable Unsuccessful (n = 39) Mean ± Std Successful (n = 54) Mean ± Std p-value 2D:4D ratio (Female) 1.00 ± 0.03 0.99 ± 0.02 0.519 2D:4D ratio (Male) 0.98 ± 0.02 0.98 ± 0.02 *0.752 2D:4D ratio (Total) 0.98 ± 0.02 0.99 ± 0.02 0.947 NHPT duration (Female) 19.56 ± 2.25 18.39 ± 2.28 0.193 NHPT duration (Male) 20.96 ± 3.29 19.30 ± 2.57 *0.048 NHPT duration (Total) 20.60 ± 3.09 18.96 ± 2.49 *0.016 Std: Standard deviation; NHPT: Nine-Hole Peg Test Student's t-test was used. * Mann-Whitney U test was used. Regression analysis showed a significant negative association between NHPT duration and anatomy performance (B = -1.63; p = 0.036). Each additional second in NHPT duration was associated with a 1.63-point decrease in exam score. However, the model explained only a small portion of the variance (R² = 0.048). No significant association was found between 2D:4D ratio and academic performance (p = 0.771) (Table 3 , Fig. 6 ). Table 3 Regression analysis predicting anatomy exam performance Variable R² Adj. R² F Model p B Beta t Coef. p 95% CI NHPT duration 0.048 0.037 4.538 0.036 -1.63 -0.218 -2.13 0.036 -3.149 to -0.110 2D:4D ratio 0.001 -0.010 0.085 0.771 31.674 0.031 0.292 0.771 -183.989 to 247.337 Histograms of NHPT durations and anatomy scores are presented in Figs. 3 and 4 , respectively. A boxplot showing the distribution of 2D:4D ratios by academic success is shown in Fig. 5 . Discussion This study explored the relationship between finger morphometry (2D:4D ratio) and hand motor performance (NHPT duration) with practical anatomy exam success among first-year medical students. Findings revealed no significant association between 2D:4D ratio and academic performance, while hand motor skills showed a significant correlation with exam success. The absence of a linear relationship between 2D:4D and academic performance aligns with the findings of Nye et al. (2012), who reported a nonlinear association dependent on gender and geography [ 16 ]. Similarly, Güçlü et al. (2021) found no significant correlation between 2D:4D and academic performance among health science students [ 17 ]. While Luxen & Buunk (2005) reported associations between 2D:4D and cognitive abilities, such findings have not been consistently replicated and often have small effect sizes [ 9 ]. Conversely, the significant relationship observed between NHPT duration and anatomy exam success in our study supports previous literature indicating that fine motor skills and hand–eye coordination can enhance performance in hands-on educational settings. Jebakani et al. (2017) found that students with better manual dexterity performed better in practical medical education [ 14 ]. Studies have shown that NHPT performance correlates with short-term task success in clinical and normative contexts [ 18 ]. Given that anatomy education requires high cognitive load and psychomotor engagement, motor skills may influence learning outcomes in addition to cognitive capabilities. Methods such as direct observation and checklist-based assessments have proven effective in promoting psychomotor competencies during anatomy instruction [ 19 ]. An integrative review in undergraduate nursing education also highlighted the importance of simulation, technology-enhanced learning, and deliberate practice in improving motor performance [ 20 ]. This study contributes to understanding the multidimensional nature of anatomy learning and supports the inclusion of motor skill assessment in practical anatomy education. Limitations This study has several limitations. Its cross-sectional design prevents causal inference. The single-center setting and limited sample size may affect generalizability. Moreover, all measurements were performed in a single session, which may limit the assessment of individual variability. Future longitudinal and multicenter studies with larger samples are needed to explore the role of morphometric and motor predictors in academic performance. The potential use of such biomarkers in academic support programs also warrants further investigation. Conclusion This study examined the relationship between finger morphometry (2D:4D ratio) and hand motor performance (NHPT duration) with anatomy practical exam success in first-year medical students. Findings demonstrated that hand motor performance was significantly associated with academic success, whereas the 2D:4D ratio was not. These results suggest that motor skills may play a critical role in student performance in practical, hands-on anatomy education. Although the predictive value of morphometric features appears limited, psychomotor skills should be considered in educational planning and student assessment. Future strategies may include the development of interventions to enhance fine motor skills and personalized educational approaches, potentially improving success in skill-based medical courses. Declarations Acknowledgments None declared. Conflict of Interest Statement The authors declare no conflict of interest. Ethics approval and consent to participate This study was approved by the Non-Interventional Clinical Research Ethics Committee of Kocaeli University Faculty of Medicine (Approval No: GOKAEK-2025/11/19, Project no: 2025/261) and was conducted in accordance with the Declaration of Helsinki. Informed consent was obtained from all participants prior to data collection. Consent for publication: Not applicable. This manuscript does not include any individual data, images, or details that could identify participants. Availability of data and materials: The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. Clinical trial number Not applicable. Funding This research was supported by the Scientific and Technological Research Council of Türkiye (TÜBİTAK) under the 2209-A Research Project Support Program for University Students (Project No: 1919B012466641). Author Contributions A.O. and H.Y. conceived and designed the study. A.O. supervised the overall project. Both authors collected the data and contributed to the analysis and interpretation of the findings. A.O. and H.Y. conducted the literature review and drafted the manuscript. A.O. critically revised the final version. All authors read and approved the final manuscript. References Turney BW. Anatomy in a modern medical curriculum. Ann R Coll Surg Engl. 2007;89(2):104–7. Estai M, Bunt S. Best teaching practices in anatomy education: A critical review. Ann Anat. 2016;208:151–7. Bergman EM, et al. Anatomical knowledge and its relevance for clinical practice: A review. Med Teach. 2011;33(2):91–6. Waterston SW, Stewart IJ. Survey of clinicians' attitudes to the anatomical teaching and knowledge of medical students. Clin Anat. 2005;18(5):380–4. Manning JT. Digit ratio: A pointer to fertility, behavior, and health. Rutgers University Press; 2002. Hönekopp J, Watson S. Meta-analysis of digit ratio 2D:4D shows greater sex difference in the right hand. Am J Hum Biol. 2010;22(5):619–30. Voracek M, Loibl LM. Scientometric analysis and bibliography of digit ratio (2D:4D) research. Psychol Rep. 2009;104(3):922–56. Putz DA et al. Sex hormones and finger length: What does 2D:4D indicate? Evol Hum Behav. 2004;25(3):182–99. Luxen MF, Buunk BP. Second-to-fourth digit ratio related to verbal and numerical intelligence and the Big Five. Pers Individ Dif. 2005;39(5):959–66. Brosnan M. Digit ratio and academic performance. Psychol Rep. 2006;98(1):21–2. Mathiowetz V, et al. Adult norms for the Nine Hole Peg Test of finger dexterity. Occup Ther J Res. 1985;5(1):24–38. Oxford Grice K, et al. Reliability of the Nine-Hole Peg Test for finger dexterity in adults. Am J Occup Ther. 2003;57(5):570–3. Desrosiers J, et al. Reliability and validity of the Nine-Hole Peg Test in people with stroke. Disabil Rehabil. 1995;17(4):217–24. Jebakani CF, et al. Assessment of hand function using Nine Hole Peg Test in medical students. Int J Res Med Sci. 2017;5(6):2505–9. Grice KO, et al. Adult norms for a commercially available Nine Hole Peg Test for finger dexterity. Am J Occup Ther. 2003;57(5):570–3. Nye JVC, et al. Correction: 2D:4D Asymmetry and Gender Differences in Academic Performance. PLoS ONE. 2013;8(3):e000000. Güçlü M, Yıldız A, Demir A. Evaluation of the relationship between 2D:4D digit ratio and academic performance among health sciences students. J Contemp Med Educ. 2021;9(2):45–9. Feys P, et al. The Nine-Hole Peg Test as a manual dexterity performance measure for multiple sclerosis. Mult Scler. 2017;23(5):711–20. Nguyen VH, Lee J, Kim S. An Introduction and Evaluation of Direct Observation with Checklist for Developing Psychomotor Skills in Surface Anatomy Education. J Anat Educ. 2025;49(2):105–13. Martel M, Rose K, Johnson T. Teaching psychomotor skills in undergraduate nursing education: an integrative review. J Nurs Educ. 2024;63(7):421–6. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 19 Jan, 2026 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 06 Nov, 2025 Reviews received at journal 06 Nov, 2025 Reviewers agreed at journal 27 Oct, 2025 Reviews received at journal 12 Aug, 2025 Reviewers agreed at journal 03 Aug, 2025 Reviewers invited by journal 24 Jul, 2025 Editor assigned by journal 24 Jul, 2025 Editor invited by journal 21 Jul, 2025 Submission checks completed at journal 19 Jul, 2025 First submitted to journal 19 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7104950","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":490263435,"identity":"a241f61a-e815-47f7-a745-420883f1a473","order_by":0,"name":"Abdullah Örs","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFElEQVRIie3QwUrDMBjA8a8E2kth18pweYUUYQxWfJYEobsUEQYyUDBjUC+OXQc+xS6eK4H00gcIOHDiCwR28TRM1yGI2dhuHvI/JCTwIx8BcLn+YxEQWN0A3R50Ua+Imw0dJpQ0xJtvibcj/hEEhTsCh0jrefISUXJ5DcH0c51UCW49jscFjPqM4+nK+shS3hpyNYSw7LYzlcbz6tUMVg0Y9wNifUZlXUMQ41Hqo0wLCorxwsuFIfbJcEMeaoLWPUPw+4chm/2ENETUBNqgBCXK/JjH95N4KYc9SkqWh9I/e6rSeFGZwagcXOR+aiWdt8lC6dEdmwU50l8ywZ1SCK3v++czJK3kp99D0D83LpfL5Tqlb7V5ZOjc/IcpAAAAAElFTkSuQmCC","orcid":"","institution":"Kocaeli University","correspondingAuthor":true,"prefix":"","firstName":"Abdullah","middleName":"","lastName":"Örs","suffix":""},{"id":490263436,"identity":"69a5543c-7a8b-4715-a69c-784c3d8c7669","order_by":1,"name":"Hamza Atalar","email":"","orcid":"","institution":"Kocaeli University","correspondingAuthor":false,"prefix":"","firstName":"Hamza","middleName":"","lastName":"Atalar","suffix":""}],"badges":[],"createdAt":"2025-07-12 00:53:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7104950/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7104950/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12909-026-08617-w","type":"published","date":"2026-01-19T15:58:07+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":87720085,"identity":"6d320ebf-8ed4-4f01-8e5a-40f23853934c","added_by":"auto","created_at":"2025-07-28 09:39:57","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":113328,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eScatter plot of Nine-Hole Peg Test duration and anatomy exam score.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe figure shows a negative linear relationship between Nine-Hole Peg Test duration and anatomy exam performance. As motor performance improves (lower test duration), exam scores tend to be higher.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-7104950/v1/9dca0c4f8435ea991d0b7b25.png"},{"id":87720089,"identity":"51981f89-8bb7-4bd9-bf4c-d47dc0810c07","added_by":"auto","created_at":"2025-07-28 09:39:57","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":56792,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eBoxplot comparing Nine-Hole Peg Test durations by academic success.\u003c/strong\u003e\u003cbr\u003e\nStudents categorized as successful had significantly shorter test durations than unsuccessful students. This supports the predictive role of motor skills on anatomy performance.\u003c/p\u003e","description":"","filename":"figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-7104950/v1/242280759c4528778fcb2a0d.png"},{"id":87720087,"identity":"b78d641b-5742-494b-9189-04389c170f86","added_by":"auto","created_at":"2025-07-28 09:39:57","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":80917,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eHistogram of Nine-Hole Peg Test durations.\u003c/strong\u003e\u003cbr\u003e\nDistribution of motor performance scores. Most students completed the test between 17 and 20 seconds.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-7104950/v1/0708d8154071bcd47ccedee1.png"},{"id":87721934,"identity":"c926e2e0-28bd-414c-8959-67b71ca1f59e","added_by":"auto","created_at":"2025-07-28 09:55:57","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":72913,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eHistogram of anatomy exam score distribution.\u003cbr\u003e\n \u003c/strong\u003eHistogram showing the distribution of anatomy exam scores. Most participants scored between 60 and 90, with a mild right-skewed pattern.\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-7104950/v1/b294199402f4d722d1ebcb72.png"},{"id":87720094,"identity":"40bd3cb0-7d33-409b-a94b-4ceafa337537","added_by":"auto","created_at":"2025-07-28 09:39:57","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":47695,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eBoxplot of 2D:4D digit ratio by academic success group.\u003cbr\u003e\n \u003c/strong\u003eNo significant differences were observed in 2D:4D ratio between successful and unsuccessful groups.\u003c/p\u003e","description":"","filename":"Figure5.png","url":"https://assets-eu.researchsquare.com/files/rs-7104950/v1/6c58f5a05223d437c4b5badc.png"},{"id":87720484,"identity":"6ba2d00e-4583-4d32-a08b-ab7b354f4af3","added_by":"auto","created_at":"2025-07-28 09:47:57","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":104527,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eRegression analysis of Nine-Hole Peg Test duration and anatomy exam score.\u003c/strong\u003e\u003cbr\u003e\nThis plot shows the linear regression model fitted to the data. A significant inverse correlation is observed, with a regression line, R² and p-value included.\u003c/p\u003e","description":"","filename":"Figure6.png","url":"https://assets-eu.researchsquare.com/files/rs-7104950/v1/1e0a6fc8dc1254aa83b6aa2d.png"},{"id":101151822,"identity":"c10224be-54bf-4ffa-abab-3485e040ec16","added_by":"auto","created_at":"2026-01-26 16:06:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1195222,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7104950/v1/ddb11b82-6d9e-4606-91a9-4ae7c0ad7b91.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluation of the Relationship Between Finger Morphometry, Hand Motor Skills, and Practical Anatomy Exam Performance Among First-Year Medical Students","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAnatomy education is a fundamental component of medical curricula and plays a critical role in shaping the professional development of future physicians. Its instruction requires comprehension of three-dimensional structures, spatial perception, visual memory, and higher-order cognitive processes [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Practical anatomy exams aim to assess students\u0026rsquo; abilities to localize, identify, and interpret the function of morphological structures. In this process, individual differences in attention, memory, and psychomotor competence may significantly influence student success [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe 2D:4D ratio\u0026mdash;the proportion between the lengths of the second and fourth fingers\u0026mdash;has been proposed as a biological marker of prenatal androgen exposure. It has been linked to various cognitive, behavioral, and physical traits [\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Several studies have examined the relationship between the 2D:4D ratio and academic performance, mathematical reasoning, musical ability, leadership, and risk-taking behavior [\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, consistent results in educational contexts remain elusive.\u003c/p\u003e\u003cp\u003eThe Nine-Hole Peg Test (NHPT) is widely used to assess hand\u0026ndash;eye coordination and fine motor skills. It is a standard tool for evaluating upper extremity function, particularly in the diagnosis and monitoring of neurological conditions [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Recently, it has also been applied to assess psychomotor performance in medical education [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Its ease of administration and reproducibility make it a practical tool in academic settings.\u003c/p\u003e\u003cp\u003eThis study aimed to evaluate the relationship between the 2D:4D digit ratio and hand motor performance with anatomy exam success among first-year medical students. By assessing morphometric and psychomotor variables together, this study sought to identify potential predictors of practical anatomy performance, ultimately contributing to personalized educational strategies and academic guidance.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e This cross-sectional study was conducted at XXX University Faculty of Medicine among first-year medical students who voluntarily participated. The relationship between students\u0026rsquo; anatomy exam performance and their finger morphometric characteristics and hand motor skills was investigated.\u003c/p\u003e\u003cp\u003eAcademic performance was assessed using two practical anatomy exams (the 5th and 6th module exams), each consisting of five stations with two questions per station. Each station included anatomical specimens with flagged pins marking specific structures, and students were given 50 seconds per station.\u003c/p\u003e\u003cp\u003eFinger morphometry was evaluated by measuring the lengths of the second (index) and fourth (ring) fingers of the right hand using a digital caliper with 0.001 mm precision. Measurements were taken from the proximal palmar crease to the fingertip, and the 2D:4D ratio was calculated.\u003c/p\u003e\u003cp\u003eHand motor performance was assessed using the Nine-Hole Peg Test. Participants were asked to place nine pegs into nine holes on a test board and remove them as quickly as possible, following a specific order. The duration to complete the task was recorded in seconds using a stopwatch.\u003c/p\u003e\u003cp\u003eStudents with a practical exam average score above 65 were classified as \u0026ldquo;successful,\u0026rdquo; while those scoring below 65 were categorized as \u0026ldquo;unsuccessful.\u0026rdquo;\u003c/p\u003e\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eAll statistical analyses were performed using SPSS version 26.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (Std). The normality of data distribution was assessed using the Shapiro-Wilk test.\u003c/p\u003e\u003cp\u003eFor comparisons between groups (e.g., by sex or academic success), independent samples t-test or Mann\u0026ndash;Whitney U test was applied based on distribution characteristics. The relationship between anatomy exam performance and independent variables (2D:4D ratio and Nine-Hole Peg Test duration) was evaluated using linear regression analysis. The significance level was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 for all tests.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 94 students participated in the study, including both male and female students. The mean age was 19.04\u0026thinsp;\u0026plusmn;\u0026thinsp;1.10 years. Male students had significantly higher height, weight, and body mass index (BMI) compared to female students (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDescriptive characteristics of participants by sex\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;Std\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMale (n\u0026thinsp;=\u0026thinsp;64)\u003c/p\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;Std\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;94)\u003c/p\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;Std\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e19.27\u0026thinsp;\u0026plusmn;\u0026thinsp;1.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e18.94\u0026thinsp;\u0026plusmn;\u0026thinsp;1.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e19.04\u0026thinsp;\u0026plusmn;\u0026thinsp;1.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e*0.238\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHeight (cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e166.43\u0026thinsp;\u0026plusmn;\u0026thinsp;5.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e179.67\u0026thinsp;\u0026plusmn;\u0026thinsp;6.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e175.40\u0026thinsp;\u0026plusmn;\u0026thinsp;8.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWeight (kg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e59.63\u0026thinsp;\u0026plusmn;\u0026thinsp;10.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e79.43\u0026thinsp;\u0026plusmn;\u0026thinsp;14.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e73.04\u0026thinsp;\u0026plusmn;\u0026thinsp;16.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e*\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI (kg/m\u0026sup2;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e21.49\u0026thinsp;\u0026plusmn;\u0026thinsp;3.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e24.56\u0026thinsp;\u0026plusmn;\u0026thinsp;3.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e23.57\u0026thinsp;\u0026plusmn;\u0026thinsp;3.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e*\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2D length (mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e63.83\u0026thinsp;\u0026plusmn;\u0026thinsp;5.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e70.64\u0026thinsp;\u0026plusmn;\u0026thinsp;4.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e68.44\u0026thinsp;\u0026plusmn;\u0026thinsp;5.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4D length (mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e64.31\u0026thinsp;\u0026plusmn;\u0026thinsp;5.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e71.11\u0026thinsp;\u0026plusmn;\u0026thinsp;4.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e68.92\u0026thinsp;\u0026plusmn;\u0026thinsp;5.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2D:4D ratio\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.99\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e0.98\u0026thinsp;\u0026plusmn;\u0026thinsp;0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e0.98\u0026thinsp;\u0026plusmn;\u0026thinsp;0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e*0.026\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnatomy exam score (0\u0026ndash;100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e69.25\u0026thinsp;\u0026plusmn;\u0026thinsp;20.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e59.80\u0026thinsp;\u0026plusmn;\u0026thinsp;21.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e62.85\u0026thinsp;\u0026plusmn;\u0026thinsp;21.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.044\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNHPT duration (sec)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e18.78\u0026thinsp;\u0026plusmn;\u0026thinsp;2.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e20.06\u0026thinsp;\u0026plusmn;\u0026thinsp;3.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e19.65\u0026thinsp;\u0026plusmn;\u0026thinsp;2.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e*0.080\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eStd: Standard deviation; BMI: Body mass index; NHPT: Nine-Hole Peg Test\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eStudent's t-test was used.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e* Mann-Whitney U test was used.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eFinger length measurements indicated that males had significantly longer 2D and 4D digits compared to females (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The mean 2D:4D ratio was 0.99\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03 for females and 0.98\u0026thinsp;\u0026plusmn;\u0026thinsp;0.02 for males, a difference that was statistically significant (p\u0026thinsp;=\u0026thinsp;0.026).\u003c/p\u003e\u003cp\u003eIn terms of academic success, male students had significantly higher average practical exam scores than female students (p\u0026thinsp;=\u0026thinsp;0.044). NHPT durations were shorter in the successful group compared to the unsuccessful group, indicating better hand motor performance among higher-performing students (p\u0026thinsp;=\u0026thinsp;0.016) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of 2D:4D ratio and NHPT duration by academic performance\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnsuccessful (n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;Std\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSuccessful (n\u0026thinsp;=\u0026thinsp;54)\u003c/p\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;Std\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2D:4D ratio (Female)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e1.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e0.99\u0026thinsp;\u0026plusmn;\u0026thinsp;0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.519\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2D:4D ratio (Male)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.98\u0026thinsp;\u0026plusmn;\u0026thinsp;0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e0.98\u0026thinsp;\u0026plusmn;\u0026thinsp;0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e*0.752\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2D:4D ratio (Total)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.98\u0026thinsp;\u0026plusmn;\u0026thinsp;0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e0.99\u0026thinsp;\u0026plusmn;\u0026thinsp;0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.947\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNHPT duration (Female)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e19.56\u0026thinsp;\u0026plusmn;\u0026thinsp;2.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e18.39\u0026thinsp;\u0026plusmn;\u0026thinsp;2.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.193\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNHPT duration (Male)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e20.96\u0026thinsp;\u0026plusmn;\u0026thinsp;3.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e19.30\u0026thinsp;\u0026plusmn;\u0026thinsp;2.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e*0.048\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNHPT duration (Total)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e20.60\u0026thinsp;\u0026plusmn;\u0026thinsp;3.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e18.96\u0026thinsp;\u0026plusmn;\u0026thinsp;2.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e*0.016\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eStd: Standard deviation; NHPT: Nine-Hole Peg Test\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eStudent's t-test was used.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e* Mann-Whitney U test was used.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eRegression analysis showed a significant negative association between NHPT duration and anatomy performance (B = -1.63; p\u0026thinsp;=\u0026thinsp;0.036). Each additional second in NHPT duration was associated with a 1.63-point decrease in exam score. However, the model explained only a small portion of the variance (R\u0026sup2; = 0.048). No significant association was found between 2D:4D ratio and academic performance (p\u0026thinsp;=\u0026thinsp;0.771) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRegression analysis predicting anatomy exam performance\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"10\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eR\u0026sup2;\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAdj. R\u0026sup2;\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eModel p\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eBeta\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003et\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eCoef. p\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNHPT duration\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.048\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.037\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.538\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.036\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-1.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e-0.218\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e-2.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.036\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-3.149 to -0.110\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2D:4D ratio\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.085\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.771\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e31.674\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.031\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.292\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.771\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-183.989 to 247.337\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eHistograms of NHPT durations and anatomy scores are presented in Figs.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e3\u003c/span\u003e and \u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e4\u003c/span\u003e, respectively. A boxplot showing the distribution of 2D:4D ratios by academic success is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study explored the relationship between finger morphometry (2D:4D ratio) and hand motor performance (NHPT duration) with practical anatomy exam success among first-year medical students. Findings revealed no significant association between 2D:4D ratio and academic performance, while hand motor skills showed a significant correlation with exam success.\u003c/p\u003e\u003cp\u003eThe absence of a linear relationship between 2D:4D and academic performance aligns with the findings of Nye et al. (2012), who reported a nonlinear association dependent on gender and geography [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Similarly, G\u0026uuml;\u0026ccedil;l\u0026uuml; et al. (2021) found no significant correlation between 2D:4D and academic performance among health science students [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. While Luxen \u0026amp; Buunk (2005) reported associations between 2D:4D and cognitive abilities, such findings have not been consistently replicated and often have small effect sizes [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eConversely, the significant relationship observed between NHPT duration and anatomy exam success in our study supports previous literature indicating that fine motor skills and hand\u0026ndash;eye coordination can enhance performance in hands-on educational settings. Jebakani et al. (2017) found that students with better manual dexterity performed better in practical medical education [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Studies have shown that NHPT performance correlates with short-term task success in clinical and normative contexts [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eGiven that anatomy education requires high cognitive load and psychomotor engagement, motor skills may influence learning outcomes in addition to cognitive capabilities. Methods such as direct observation and checklist-based assessments have proven effective in promoting psychomotor competencies during anatomy instruction [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. An integrative review in undergraduate nursing education also highlighted the importance of simulation, technology-enhanced learning, and deliberate practice in improving motor performance [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis study contributes to understanding the multidimensional nature of anatomy learning and supports the inclusion of motor skill assessment in practical anatomy education.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study has several limitations. Its cross-sectional design prevents causal inference. The single-center setting and limited sample size may affect generalizability. Moreover, all measurements were performed in a single session, which may limit the assessment of individual variability.\u003c/p\u003e\u003cp\u003eFuture longitudinal and multicenter studies with larger samples are needed to explore the role of morphometric and motor predictors in academic performance. The potential use of such biomarkers in academic support programs also warrants further investigation.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study examined the relationship between finger morphometry (2D:4D ratio) and hand motor performance (NHPT duration) with anatomy practical exam success in first-year medical students. Findings demonstrated that hand motor performance was significantly associated with academic success, whereas the 2D:4D ratio was not.\u003c/p\u003e\u003cp\u003eThese results suggest that motor skills may play a critical role in student performance in practical, hands-on anatomy education. Although the predictive value of morphometric features appears limited, psychomotor skills should be considered in educational planning and student assessment.\u003c/p\u003e\u003cp\u003eFuture strategies may include the development of interventions to enhance fine motor skills and personalized educational approaches, potentially improving success in skill-based medical courses.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone declared.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Non-Interventional Clinical Research Ethics Committee of Kocaeli University Faculty of Medicine (Approval No: GOKAEK-2025/11/19, Project no: 2025/261) and was conducted in accordance with the Declaration of Helsinki. Informed consent was obtained from all participants prior to data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication: \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. This manuscript does not include any individual data, images, or details that could identify participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials: \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was supported by the Scientific and Technological Research Council of Türkiye (TÜBİTAK) under the 2209-A Research Project Support Program for University Students (Project No: 1919B012466641).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA.O. and H.Y. conceived and designed the study. A.O. supervised the overall project. Both authors collected the data and contributed to the analysis and interpretation of the findings. A.O. and H.Y. conducted the literature review and drafted the manuscript. A.O. critically revised the final version. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eTurney BW. Anatomy in a modern medical curriculum. Ann R Coll Surg Engl. 2007;89(2):104\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEstai M, Bunt S. Best teaching practices in anatomy education: A critical review. Ann Anat. 2016;208:151\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBergman EM, et al. Anatomical knowledge and its relevance for clinical practice: A review. Med Teach. 2011;33(2):91\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWaterston SW, Stewart IJ. Survey of clinicians' attitudes to the anatomical teaching and knowledge of medical students. Clin Anat. 2005;18(5):380\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eManning JT. Digit ratio: A pointer to fertility, behavior, and health. Rutgers University Press; 2002.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eH\u0026ouml;nekopp J, Watson S. Meta-analysis of digit ratio 2D:4D shows greater sex difference in the right hand. Am J Hum Biol. 2010;22(5):619\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVoracek M, Loibl LM. Scientometric analysis and bibliography of digit ratio (2D:4D) research. Psychol Rep. 2009;104(3):922\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePutz DA et al. Sex hormones and finger length: What does 2D:4D indicate? Evol Hum Behav. 2004;25(3):182\u0026ndash;99.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLuxen MF, Buunk BP. Second-to-fourth digit ratio related to verbal and numerical intelligence and the Big Five. Pers Individ Dif. 2005;39(5):959\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrosnan M. Digit ratio and academic performance. Psychol Rep. 2006;98(1):21\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMathiowetz V, et al. Adult norms for the Nine Hole Peg Test of finger dexterity. Occup Ther J Res. 1985;5(1):24\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOxford Grice K, et al. Reliability of the Nine-Hole Peg Test for finger dexterity in adults. Am J Occup Ther. 2003;57(5):570\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDesrosiers J, et al. Reliability and validity of the Nine-Hole Peg Test in people with stroke. Disabil Rehabil. 1995;17(4):217\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJebakani CF, et al. Assessment of hand function using Nine Hole Peg Test in medical students. Int J Res Med Sci. 2017;5(6):2505\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGrice KO, et al. Adult norms for a commercially available Nine Hole Peg Test for finger dexterity. Am J Occup Ther. 2003;57(5):570\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNye JVC, et al. Correction: 2D:4D Asymmetry and Gender Differences in Academic Performance. PLoS ONE. 2013;8(3):e000000.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eG\u0026uuml;\u0026ccedil;l\u0026uuml; M, Yıldız A, Demir A. Evaluation of the relationship between 2D:4D digit ratio and academic performance among health sciences students. J Contemp Med Educ. 2021;9(2):45\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFeys P, et al. The Nine-Hole Peg Test as a manual dexterity performance measure for multiple sclerosis. Mult Scler. 2017;23(5):711\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNguyen VH, Lee J, Kim S. An Introduction and Evaluation of Direct Observation with Checklist for Developing Psychomotor Skills in Surface Anatomy Education. J Anat Educ. 2025;49(2):105\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMartel M, Rose K, Johnson T. Teaching psychomotor skills in undergraduate nursing education: an integrative review. J Nurs Educ. 2024;63(7):421\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Anatomy education, Academic achievement, 2D:4D ratio, Nine-Hole Peg Test","lastPublishedDoi":"10.21203/rs.3.rs-7104950/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7104950/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThis study aimed to investigate the relationship between finger morphometric characteristics (2D:4D ratio) and hand motor skills (Nine-Hole Peg Test duration) with practical anatomy exam performance among first-year medical students.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis cross-sectional study included voluntary first-year medical students at Kocaeli University Faculty of Medicine. The lengths of the second (2D) and fourth (4D) fingers of the right hand were measured using a digital caliper, and the 2D:4D ratio was calculated. Hand motor performance was evaluated using the Nine-Hole Peg Test (NHPT). Practical anatomy exam scores were used to determine academic achievement. Students with an average score above 65 were classified as successful.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eRegression analysis showed no significant association between 2D:4D ratio and anatomy exam performance (p\u0026thinsp;=\u0026thinsp;0.771). However, there was a significant negative relationship between NHPT duration and academic performance (B = -1.63; p\u0026thinsp;=\u0026thinsp;0.036). Successful students completed the test in significantly shorter time than their peers (p\u0026thinsp;=\u0026thinsp;0.016).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eHand motor performance appears to be a significant predictor of anatomy exam success, whereas the 2D:4D ratio does not show such predictive power. These findings emphasize the importance of integrating psychomotor skills into medical education strategies.\u003c/p\u003e","manuscriptTitle":"Evaluation of the Relationship Between Finger Morphometry, Hand Motor Skills, and Practical Anatomy Exam Performance Among First-Year Medical Students","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-28 09:39:52","doi":"10.21203/rs.3.rs-7104950/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-07T04:07:52+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-06T19:19:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"147481491317130379441380081595813086492","date":"2025-10-27T15:58:08+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-13T02:07:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"253457038433477019053599434442963489520","date":"2025-08-03T19:48:52+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-24T05:08:40+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-24T05:00:30+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-21T10:22:36+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-19T09:59:32+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-07-19T09:57:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5c9c20be-dfe6-413b-bee2-0b43143008d1","owner":[],"postedDate":"July 28th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-26T16:02:46+00:00","versionOfRecord":{"articleIdentity":"rs-7104950","link":"https://doi.org/10.1186/s12909-026-08617-w","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2026-01-19 15:58:07","publishedOnDateReadable":"January 19th, 2026"},"versionCreatedAt":"2025-07-28 09:39:52","video":"","vorDoi":"10.1186/s12909-026-08617-w","vorDoiUrl":"https://doi.org/10.1186/s12909-026-08617-w","workflowStages":[]},"version":"v1","identity":"rs-7104950","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7104950","identity":"rs-7104950","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}