Histology education in an integrated, time-restricted medical curriculum: Academic outcomes and students' study adaptations

Validating instructional design and predicting student performance in histology education: Using machine learning via virtual microscopy

As a part of modern technological environments, virtual microscopy enriches histological learning, with support from large institutional investments. However, existing literature does not supply empirical evidence of its role in improving pedagogy. Virtual microscopy provides fresh opportunities for investigating user behavior during the histology learning process, through digitized histological slides. This study establishes how students' perceptions and user behavior data can be processed and analyzed using machine learning algorithms. These also provide predictive data called learning analytics that enable predicting students' performance and behavior favorable for academic success. This information can be interpreted and used for validating instructional designs. Data on the perceptions, performances, and user behavior of 552 students enrolled in a histology course were collected from the virtual microscope, Cytomine®. These data were analyzed using an ensemble of machine learning algorithms, the extra-tree regression method, and predictive statistics. The predictive algorithms identified the most pertinent histological slides and descriptive tags, alongside 10 types of student behavior conducive to academic success. We used these data to validate our instructional design, and align the educational purpose, learning outcomes, and evaluation methods of digitized histological slides on Cytomine®. This model also predicts students' examination scores, with an error margin of <0.5 out of 20 points. The results empirically demonstrate the value of a digital learning environment for both students and teachers of histology.

Early practice makes histology masters: The use of a formative assessment quiz to prepare histology learners for a high-stakes final examination

Assessment of learners in the anatomical sciences is a complex task as it not only tests students' fact knowledge, but also the analysis of visual information. Sometimes, novice histology learners must acquire image recognition skills of microscopic structures in a short time frame. This paper describes a strategy of offering first year dental students at the University of Michigan a short, non-grade contributing, formative assessment quiz in order to better prepare them for a high-stakes, final summative histology examination. Data collected over 7 years indicate that students, who made use of this formative assessment opportunity, performed significantly better in their summative examination than students, who did not. Especially early practice quiz users profited most. Students, who used the practice quiz until they achieved a perfect score, also had statistically higher final examination scores. Students, who did not use the practice quiz, had a significantly lower cumulative D1-year Grade Point Average (D1-GPA) than students, who did, indicating that academically weaker students often underuse supporting learning resources. In general, scores from the Dental Admission Test (DAT) were weak predictors of learning success in the DENT 510 histology course. In contrast, the D1-GPA values had a medium strength positive correlation with final histology examination scores. The major problem that was encountered with this practice quiz strategy was that many students waited until close to the day of the final examination before taking advantage of this feedback opportunity, thereby reducing its potential benefit for improving their overall learning strategy for histology.

Transforming histology students from passive lecture listeners into active lecture learners

Traditional academic lectures have long been criticized as providing a passive learning environment to students. Often, they do not capture the audience's attention, resulting in learners being distracted or bored and thereby reducing their learning efficacy. Consequently, they are being abandoned by many schools and universities as an educational modus or modified into more learner-centered experiences. This descriptive article outlines a strategy of inserting active learning PowerPoint slides into traditional histology lectures. Suggestions and advice for adding or improving existing active learning slides are being offered to readers, who are planning to modify their own lecture presentations. The author's experience of using this formative assessment strategy with different types of histology learners is also discussed.

Interprofessional socialization of first-year medical and midwifery students: effects of an ultra-brief anatomy training

BACKGROUND

Interprofessionalism is considered a key component in modern health profession education. Nevertheless, there remains ongoing debate about when and where to introduce interprofessional trainings in the curriculum. We identified anatomy, a subject commonly shared among health professionals, as a practical choice for initiating early intergroup-contact between first-year medical and midwifery students. Our study examined the effects of a four-hour block course in anatomy on interprofessional socialization and valuing, as well as long-term effects on intergroup contact.

METHODS

Based on different concepts and theories of learning, we implemented 12 interprofessional learning stations. Several measures were taken to foster group cohesion: (1) self-directed working in interprofessional tandems on authentic obstetric tasks, (2) competing with other tandems, (3) creating positive interdependencies during task completion, and (4) allowing room for networking. In a pre-post design with a three-month follow-up, we assessed the outcomes of this ultra-brief training with qualitative essays and quantitative scales.

RESULTS

After training, both groups improved in interprofessionalism scores with strong effect sizes, mean difference in ISVS-21 = 0.303 [95% CI: 0.120, 0.487], P < .001, η² = 0.171, while the scales measuring uniprofessional identity were unaffected, mean difference in MCPIS = 0.033 [95% CI: -0.236, 0.249], P = .789. A follow-up indicated that these positive short-term effects on the ISVS-21 scale diminished after 12 weeks to baseline levels, yet, positive intergroup contact was still reported. The qualitative findings revealed that, at this initial stage of their professional identity development, both medical and midwifery students considered interprofessionalism, teamwork and social competencies to be of importance for their future careers.

CONCLUSION

This study advocates for an early implementation of interprofessional learning objectives in anatomical curricula. Young health profession students are receptive to interprofessional collaboration at this initial stage of their professional identity and derive strong advantages from a concise training approach. Yet, maintaining these gains over time may require ongoing support and reinforcement, such as through longitudinal curricula. We believe that an interprofessional socialization at an early stage can help break down barriers, and help to avoid conflicts that may arise during traditional monoprofessional curricula.

Growing Medical Educators from Medical Students by Supporting Self-directing Learning Opportunities Born Out of Cadaveric Dissection

This study focuses on a subset of medical students who participated in an anatomy dissection program and undertook an additional self-directed learning (SDL) project investigating incidental findings of cadaveric pathology. The value of SDL activity is explored as a means of enhancing medical student education, particularly its student perceived value in preparing and developing them as future medical educators. It was assessed whether the project advanced student interest in medical education by analyzing their motivations for participation. The results of the study highlight the potential of SDL as an experiential learning opportunity for medical students and the role of anatomic pathology in connecting multiple domains of medical education.

Transfer of learning in histology: Insights from a longitudinal study

All anatomical educators hope that students apply past training to both similar and new tasks. This two-group longitudinal study investigated the development of such transfer of learning in a histology course. After 0, 10, and 20 sessions of the 10-week-long course, medical students completed theoretical tasks, examined histological slides trained in the course (retention task), and unfamiliar histological slides (transfer task). The results showed that students in the histology group gradually outperformed the control group in all tasks, especially in the second half of the course, η2  = 0.268 (p < 0.001). The best predictor of final transfer performance was students' retention performance after 10 sessions, β = 0.32 (p = 0.028), and theoretical knowledge after 20 sessions, β = 0.46 (p = 0.003). Results of eye tracking methodology further revealed that the histology group engaged in greater "visual activity" when solving transfer tasks, as indicated by an increase in the total fixation count, η2  = 0.103 (p = 0.014). This longitudinal study provides evidence that medical students can use what they learn in histology courses to solve unfamiliar problems but cautions that positive transfer effects develop relatively late in the course. Thus, course time and the complex relationship between theory, retention, and transfer holds critical implications for anatomical curricula seeking to foster the transfer of learning.

Designing a Shortened Preclinical Basic Science Curriculum: Expert-Derived Recommendations

PURPOSE

To generate an expert-derived list of recommendations for how medical schools should approach decisions about the placement of basic science topics within shortened preclinical curricula, which allow for early clinical immersion.

METHOD

A modified Delphi process was used to develop consensus on recommendations (March-November 2021). The authors performed semistructured interviews with national undergraduate medical education (UME) experts from institutions that previously underwent curricular reforms involving shortened preclinical curricula to elicit perspectives on how decisions were made at their institutions. The authors condensed the findings into a preliminary list of recommendations and distributed this list in 2 survey rounds to a larger group of national UME experts (from institutions that previously underwent curricular reforms or held positions of authority within national UME organizations) to gauge their level of agreement with each recommendation. Recommendations were revised based on participant comments, and those with at least 70% somewhat or strong agreement after the second survey were included in the final comprehensive list of recommendations.

RESULTS

Interviews were conducted with 9 participants and resulted in 31 preliminary recommendations that were then sent via survey to the 40 recruited participants. Seventeen/40 (42.5%) participants completed the first survey, after which 3 recommendations were removed, 5 were added, and 5 were revised based on comments-resulting in 33 recommendations. Twenty-two/38 (57.9%) participants responded to the second survey, after which all 33 recommendations met inclusion criteria. The authors removed 3 recommendations that did not directly address the curriculum reform process and consolidated the final 30 recommendations into 5 succinct, actionable takeaways.

CONCLUSIONS

This study generated 30 recommendations (summarized by the authors in 5 succinct takeaways) for medical schools designing a shortened preclinical basic science curriculum. These recommendations reinforce the importance of vertically integrating basic science instruction with explicit clinical relevance into all curricular phases.

Histology as a paradigm for a science-based learning experience: Visits by histology education spirits of past, present, and future

The term "histology" was coined a little over 200 years ago and the subject has always relied on microscopy as its defining technology. Microscopy was and still is an essential approach for the description of cellular components and their arrangements in living organisms. For more than a century and a half, histology or microanatomy has also been part of the basic science education for biomedical students. Traditionally, it has been taught in two major components, a didactic transfer of information, either in a lecture or self-learning format, and in active-learning laboratory sessions. These two modes of histology instruction conform with the dual-processing theory of learning, one being more automatic and depending mainly on rote memorization, whereas the other is analytical, requiring more advanced reasoning skills. However, these two components of histology education are not separate and independent, but rather complementary and part of a multi-step learning process that encourages a scientific analysis of visual information and involves higher-level learning skills. Conventional, as well as modern electronic instruction methods (e-learning) have been used in complementary ways to support the integrated succession of individual learning steps as outlined in this manuscript. However, as recent curricular reforms have curtailed instructional time, this traditional format of teaching histology is no longer sustainable and a reflective reassessment of the role of histology in modern biomedical education is a timely necessity.

The Michigan Histology website as an example of a free anatomical resource serving learners and educators worldwide

With anatomical education becoming a global endeavor, free online resources offered via the Internet or other electronic venues are of increasing importance for teaching and learning communities worldwide. Students and instructors from developing countries, often limited in access to modern instructional resources by infrastructural and financial constraints, are frequent users of such online learning tools. During the recent Covid-19 pandemic when all academic institutions were forced to quickly switch to a non-contact mode of teaching, free online instructional resources were often essential for continuing the educational mission. However, there are a number of obstacles and issues that need to be considered when creating and offering such learning resources. These include the type, quality, and completeness of the content, their educational purpose, access to technical and financial resources, copyright and ethical issues, and more. Educators, who plan to generate and maintain free online resources, should also be aware that such projects usually require a considerable long-term time commitment. In this article, these issues are discussed using the Michigan Histology website as an example. The discussion also addresses how e-learning resources like the Michigan Histology website supported online learning during the recent Covid-19 pandemic.

The Effect of Histology Examination Format on Medical Student Preparation and Performance: Stand-Alone Versus Integrated Examinations

Most medical schools have transitioned from discipline-based to integrated curricula. Although the adoption of integrated examinations usually accompanies this change, stand-alone practical examinations are often retained for disciplines such as gross anatomy and histology. Due to a variety of internal and external factors, faculty at the University of Cincinnati College of Medicine recently began to phase out stand-alone histology practical examinations in favor of an integrated approach to testing. The purpose of this study was to evaluate this change by (1) comparing examination performance on histology questions administered as part of stand-alone versus integrated examinations and (2) ascertaining whether students alter their approach to learning histology content based on the examination format. Data from two courses over a period ranging from 2018 to 2022 were used to evaluate these questions. Results indicated histology question performance initially dropped after being included on integrated examinations. Stratification of students by class rank revealed this change had a greater impact on lower-performing students. Longitudinal data showed that performance 2 years after the change yielded scores similar to previous standards. Despite the initial performance drop, survey results indicate students overwhelmingly prefer when histology is included on integrated examinations. Additionally, students described alterations in study approaches that align with what is known to promote better long-term retention. The results presented in this study have important implications for those at other institutions who are considering making similar changes in assessment strategies.

Perceptions of medical students towards the role of histology and embryology during curricular review

BACKGROUND

The continuous changes in the medical education to prepare medical doctors for the future requires updates in medical curriculum. However, the perspectives of the medical students are not frequently considered during the revision of the medical curriculum. In parallel with the process of defining and adjusting the medical curriculum, a large survey was performed to inquire the perspectives of the medical students at the Faculty of Medicine of the University of Porto (FMUP), Portugal, about the role of Histology and of Embryology.

METHODS

Medical students at FMUP (Portugal) completed a structured and anonymous online questionnaire about the subjects Histology and Embryology. The questionnaire was prepared using questions of previous surveys performed in Europe, including another Portuguese medical school, and additional questions that were specifically prepared to this study. The questions referred to teaching methods, clinical relevance, use of virtual (digital) microscopes and association of Histology and Embryology with other subjects of the medical curriculum.

RESULTS

Four hundred and sixty-two students participated in the study. The students in clinical years were more likely to recognise the clinical relevance of Histology (p = 0.016) and Embryology (p < 0.001). Students agree that teaching of these subjects would benefit from a clinical orientation (89% for Histology; 90% for Embryology). Students highlighted that Histology is crucial to understand Biopathology and agree (75%) that an integration of Histology with Biopathology could be considered in the medical curriculum. Most students (55%) agree that slide microscopes are more useful than virtual microscopes.

CONCLUSIONS

Our study contributes to the debate about the evolution of medical curriculum. Gathering the medical students' perceptions using large surveys such as that performed in the present study may be useful to adapt the methods of teaching which may increase the motivation of the students. In the case of Histology and Embryology at the FMUP (Portugal) providing more clinically oriented teaching may be useful to motivate the students. Students of clinical years have strong clinical perspectives of Histology and Embryology and their enrolment in teaching of Histology and Embryology can also contribute to increase motivation of younger students. Consulting and involving medical students in the development of the medical curriculum can be positive and students should be more responsible and engaged in building their own education.

Teaching Cellular Architecture: The Global Status of Histology Education

Histology or microanatomy is the science of the structure and function of tissues and organs in metazoic organisms at the cellular level. By definition, histology is dependent on a variety of microscope techniques, usually light or more recently virtual, as well as electron microscopy. Since its inception more than two centuries ago, histology has been an integral component of biomedical education, specifically for medical, dental, and veterinary students. Traditionally, histology has been taught in two sequential phases, first a didactic transfer of information to learners and secondly a laboratory segment in which students develop the skill of analyzing micrographic images. In this chapter, the authors provide an overview of how histology is currently taught in different global regions. This overview also outlines which educational strategies and technologies are used, and how the local and cultural environment influences the histology education of medical and other students in different countries and continents. Also discussed are current trends that change the teaching of this basic science subject.

Virtual Microscopy Goes Global: The Images Are Virtual and the Problems Are Real

For the last two centuries, the scholarly education of histology and pathology has been based on technology, initially on the availability of low-cost, high-quality light microscopes, and more recently on the introduction of computers and e-learning approaches to biomedical education. Consequently, virtual microscopy (VM) is replacing glass slides and the traditional light microscope as the main instruments of instruction in histology and pathology laboratories. However, as with most educational changes, there are advantages and disadvantages associated with a new technology. The use of VM for the teaching of histology and pathology requires an extensive infrastructure and the availability of computing devices to all learners, both posing a considerable financial strain on schools and students. Furthermore, there may be valid reasons for practicing healthcare professionals to maintain competency in using light microscopes. In addition, some educators may be reluctant to embrace new technologies. These are some of the reasons why the introduction of VM as an integral part of histology and pathology instruction has been globally uneven. This paper compares the teaching of histology and pathology using traditional or VM in five different countries and their adjacent regions, representing developed, as well as developing areas of the globe. We identify general and local roadblocks to the introduction of this still-emerging didactic technology and outline solutions for overcoming these barriers.