Teaching Veterinary Histopathology: A Comparison of Microscopy and Digital Slides

The increasing inclusion of technologies in histology teaching: A systematic review

Histology is part of the curricular base of all health courses, being the basis for understanding the composition of all tissues in the human body. Over the years, more and more technologies have entered the academic environment, with the aim of improving the teaching and learning process. Thus, the objective of this work was to conduct a systematic review on the use of digital technologies in teaching histology. The PICo strategy was used to develop the guiding question and the results were presented in a Prisma Flow. The following platforms were used to search for articles: PubMed, Embase. Web of Science, Science Direct, Medline, Scielo, Periódicos CAPES and LILACS, Open Gray and Google Scholar, with a time limit between 2012 and 2022. The results showed that this area is still little explored, with there not being a wide range of technologies being used and applied in teaching, with gamification and virtual microscopy being the most applied. However, it was realized that the use of these technologies can improve student performance and increase their interest in the subject. Therefore, these tools are great methods to reduce difficulties and encourage the development of a more receptive environment for the histology teaching and learning process.

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.

Digital Cytology in Veterinary Education: A Comprehensive Survey of Its Application and Perception among Undergraduate and Postgraduate Students

The COVID-19 pandemic accelerated technological changes in veterinary education, particularly in clinical pathology and anatomic pathology courses transitioning from traditional methods to digital pathology (DP). This study evaluates the personal effectiveness and satisfaction, as well as the advantages and disadvantages, of DP, in particular digital cytology (DC), as a teaching method among European veterinary students, both at the undergraduate and postgraduate level, who attended digital pathology courses during and before the pandemic. A further aim is to discuss the differences between the two student groups. A Google Form survey consisting of 11 multiple-choice questions was emailed to pathology teachers and distributed to their students. Results indicated that undergraduate students showed greater digital pathology training, favouring DC as the most effective learning modality. In contrast, postgraduate students reported less digital slide training, and their preference for learning cytology was split between DC alone and DC integrated with traditional microscopy. All students experienced whole slide imaging for learning cytology slides prevalently, and they stated that DC enhanced their learning experience. While DC demonstrates personal effectiveness and satisfaction as a teaching method, it is important to not replace pathology training with light microscopy completely, as almost a third of the students indicated.

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.

Effect of Romanowsky-Stained Concentrated Preparations versus Direct Smears on Veterinary Students' Ability to Identify Bacterial Sepsis in Fluid Cytology Samples from Dogs, Cats, and Horses

Veterinary students' accuracy, confidence, and time required to diagnose bacterial sepsis in fluid cytology samples was evaluated using two different slide preparation methods: direct smears and cytocentrifuged concentrated preparations. We hypothesized veterinary students would diagnose fluids as septic on concentrated preparations more accurately and quickly than on direct smears. Thirty third- and fourth-year students who had previously participated in a clinical pathology course completed a survey regarding general cytology experience and reviewed 40 randomized Romanowsky-stained slides via microscopy. Slides consisted of 10 septic and 10 non-septic samples with matched direct and concentrated slides, prepared from fluids from dogs, cats, and a horse. Participants' slide evaluation time, diagnosis, confidence, and slide photographs of areas considered septic were recorded. No difference in diagnostic accuracy between direct and concentrated samples was identified (area under the curve: 57% for both preparations, p = 0.77), although students agreed with pathologist-determined diagnoses more often when viewing concentrated samples (M = 63%, SD = 11% for concentrated; M = 56%, SD = 21% for direct, p = .012). A positive relationship existed between accuracy of diagnosis (R² = .59) and senior status (p = .002), comfort interpreting cytology slides (p < .03), and if the student had taken the senior pathology rotation (p = .02). Only 38% (121/319) of participant photographs correctly identified sepsis. Under experimental conditions, concentrated preparations did not increase the accuracy of veterinary students' bacterial sepsis diagnosis; however, since accuracy did increase with cytology experience and comfort level, additional pre-clinical and clinical cytology training may benefit students before entering practice.

Identification of histological threshold concepts in health sciences curricula: Students' perception

Students' metacognitive skills and perceptions are considered important variables for high-quality learning. In this study, students' perceptions were used to identify histological threshold concepts (integrative, irreversible, transformative, and troublesome) in three health sciences curricula. A specific questionnaire was developed and validated to characterize students' perceptions of histological threshold concepts. A sample of 410 undergraduate students enrolled in the dentistry, medicine, and pharmacy degree programs participated in the study. Concepts assessed in the study were clustered to ten categories (factors) by exploratory and confirmatory factor analysis. Concepts linked to tissue organization and tissue functional states received the highest scores from students in all degree programs, suggesting that the process of learning histology requires the integration of both static concepts related to the constituent elements of tissues and dynamic concepts such as stem cells as a tissue renewal substrate, or the euplasic, proplasic and retroplasic states of tissues. The complexity of integrating static and dynamic concepts may pose a challenging barrier to the comprehension of histology. In addition, several differences were detected among the students in different degree programs. Dentistry students more often perceived morphostructural concepts as threshold concepts, whereas medical students highlighted concepts related to two-dimensional microscopic identification. Lastly, pharmacy students identified concepts related to tissue general activity as critical for the comprehension and learning of histology. The identification of threshold concepts through students' perceptions is potentially useful to improve the teaching and learning process in health sciences curricula.

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.

Implementing Digital Pathology into Veterinary Academics and Research

The advantages of digital pathology (DP) have been recognized as early as 1963, but only within the last decade or so have the advancements of slide scanners and viewing software made the use and implementation of DP feasible in the classroom and in research. Several factors must be considered prior to undertaking the project of implementing the DP workflow in any setting, but particularly in an academic environment. Sustained and open dialogue with information technology (IT) is critical to the success of this enterprise. In addition to IT, there is a multitude of criteria to consider when determining the best hardware and software to purchase to support the project. The goals and limitations of the laboratory and the requirements of its users (students, instructors, and researchers) will ultimately direct these decisions. The objectives of this article are to provide an overview of the opportunities and challenges associated with the integration of DP in education and research, to highlight some important IT considerations, and to discuss some of the requirements and functionalities of some hardware and software options.

Evaluation of a Probability-Based Predictive Tool on Pathologist Agreement Using Urinary Bladder as a Pilot Tissue

Simple Summary

There is a common joke in pathology—put three pathologists in a room and you will obtain three different answers. This saying comes from the fact that pathology can be subjective; pathologists’ diagnoses can be influenced by many different biases, and pathologists are also influenced by the presence or absence of animal information and medical history. Compared to pathology, statistics is a much more objective field. This study aimed to develop a probability-based tool using statistics obtained by analyzing 338 histopathology slides of canine and feline urinary bladders, then see if the tool affected agreement between the test pathologists. Four pathologists diagnosed 25 canine and feline bladder slides and they conducted this three times: without animal and clinical information, then with this information, and finally using the probability tool. Results showed large differences in the pathologists’ interpretation of bladder slides, with kappa agreement values (low value for digital slide images, high value for glass slides) of 7–37% without any animal or clinical information, 23–37% with animal signalment and history, and 31–42% when our probability tool was used. This study provides a starting point for the use of probability-based tools in standardizing pathologist agreement in veterinary pathology.

Abstract

Inter-pathologist variation is widely recognized across human and veterinary pathology and is often compounded by missing animal or clinical information on pathology submission forms. Variation in pathologist threshold levels of resident inflammatory cells in the tissue of interest can further decrease inter-pathologist agreement. This study applied a predictive modeling tool to bladder histology slides that were assessed by four pathologists: first without animal and clinical information, then with this information, and finally using the predictive tool. All three assessments were performed twice, using digital whole-slide images (WSI) and then glass slides. Results showed marked variation in pathologists’ interpretation of bladder slides, with kappa agreement values of 7–37% without any animal or clinical information, 23–37% with animal signalment and history, and 31–42% when our predictive tool was applied, for digital WSI and glass slides. The concurrence of test pathologists to the reference diagnosis was 60% overall. This study provides a starting point for the use of predictive modeling in standardizing pathologist agreement in veterinary pathology. It also highlights the importance of high-quality whole-slide imaging to limit the effect of digitization on inter-pathologist agreement and the benefit of continued standardization of tissue assessment in veterinary pathology.

Evaluation of the COVID-19 Lockdown-Adapted Online Methodology for the Cytology and Histology Course as Part of the Degree in Veterinary Medicine

The COVID-19 pandemic and lockdown brought numerous teaching challenges requiring innovative approaches to teaching and learning, including novel modes of content delivery, virtual classrooms, and online assessment schemes. The aim of this study is to describe and assess the efficacy of the methods implemented at the University of León (Spain) to adapt to lockdowns in the context of the Cytology and Histology (CH) course for veterinary medicine undergraduate students. To evaluate the success of lockdown-adapted methodologies, we used inferential statistical analysis to compare the academic outcomes of two cohorts: 2018–2019 (traditional face-to-face—presential—learning and evaluation) and 2019–2020 (some face-to-face and some online lockdown-adapted learning and online lockdown-adapted evaluation). This analysis considered scores in both theoretical and practical exams and students’ final subject score. We also evaluated the number of logs onto the Moodle platform throughout the 2019–2020 period, as well as performing a student satisfaction survey in both courses. The use of explanatory pre-recorded lectures, continuous online self-assessment tests, and virtual microscopy (VM) may have produced significant improvements in the acquisition of histology competencies among students in the lockdown cohort. However, we need to implement further strategies to improve the assessment of students’ true level of knowledge acquisition. According to the student feedback, VM is a well-accepted resource that is perceived as a flexible and enjoyable tool to use. However, while students found that the resource enhances their ability to learn about microscopic structures, they felt that it should not completely replace optical microscopy.

Survey of Institutional Teaching Approaches to Clinical-Year Clinical Pathology Instruction and Comparison with Prior Survey Results

Teaching approaches to veterinary clinical pathology in the final (clinical) year of veterinary school are often different than those for other specialties. Anecdotally, many schools teach these rotations separately from the routine diagnostic service, but minimal published data are available on this topic or on approaches to teaching and assessment in these rotations. An online survey of 69 veterinary institutions around the world was conducted in 2019. A total of 30 completed surveys were received from 10 countries; 22 completed responses were from North American institutions (73.3%). Survey question categories included information on basic rotations, including microscopy format, personnel involved in instruction, and assessment methods; information on advanced rotations; and challenges and successes with clinical pathology instruction. Data were analyzed and, when appropriate, compared with results from a similar survey conducted in 1997. Formats and content varied greatly among institutions. Several shifts in teaching strategies and rotation format over time were found since the 1997 survey, including increased use of projection microscopy and decreased use of multiheaded microscopy in 2019. More teaching by medical technologists and residents, less teaching by faculty, and a significant increase in the number of students per rotation were seen in 2019 compared with 1997. Several free-text comments referred to challenges related to increasing class size. These data and the comparison with the prior survey highlight common challenges and potential solutions to final-year clinical pathology instruction. Creation of specific, measurable objectives for clinical pathology competence may aid future development and refinement of clinical pathology teaching.

A Web-Based Virtual Microscopy Platform for Improving Academic Performance in Histology and Pathology Laboratory Courses: A Pilot Study

Virtual microscopy (VM) has been utilized to improve students' learning experience in microscope laboratory sessions, but minimal attention has been given to determining how to use VM more effectively. The study examined the influence of VM on academic performance and teacher and student perceptions and compared laboratory test scores before and after VM incorporation. A total of 662 third-year students studying histology and 651 fourth-year students studying pathology were divided into two groups. The light microscopy (LM) group used a light microscope in 2014 and 2015, while the LM + VM group used the VM platform and a light microscope in 2016 and 2017. Four factors positively predict laboratory scores (R square, 0.323; P < 0.001): (i) the pathology course and test-enhanced learning, (ii) the VM platform and experience, (iii) medical students and lecture scores, and (iv) female students. The LM + VM group exhibited less score variability on laboratory examinations relative to their mean than the LM group. The LM + VM group was also associated with fewer failing grades (F grade; odds ratio, 0.336; P < 0.001) and higher scores (A grade; odds ratio, 2.084; P < 0.001) after controlling for sex, school, course, and lecture grades. The positive effect of the VM platform on laboratory test grades was associated with prior experience using the VM platform and was synergistic with more interim tests. Both teachers and students agreed that the VM platform enhanced laboratory learning. The incorporation of the VM platform in the context of test-enhanced learning may help more students to master microscopic laboratory content.

Virtual Microscopy Is More Effective Than Conventional Microscopy for Teaching Cytology to Veterinary Students: A Randomized Controlled Trial

Virtual microscopy (VM) using scanned slides and imaging software is increasingly used in medical curricula alongside instruction in conventional microscopy (CM). Limited reports suggest that VM is useful in the veterinary education setting, and generally well-received by students. Whether students can apply knowledge gained through VM to practical use is unknown. Our objective was to determine whether instruction using VM, compared to CM, is a successful method of training veterinary students for the application of cytology in practice (i.e., using light microscopes). Seventy-one veterinary students from Colorado State University who attended a voluntary 3-hour cytology workshop were randomized to receive the same instruction with either VM (n = 35) or CM (n = 36). We compared these students to a control group (n = 22) of students who did not attend a workshop. All students took a post-workshop assessment involving the interpretation of four cases on glass slides with CM, designed to simulate the use of cytology in general practice. Students also took an 18-question survey related to the effectiveness of the workshop, providing their opinions on cytology instruction in the curriculum and their learning preference (VM or CM). The mean assessment score of the VM group (14.18 points) was significantly higher than the control group (11.33 points, p = .003), whereas the mean of the CM group (12.77 points) was not statistically significantly different from controls (p = .170). Not only is VM an effective method of teaching cytology to veterinary students that can be translated to a real-world case scenario, but it outperformed CM instruction in this study.

From Scope to Screen: The Evolution of Histology Education

Histology, the branch of anatomy also known as microscopic anatomy, is the study of the structure and function of the body's tissues. To gain an understanding of the tissues of the body is to learn the foundational underpinnings of anatomy and achieve a deeper, more intimate insight into how the body is constructed, functions, and undergoes pathological change. Histology, therefore, is an integral element of basic science education within today's medical curricula. Its development as a discipline is inextricably linked to the evolution of the technology that allows us to visualize it. This chapter takes us on the journey through the past, present, and future of histology and its education; from technologies grounded in ancient understanding and control of the properties of light, to the ingenuity of crafting glass lenses that led to the construction of the first microscopes; traversing the second revolution in histology through the development of modern histological techniques and methods of digital and virtual microscopy, which allows learners to visualize histology anywhere, at any time; to the future of histology that allows flexible self-directed learning through social media, live-streaming, and virtual reality as a result of the powerful smart technologies we all carry around in our pockets. But, is our continuous pursuit of technological advancement projecting us towards a dystopian world where machines with artificial intelligence learn how to read histological slides and diagnose the diseases in the very humans that built them?

Optical Versus Virtual Microscope for Medical Education: A Systematic Review

Many technological innovations have changed the traditional practice of medical education and clinical practice. Whole slide imaging (WSI) technology provided an unique way of viewing conventional glass slides in histology and pathology laboratories. The WSI technology digitalized glass slide images and made them readily accessible via the Internet using tablets or computers. Users utilized the pan-and-zoom function to view digital images of slides, also referred to as the virtual microscope (VM), simulating use of an optical microscope (OM). Several articles have reported various outcomes on the utility of VM in teaching laboratories. Recently, the Royal College of Physicians and Surgeons of Canada certification examinations for anatomical pathologists ha completely adopted VM for the national licensing examination. To better inform medical educators, there is an urgent need for more structured reviews to draw evidence-based conclusions on the effectiveness of VM and learner's perceptions, in comparison to OM. The current study provides a descriptive summary of published outcomes using the systematic review approach. In conclusion, medical students' performance was improved with adoption of VM into the curriculum and recognized as a preferred learning modality, compared to OM. On the contrary, resident learners' performance was comparable between using OM and VM, with OM being the favored slide-viewing modality.

Virtual Microscopy in Histopathology Training: Changing Student Attitudes in 3 Successive Academic Years

Several veterinary faculties have integrated virtual microscopy into their curricula in recent years to improve and refine their teaching techniques. The many advantages of this recent technology are described in the literature, including remote access and an equal and constant slide quality for all students. However, no study has analyzed the change of perception toward virtual microscopy at different time points of students' academic educations. In the present study, veterinary students in 3 academic years were asked for their perspectives and attitudes toward virtual microscopy and conventional light microscopy. Third-, fourth-, and fifth-year veterinary students filled out a questionnaire with 12 questions. The answers revealed that virtual microscopy was overall well accepted by students of all academic years. Most students even suggested that virtual microscopy be implemented more extensively as the modality for final histopathology examinations. Nevertheless, training in the use of light microscopy and associated skills was surprisingly well appreciated. Regardless of their academic year, most students considered these skills important and necessary, and they felt that light microscopy should not be completely replaced. The reasons for this view differed depending on academic year, as the perceived main disadvantage of virtual microscopy varied. Third-year students feared that they would not acquire sufficient light microscopy skills. Fifth-year students considered technical difficulties (i.e., insufficient transmission speed) to be the main disadvantage of this newer teaching modality.

RecutClub.com: An Open Source, Whole Slide Image-based Pathology Education System

BACKGROUND

Our institution's pathology unknown conferences provide educational cases for our residents. However, the cases have not been previously available digitally, have not been collated for postconference review, and were not accessible to a wider audience. Our objective was to create an inexpensive whole slide image (WSI) education suite to address these limitations and improve the education of pathology trainees.

MATERIALS AND METHODS

We surveyed residents regarding their preference between four unique WSI systems. We then scanned weekly unknown conference cases and study set cases and uploaded them to our custom built WSI viewer located at RecutClub.com. We measured site utilization and conference participation.

RESULTS

Residents preferred our OpenLayers WSI implementation to Ventana Virtuoso, Google Maps API, and OpenSlide. Over 16 months, we uploaded 1366 cases from 77 conferences and ten study sets, occupying 793.5 GB of cloud storage. Based on resident evaluations, the interface was easy to use and demonstrated minimal latency. Residents are able to review cases from home and from their mobile devices. Worldwide, 955 unique IP addresses from 52 countries have viewed cases in our site.

CONCLUSIONS

We implemented a low-cost, publicly available repository of WSI slides for resident education. Our trainees are very satisfied with the freedom to preview either the glass slides or WSI and review the WSI postconference. Both local users and worldwide users actively and repeatedly view cases in our study set.