Turning Microscopy in the Medical Curriculum Digital: Experiences from The Faculty of Health and Medical Sciences at University of Copenhagen

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.

Digitization of Pathology Labs: A Review of Lessons Learned

Pathology laboratories are increasingly using digital workflows. This has the potential of increasing laboratory efficiency, but the digitization process also involves major challenges. Several reports have been published describing the individual experiences of specific laboratories with the digitization process. However, a comprehensive overview of the lessons learned is still lacking. We provide an overview of the lessons learned for different aspects of the digitization process, including digital case management, digital slide reading, and computer-aided slide reading. We also cover metrics used for monitoring performance and pitfalls and corresponding values observed in practice. The overview is intended to help pathologists, information technology decision makers, and administrators to benefit from the experiences of others and to implement the digitization process in an optimal way to make their own laboratory future-proof.

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.

An international collaborative approach to learning histology using a virtual microscope

Histology is often taught in higher education settings using online virtual microscopes (VM). This study aimed to develop and evaluate the use of VM in teaching on a BSc degree at the University of Nottingham by surveying students and staff. A key development was the use of an e-workbook so that students were actively engaged in creating their own bespoke revision material. Subsequently, this approach was used in a second study evaluating the use of VM in teaching the histology and pathology of the gastrointestinal (GI) tract via group work with students from two BSc courses at the University of Nottingham; one based at Derby (RDHC) and the other in Malaysia (UNMC). Students worked together in groups to complete an e-workbook, develop a presentation, and decide how to collaborate and communicate. An evaluation of these activities revealed advantages in developing transferrable skills, and good engagement with both the histology topic and group work. Analysis of assessment of the module at UNMC showed that student performance improved in the histology-based module after the intervention (p < 0.01) and that this improvement was not evident in other modules taken by the cohort. Furthermore, when interrogating the questions from the examination paper that asked students to identify features from histological images, fewer questions were seen as 'difficult' (p < 0.001) and more were seen as 'average' (p < 0.01). This study demonstrates that the use of VM in histology combined with active learning in creating a revision resource enhances engagement and depth of learning. When further combined with collaborative active group work, students developed a range of histology knowledge and transferrable skills, with notable improvement in examination performance relative to other contemporaneous modules.

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.

Effectiveness comparison between blended learning of histology practical in flipped physical classrooms and flipped virtual classrooms for MBBS students

BACKGROUND

The flipped classroom blended learning model has been proven effective in the teaching of undergraduate medical courses as shown by student acceptance and results. Since COVID-19 necessitated the application of online learning in Histology practical for MBBS students, the effectiveness of the blended learning model on teaching quality has required additional attention.

METHODS

A blended learning of histology practical was flipped in a virtual classroom (FVCR-BL) or in a physical classroom (FPCR-BL) in School of Medicine, Zhejiang University in China. Students were split into FVCR-BL group (n = 146) due to COVID-19 pandemic in 2020 or were randomly allocated into FPCR-BL group (n = 93) in 2021, and retrospectively, students with traditional learning in 2019 were allocated into traditional learning model in a physical classroom (PCR-TL) group (n = 89). Same learning requirements were given for 3 groups; all informative and summative scores of students were collected; a questionnaire of student satisfaction for blended learning activities were surveyed in 2021. Data of scores and scales were analyzed with Kruskal-Wallis test and Kolmogorov-Smirnov test in SPSS Statics software.

RESULTS

The results clarified that FPCR-BL students obtained higher final exam scores and were more likely to engage in face-to-face interactions with instructors than FVCR-BL students. FPCR-BL and FVCR-BL students had higher classroom quiz scores than the PCR-TL students owing to the contribution of blended learning. The results of the questionnaire showed that participants of FPCR-BL positively rated the online learning and preview test, with a cumulative percentage of 68.31%, were more satisfying than other learning activities of blended learning. There were significant correlations (r = 0.581, P < 0.05) between online learning and the other three blended learning strategies.

CONCLUSIONS

In the flipped classroom with a blended learning process of histology practical, enhancing the quality of online learning boosts student satisfaction and improves knowledge learning; peer-to-peer interactions and instructor-to-peer interactions in the physical classroom improved knowledge construction.

On the Road to Digital Pathology in Denmark-National Survey and Interviews

Digital pathology (DP) is changing pathology departments dramatically worldwide, yet globally, few departments are presently digitalized for the full diagnostic workflow. Denmark is also on the road to full digitalization countrywide, and this study aim to cover experiences during the implementation process in a national context. Thus, quantitative questionnaires were distributed to all pathology departments in Denmark (n = 13) and distributed to all professions including medical clinical directors, medical doctors (MD) and biomedical laboratory scientists (BLS). For a qualitative perspective, we interviewed four employees representing four professions. Data were collected in 2019–2020. From the questionnaire and interviews, we found strategies differed at the Danish departments with regards to ambitions, technological equipment, workflows, and involvement of type of professions. DP education was requested by personnel. Informants were in general positive toward the digital future but mainly had concerns regarding the political pressure to integrate DP before technological advances are sufficient for maintaining rational budgets, workflows, and for sustaining diagnostic quality. This study is a glance on the Danish implementation process in its early stages from personnel’s point of view. It shows the complexity when large new workflow processes are to be implemented countrywide and with a large diversity of stakeholders like managers, MD, BLS, IT-professionals, and authorities. To ensure best technological and economical solutions and to maintain—or even optimize—diagnostic quality with DP and workflow alignment, we suggest superior inter- and intradepartmental communication. When implementing DP countrywide, a national working group is warranted with the variety of stakeholders represented.

Development of a Remote Online Collaborative Medical School Pathology Curriculum with Clinical Correlations, across Several International Sites, through the Covid-19 Pandemic

INTRODUCTION

Due to the Covid-19 social distancing restrictions, in March 2020, Weill Cornell Medicine-Qatar decided to replace students' clinical instruction with novel online electives. Hence, we implemented an innovative online and remote pathology curriculum, anchored on virtual microscopy and Zoom videoconferencing: ideal tools to support online teaching.

OBJECTIVE

To assess a new curriculum implementation at Weill Cornell Medicine-Qatar.

MATERIALS AND METHODS

This for-credit, 2-week elective included 6 synchronous Zoom sessions where complex clinicopathological cases were discussed in small groups. We used open access digital microscopy slides from the University of Leeds' Virtual Pathology Library (http://www.virtualpathology.leeds.ac.uk/slides/library/). Students independently prepared for these sessions by reviewing cases, slides, readings, and questions in advance (asynchronous self-directed learning anchored on a flipped classroom model), and wrote a final review of a case. An assessment and feedback were given to each student.

RESULTS

Four elective iterations were offered to a total of 29 students, with learners and faculty spread over 4 countries. During the Zoom sessions, students controlled the digital slides and offered their own diagnoses, followed by group discussions to strengthen autonomy and confidence. We surveyed learners about the elective's performance (program evaluation). Students conveyed high levels of satisfaction about the elective's overall quality, their pathology learning and online interactions, with minimal challenges related to the remote nature of the course.

DISCUSSION AND CONCLUSIONS

Technological innovations mitigate sudden disruptions in medical education. A remote curriculum allows instruction at any distance, at any time, from anywhere, enhancing educational exchanges, flexibility and globalization in medical education.

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.

Histology and Embryology Education in China: The Current Situation and Changes Over the Past 20 Years

In mainland China, histology and embryology (HE) are taught in one course as an essential component of medical curricula. The effectiveness of HE courses directly affects the quality of medical students. To determine the present situation and changes in HE teaching in Chinese medical schools, a nationwide survey was conducted among the HE departmental leaders. In total, 66 responses were included in the study, representing prominent Chinese mainland medical schools. The results revealed that most HE teachers have medical educational backgrounds; an increasing number of teaching staff with PhDs have joined the teaching staffs. A range of 71 to 90 HE curriculum contact hours is predominant. The ratio of theory to practice for HE contact hours is 1:1 at half of the surveyed medical schools. The numbers of students in each laboratory are less than 30 and from 31 to 60 at 23 and 36 medical schools, respectively. Virtual microscopy is employed in 40% of the surveyed medical schools. Didactic teaching is the most common strategy, although new teaching approaches are being employed gradually. During the past 20 years, both the total number of HE teachers and the number of HE teachers with medical educational backgrounds have been reduced in at least half of the surveyed schools. A total of 83.33% of the surveyed schools have reduced their HE contact hours. Almost half of the Chinese medical schools remained unchanged in both their ratio of theory to practice and the number of students in each laboratory. The data derived from this study help to understand the development of the HE discipline at Chinese medical schools.

Practicing Histotechnologists Identify the Core Competencies Needed by Newly Graduated Biomedical Laboratory Scientists in Histotechnology and Histology

The universities of applied sciences in Finland offer 3.5-year courses for histotechnologists and they graduate as biomedical laboratory scientist with 12 credits in histology and histotechnology. The aim of this study was to survey practicing histotechnologists about the core competencies needed by newly graduated biomedical scientists in histology and histotechnology. The data were collected in Finland in 2015. We asked 43 participants to complete a questionnaire that comprised two background questions, five open-ended questions and 38 Likert scale questions, with the responses ranging from five (strongly agree) to one (strongly disagree), and 22 (51%) responded. They stated that the most important competencies were the principles of tissue processing (mean 4.77), embedding (4.64), laboratory safety (4.57), fixation methods (4.55), cutting by microtomy (4.55), quality control of sections (4.55), fixation methods (4.55), and principles of stains (4.36). The least important competencies were quality control of molecular pathology (2.56), interpretation of immunohistological stains (2.71), use of molecular pathology (2.89), and independent dissection (2.91). The respondents stated that there were 20 stains that newly graduated biomedical laboratory scientists needed to know. The practices involving staining emerged in the open responses and four were considered to be important: Hematoxylin-Eosin (n = 18), Periodic Acid Schiff (n = 11), Alcian Blue-Periodic Acid Schiff (n = 9), and Giemsa (n = 9). The most essential tissues to identify were the histology of the alimentary track (n = 9), skin (n = 6), and liver (n = 5). The core competencies that histotechnologists felt were important for newly graduated biomedical laboratory scientists seemed to be consistent with the current curriculum.

Virtual microscopy enhances the reliability and validity in histopathology curriculum: Practical guidelines

This article was migrated. The article was marked as recommended. Digital pathology innovation and application in medical education have paved the path for a significant shift in the advancement of the medical curriculum. The new technology of virtual microscopy is a proven reliable and valid pedagogy method for histopathology learning objectives, and assessments. The current transformation has brought educators around the globe nearer towards the goal of achieving competence in Curriculum Inventory in the medical curriculum. This paper emphasises the practical tips and guidelines for cost-effective implementation and the successful use of Virtual Microscope technology to enhance the histopathology curriculum in a medical school.

Interactive Digital Microscopy at the Center for a Cross-Continent Undergraduate Pathology Course in Mozambique

Background

Recent medical education trends encourage the use of teaching strategies that emphasize student centeredness and self-learning. In this context, the use of new educative technologies is stimulated at the Faculty of Medicine of Eduardo Mondlane University (FMUEM) in Mozambique. The Faculty of Medicine of University of Porto (FMUP) and FMUEM have a long-lasting record of collaborative work. Within this framework, both institutions embarked in a partnership, aimed to develop a blended learning course of pathology for undergraduates, shared between the two faculties and incorporating interactive digital microscopy as a central learning tool.

Methods

A core team of faculty members from both institutions identified the existing resources and previous experiences in the two faculties. The Moodle course for students from the University of Porto was the basis to implement the current project. The objective was to develop educational modules of mutual interest, designed for e-learning, followed by a voluntary student's survey conducted in FMUEM to get their perception about the process.

Results

We selected contents from the pathology curricula of FMUP and FMUEM that were of mutual interest. We next identified and produced new contents for the shared curricula. The implementation involved joint collaboration and training to prepare the new contents, together with building quizzes for self-evaluation. All the practical sessions were based on the use of interactive digital microscopy. The students have reacted enthusiastically to the incorporation of the online component that increased their performance and motivation for pathology learning. For the students in Porto, the major acquisition was the access to slides from infectious diseases as well as autopsy videos.

Conclusions

Our study indicates that students benefited from high-quality educational contents, with emphasis on digital microscopy, in a platform generated in a win-win situation for FMUP and FMUEM.