Leveraging Technology for Remote Learning in the Era of COVID-19 and Social Distancing

Online Learning for Surgical Skill in Clinical-year Medical Students: a Rapid Review

Background

Surgical skills are essential competencies in medical education. All doctors registered with the General Medical Council (GMC) are required to perform surgical tasks safely and effectively. There are no reviews specifically investigating the use of online learning in teaching surgical skills for medical students in their clinical years. The aim of this rapid review was to investigate the effectiveness and perceptions of online teaching of surgical skills for medical students in their clinical years.

Methods

A rapid review was performed of the MEDLINE and EMBASE database in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The quality of the searched articles was evaluated using the Medical Education Research Study Quality Instrument. Both observational studies and randomised controlled trials were included in the review if they met the inclusion criteria of involving medical students in their clinical years, online learning, and surgical-related skills or content.

Findings

Our search strategy yielded 140 studies. Eleven studies were included in the review equating to an analysis of 636 medical students. The results indicate that online teaching of surgical skills allows improved surgical skill acquisition, with medical students having an overall positive perception towards it.

Conclusion

This rapid review suggests that online teaching of surgical skills can be effective for medical students in their clinical years in surgical skill acquisition and positive medical student perception. Further studies with larger sample sizes are required to support the conclusions of this review.

Is Social Media Here to Stay?: Survey Results Indicate Increasing Pathologist Interest and Engagement Over Time

CONTEXT.—

Social media has become widely adopted by pathologists and other physicians for professional purposes. While engagement has likely increased over time, there remain few concrete data regarding attitudes toward its use.

OBJECTIVE.—

To assess pathologists' use of and attitudes toward social media over time.

DESIGN.—

We created a survey regarding personal and professional use of social media and circulated it via multiple channels in December 2017 and again in February 2022. Results of the 2 surveys were compared for statistically significant differences.

RESULTS.—

The 2017 survey was completed by 97 participants, and the 2022 survey by 305 participants. Respondents were predominantly female and academics, included pathologists in all age categories and all time-in-practice length. In both surveys, Twitter (now X) was the most popular platform for professional use and Facebook was the most popular for personal use. Professional barriers to social media use remained consistent between the 2 surveys, including the amount of time required. Education was seen as the main benefit of social media use in both surveys, while other benefits such as networking and increasing professional visibility were endorsed significantly less often in the second survey. While the second survey received more than 3 times as many responses as the first, several aspects of social media use (mainly demographics) remained similar during the timeframe, while other aspects (such as usage and perceived values) decreased.

CONCLUSIONS.—

Pathologists continue to find social media valuable. Barriers remain, though overall pathologists of all ages and practice settings appear receptive to using social media to further educational and other opportunities.

Pathology students' perceptions of virtual learning: A case study of students in Saudi Arabia

BACKGROUND

Pathology laboratory classes are traditionally conducted using a conventional light microscope. The Coronavirus Disease 2019 (COVID-19) pandemic and recent technological advances necessitated remote learning through online classes using virtual slides (VS) instead of glass slides (GS).

AIM

The purpose of this study was to gauge the perception of learning pathology using virtual slides (VS) as opposed to glass slides (GS) for medical students in Saudi Arabia. This study would help modify teaching methods with the advancement of the application of newer methods in online teaching.

METHODS

This two-phased study evaluated learning outcomes and perceptions in pathology online education for medical students. Using a questionnaire, Phase one analyzed second and third-year students' perceptions of the teaching methods after an online pathology course. Phase Two assessed the learning outcomes of third-year students during online practical sessions using a pretest and post-test design. Statistical data were collected using a simple additive approach. Statistical tools were used to determine the factors affecting students' perceptions.

RESULTS

The accessibility of VS at any possible time, location, or device was the most advantageous trait of virtual learning (mean = 2.94±0.9). Students agreed the least with virtual slides as the only optimal method of learning pathology (mean = 2.25±0.9). Most enjoyed the virtual lab experience (51.7%) but still prefer both laboratory-GS and virtual-VS classes (83.5%).

CONCLUSIONS

VS had the benefit of accessibility and efficiency. The acceptance of VS was significantly affected by the orientation prior to the online class. Findings showed that VS cannot completely replace GS and more aspects such as technical difficulties and prior VS experience should be explored.

COVID and cytopathology training: Impact and innovations

Graduate medical education and training in Cytopathology faced numerous unexpected challenges during the COVID-19 pandemic of 2020. It was caused by the SARS-Co-V2 coronavirus and transmitted by breathing droplets or aerosol particles containing the virus and less commonly by contact with infected surfaces and fomites. To mitigate the rapid spread of disease non-essential services were closed, surgical procedures were prioritized, and "social distancing" was implemented. These measures led to a marked decline in the volume of specimens, number of fine needle aspiration (FNA) and rapid on-site evaluation procedures performed. The trainees in Pathology were required to stay at home either entirely or partly during the early period of the pandemic. This led to re-designing of the cytopathology training program nationwide. Many innovative methods and protocols were put in place to overcome the challenges faced and adjustments made in creating the virtual training program in Cytopathology. On May 5th, 2023, the WHO declared that COVID-19 was no longer a global emergency. Regulations were lifted and healthcare services returned to pre-pandemic era. Graduate medical education and training returned to normal however many changes were incorporated into the training program moving forward. Herein the impacts and innovations that COVID-19 had on Cytopathology training are described.

A Reassessment of the Impact and Significance of Social Media to Pathology

CONTEXT

Social media (SM) use in pathology and medicine today is widespread, receives active advocacy, and is said to bring a host of benefits. In latter days, the harmful effects of SM have received attention, but they have yet been followed by greater encouragement of professionalized SM usage. SM use in medicine has seen adoption in parallel to its general ascendancy, even though the platforms are products with purposes misaligned with the practice of medicine.

OBJECTIVE

To (1) characterize premises and forces that propel professional SM platform adoption and use, and (2) examine wide-ranging literature, both medical and nonmedical, that substantiates the premises and to find counteracting perspectives and evidence.

DATA SOURCES

Review of the literature using relevant keyword searches in PubMed, Google Scholar, Dimensions, and Web of Science for articles that study/describe professional SM use in pathology and medicine. Additionally, we examined business, technology, and social sciences literature and high-quality gray literature (newspapers, books, blogs) that addressed questions in relation to the topic of professional SM adoption.

CONCLUSIONS

We identified 6 major premises as motivators of professional SM use and highlight significant counteracting factors. We conclude that the harms of professionalized SM use have not been fully considered in the medical literature and that a change in direction and the creation of new communication platforms would be beneficial.

Evolving educational landscape in pathology: a comprehensive bibliometric and visual analysis including digital teaching and learning resources

AIMS

Pathology education is a core component of medical training, and its literature is critical for refining educational modalities. We performed a cross-sectional bibliometric analysis to explore publications on pathology education, focusing on new medical education technologies.

METHODS

The analysis identified 64 pathology journals and 53 keywords. Relevant articles were collected using a web application, PaperScraper, developed to accelerate literature search. Citation data were collected from multiple sources. Descriptive statistics, with time period analysis, were performed using Microsoft Excel and visualised with Flourish Studio. Two article groups were further investigated with a bibliometric software, VOSViewer, to establish co-authorship and keyword relationships.

RESULTS

8946 citations were retrieved from 905 selected articles. Most articles were published in the last decade (447, 49.4%). The top journals were Archives of Pathology & Laboratory Medicine (184), Human Pathology (122) and the American Journal of Clinical Pathology (117). The highest number of citations was found for Human Pathology (2120), followed by Archives of Pathology & Laboratory Medicine (2098) and American Journal of Clinical Pathology (1142). Authors with different backgrounds had the greatest number of articles and citations. 12 co-authorship, 3 keyword and 8 co-citation clusters were found for the social media/online resources group, 8 co-authorship, 4 keyword and 7 co-citation clusters for the digital pathology/virtual microscopy/mobile technologies group.

CONCLUSIONS

The analysis revealed a significant increase in publications over time. The emergence of digital teaching and learning resources played a major role in this growth. Overall, these findings underscore the transformative potential of technology in pathology education.

Pivoting Continuing Professional Development During the COVID-19 Pandemic: A Narrative Scoping Review of Adaptations and Innovations

INTRODUCTION

Most formal continuing professional development (CPD) opportunities were offered in person until March 2020 when the COVID-19 pandemic disrupted traditional structures of CPD offerings. The authors explored the adaptations and innovations in CPD that were strengthened or newly created during the first 16 months of the pandemic.

METHODS

The objectives of the narrative review were to answer the following questions: (1) what types of adaptations to CPD innovations are described? and (2) what may shape future innovations in CPD? The following databases were searched: Medline, Embase, CINAHL, and ERIC to identify the literature published between March 2020 to July 2021. The authors conducted a comprehensive search by including all study types that described adaptations and/or innovations in CPD during the stated pandemic period.

RESULTS

Of the 8295 citations retrieved from databases, 191 satisfied the inclusion criteria. The authors found three categories to describe adaptations to CPD innovations: (1) creation of new online resources, (2) increased use of the existing online platforms/software to deliver CPD, and (3) use of simulation for teaching and learning. Reported advantages and disadvantages associated with these adaptations included logistical, interactional, and capacity building elements. The review identified five potential future CPD innovations: (1) empirical research on the effectiveness of virtual learning; (2) novel roles and ways of thinking; (3) learning from other disciplines beyond medicine; (4) formation of a global perspective; and (5) emerging wellness initiatives.

DISCUSSION

This review provided an overview of the adaptations and innovations that may shape the future of CPD beyond the pandemic.

The COVID-19 pandemic has impeded cytopathology practices and hindered cancer screening and management

The COVID-19 pandemic has had a global impact on the environment and economy and has affected hospital administration and patient behaviour. Since human-to-human coronavirus transmission occurs via droplets and physical contact, health care professionals are particularly vulnerable to contracting COVID-19. Many cytopathology laboratories updated their workflow, established new standard biosafety protocols, and built digital pathology or telescope platforms to mitigate these risks and deal with the shortage of health care personnel. The COVID-19 pandemic also disrupted medical education-all indoor training events, including conferences, multidisciplinary tumour boards, seminars, and microscope inspections were postponed. As a result, many laboratories now use new web-based applications and platforms to maintain educational programs and multidisciplinary tumour boards. To comply with government directives, health care facilities postponed non-emergency surgeries, reduced the number of routine medical examinations, restricted visitor numbers, and scaled back cancer screening activities, resulting in a sharp decline in cytopathology diagnoses, cancer screening specimens, and molecular testing for cancer. Subsequent misses or delays in the diagnosis and treatment of cancer were not uncommon. This review aims to provide comprehensive summaries of the consequences of the COVID-19 pandemic for cytopathology, particularly in terms of cancer diagnosis, workload, human resources, and molecular testing.

Scientific seminars in lockdown: Lessons for a post-pandemic time in defense of a permanent platform for science dissemination in the world

In an academic semester, living in social isolation and under restrictions of the pandemic, we organized weekly multidisciplinary seminars from a postgraduate course program in Curitiba, Southern Brazil, integrating students from different regions of Brazil and South America. Outstanding researchers from Brazil, Germany, France, Argentina, Mexico, Portugal, England, and United States' institutions gave seminars on chronic and infectious diseases with immunological, pharmacological, biochemical, cellular, and molecular biology point of views. The meetings were longer than traditional seminars, containing a part with scientific debate and other with a humanization or deconstruction of the researcher including trajectory, hobbies, scientific, and social thoughts. To facilitate learning and conceptualization, the seminars were available through YouTube and we applied weekly questionnaires to be answered rescuing scientific and motivational topics to give companionship and support to the students in pandemic times. Here, we are defending the creation of permanent platforms for scientific diffusion, with higher accessibility, connecting centers of different levels and giving academic excellence and opportunities for young researchers. Feedback received from participants indicates that this seminar structure can increase confidence and improve their perception of scientific processes and inspire researchers with development trajectories. We have discussed multidisciplinarity, scientific excellence, regional isolation and economic inequality, integration, humanization, and the value of science in society.

Performance in Kahoot! activities as predictive of exam performance

BACKGROUND

Game-based learning (GBL) is effective for increasing participation, creativity, and student motivation. However, the discriminative value of GBL for knowledge acquisition has not yet been proven. The aim of this study is to assess the value of Kahoot! as a discriminative tool for formative assessment in medical education in two different subjects.

METHODS

A prospective experimental study was conducted on a sample of 173 students enrolled in neuroanatomy (2021-2022). One hundred twenty-five students individually completed the Kahoot! prior to the final exam. In addition, students enrolled in human histology during two academic courses were included in the study. The control group course (2018-2019) received a traditional teaching methodology (N = 211), while Kahoot! was implemented during 2020-2021 (N = 200). All students completed similar final exams for neuroanatomy and human histology based on theory tests and image exams.

RESULTS

The correlation between the Kahoot score and the final grade was analyzed for all students enrolled in neuroanatomy who completed both exercises. The correlation between the Kahoot exercise and the theory test, image exam and final grade was significantly positive in all cases (r = 0.334 p < 0.001, r = 0.278 p = 0.002 and r = 0.355 p < 0.001, respectively). Moreover, students who completed the Kahoot! exercise obtained significantly higher grades in all parts of the exam. Regarding human histology, the theory tests, image exams and final grades were significantly higher when using Kahoot! versus the "traditional" methodology (p < 0.001, p < 0.001 and p = 0.014, respectively).

CONCLUSIONS

Our study demonstrates for the first time that Kahoot! can be used to improve and predict the final grade in medical education subjects.

Maintaining informatics training learning outcomes with a COVID-19 era shift to a fully online flipped course

The emergence of the coronavirus disease 2019 pandemic forced us to adapt our recently developed informatics training serving a variety of students as well as faculty and staff. The successful flipped classroom course series (a hybrid-format with both asynchronous online learning and in-person synchronous components) was shifted to a fully online format with the synchronous portion now held via web-based video conference. We repeated our participant survey at the end of each of the 3 one-credit courses to compare student satisfaction and learning outcomes achievement to the original offering. The responses were overall very positive again and while there were no differences in satisfaction levels for 2 of the courses, overall satisfaction was higher for the new, fully online Python Programming course. Likewise, students reported similar achievement of the learning outcomes across all courses with 1 of the 12 objectives receiving higher competency agreement in the new, fully online version. Overall, the fully online version of the course series was equally successful, if not more so, than the original version with a physical classroom session each week. Given that participants also had strong agreement with a new question that they would prefer online class meetings instead of in a classroom, even if there wasn’t a global pandemic (citing a variety of logistical reasons such as “convenience of screen sharing,” parking issues, and job-related time constraints), the fully online version of the informatics training will be retained.

Is Online Video-Based Education an Effective Method to Teach Basic Surgical Skills to Students and Surgical Trainees? A Systematic Review and Meta-analysis

BACKGROUND

Online education has been increasingly utilized over the past decades. The COVID-19 pandemic accelerated the transition of conventional face-to-face curricula to online platforms, with limited evidence for its teaching efficacy. This systematic review aims to assess the effectiveness of online video-based education compared with standard conventional education in teaching basic surgical skills to surgical trainees and students undergoing medical training.

METHODS

We performed a literature search in Embase, Medline, Cochrane CENTRAL and Scopus from inception until February 2022. Studies included were randomised controlled trials (RCTs) and observational studies. We included randomised controlled trials only for meta-analysis. The primary outcome was surgical skill proficiency. The secondary outcomes were participant perception, confidence and satisfaction. Two authors independently assessed the search results for eligibility, extracted the data and assessed the risk of bias using the Cochrane Risk of Bias tool 2. Where appropriate, we performed random effects meta-analyses of the pooled study data to calculate a standardized mean difference.

RESULTS

A total of 11 studies met the inclusion criteria totaling 715 participants; 603 were included in qualitative analysis and 380 in meta-analysis. All included studies were assessed as having a low risk of bias. The majority of studies found no significant difference between conventional and video-based education in teaching basic surgical skills, three studies found video-based education was superior and one study found conventional education was superior. There was no statistically significant difference in skill proficiency between the two groups (standardized mean difference of -0.02 (95% CI: -0.34, 0.30); p=0.90). Video-based education results in an equivalent improvement in confidence and satisfaction rates. Additional benefits of video-based education include convenience, accessibility and efficiency.

CONCLUSIONS

Basic surgical skills can be taught as effectively through online video-based education as conventional teaching methods. Online education should be utilized as an adjunct to medical curricula beyond the COVID-19 era.

Community-Based Workforce for COVID-19 Contact Tracing and Prevention Activities in New York City, July-December 2020

OBJECTIVES

High rates of hospitalization and death disproportionately affected Black, Latino, and Asian residents of New York City at the beginning of the COVID-19 pandemic. To suppress COVID-19 transmission, New York City implemented a workforce of community engagement specialists (CESs) to conduct home-based contact tracing when telephone numbers were lacking or telephone-based efforts were unsuccessful and to disseminate COVID-19 information and sanitary supplies.

MATERIALS AND METHODS

We describe the recruitment, training, and deployment of a multilingual CES workforce with diverse sociodemographic backgrounds during July-December 2020 in New York City. We developed standard operating procedures for infection control and safety measures, procured supplies and means of transportation, and developed protocols and algorithms to efficiently distribute workload.

RESULTS

From July through December 2020, 519 CESs were trained to conduct in-person contact tracing and activities in community settings, including homes, schools, and businesses, where they disseminated educational materials, face masks, hand sanitizer, and home-based specimen collection kits. During the study period, 94 704 records of people with COVID-19 and 61 246 contacts not reached by telephone-based contact tracers were referred to CESs. CESs attempted home visits or telephone calls with 84 230 people with COVID-19 and 49 303 contacts, reaching approximately 55 592 (66%) and 35 005 (71%), respectively. Other CES activities included monitoring recently arrived travelers under quarantine, eliciting contacts at point-of-care testing sites, and advising schools on school-based COVID-19 mitigation strategies.

PRACTICE IMPLICATIONS

This diverse CES workforce allowed for safe, in-person implementation of contact tracing and other prevention services for individuals and communities impacted by COVID-19. This approach prioritized equitable delivery of community-based support services and resources.

Immediate consequences and solutions used to maintain medical education during the COVID-19 pandemic for residents and medical students: a restricted review

BACKGROUND

The COVID-19 outbreak has dramatically impacted medical education, both bedside and academic teaching had to be adapted to comply with the reorganisation of care and social distancing measures.

OBJECTIVES

To overview the impact of the pandemic on medical education, including the pedagogical responses adopted and their assessment by medical students and residents.

MATERIAL AND METHODS

This restricted systematic review was performed using Rayyan QCRI, to select observational or interventional articles and field experience reports assessing the impact of the COVID-19 pandemic on medical education for medical students and residents. Study design, study population, geographical origin, use of an educational tools (including softwares and social media), their type and assessment, were recorded. For studies evaluating a specific tool the Medical Education Research Study Quality Instrument (MERSQI) was used to assess study quality.

RESULTS

The literature search identified 1480 references and 60 articles were selected. Most articles focused on residents (41/60; 69%), and half (30/60; 50%) involved surgical specialties. Online courses were the most frequently used pedagogical tool (52/60; 88%). Simulation tools were used more frequently in articles involving surgical specialties (15/29; 52%) compared with medical specialties (2/14; 12%) (p=0.01). Only four studies reported the assessment of pedagogical tools by medical students, their MERSQI scores ranged from 5.5/18 to 9.0/18.

CONCLUSION

Medical education was highly impacted by the COVID-19 pandemic particularly in surgical specialties. Online courses were the most frequently attempted solution to cope with social distancing constraints. Medical students' assessment of pedagogical tools was mostly positive, but the methodological quality of those studies was limited.

Global analysis of the COVID-19 research landscape and scientific impact

OBJECTIVES

To consider a 1-year time window of the coronavirus disease 2019 (COVID-19) crisis to integrate qualitative and quantitative data and provide an in-depth analysis of all COVID-19 publications from geographical, epidemiological and chronological perspectives.

METHODS

Publications on COVID-19 from December 1, 2019, to December 31, 2020 without document type limitations were extracted from the Web of Science database. Microsoft Excel 2016, GraphPad Prism 9, VOSviewer 1.6.15 and IBM SPSS 21.0 were used to analyze the global epidemiological publication landscape and its correlations, research hotspots around the world and the top 5 countries in terms of publications.

RESULTS

A total of 51,317 documents were analyzed in the present study. The publication trend could be divided into an increasing output stage and an explosive output stage. There were positive correlations between monthly publications, confirmed cases and deaths. Research hotspots from the whole year, from individual quarters, and from the top 5 countries with the most publications were further identified.

CONCLUSIONS

The correlation analysis of publications indicated that confirmed cases and deaths were forces driving the scientific output, reflecting the growing trend to some extent. Moreover, the hotspot analysis provided valuable information for scientists, funders, policy and decision-makers to determine what areas should be their focus when faced with public health emergencies in the future.

Practical Scientific Writing and Publishing in Anatomic Pathology

OBJECTIVES

To develop a structured, introductory curriculum in scientific writing and publishing for residents in anatomic pathology.

METHODS

We assessed the need for this curriculum by using an online questionnaire sent to anatomic pathology residents in our program and tailored content to address areas of least familiarity. The curriculum consisted of 4 virtual lectures delivered by select experts in the field. Curriculum evaluation was assessed through a postcurriculum questionnaire.

RESULTS

In total, 27 of 31 (87%) residents responded to the initial questionnaire. The major educational need was identified in the following topics: "responsibilities of a corresponding author"; "selecting a journal for publication"; "editor's approach to evaluating a manuscript"; "correspondence with editors and reviewers"; and "open access, cost and increasing exposure to manuscript." Eight residents participated in at least 3 of 4 lectures and completed the pre- and postcurriculum survey. The postcurriculum survey demonstrated statistically significant interval increases in familiarity with 7 of 18 topics, and the leading increases were noted in topics of most significant educational need.

CONCLUSIONS

Development of novel curricula is vital to the ever-changing landscape of pathology resident education. This study proposes a generalizable algorithmic approach to assessing new areas of educational need and effectively addressing them through targeted curricula.

An integrated virtual pathology education platform developed using Microsoft Power Apps and Microsoft Teams

The transition towards digital pathology and an extensive selection of video conferencing platforms have helped provide continuity to education even during the COVID-19 pandemic. Innovative approaches for pathology education, will likely persist beyond the pandemic, as they have powerful didactic potential. While there is a wide selection of software for use as educational tools, an environment to access all resources with ease is clearly lacking. In this technical note, we highlight our customized educational applications built using a low-code approach. Our applications, developed with Microsoft Power Apps, serve both educational and examination purposes and are launched using Microsoft Teams. Building applications using a low-code approach has made our applications very specific to our use and enabled daily distanced education. Combined with existing features on Teams, such as file sharing, meeting scheduling, and messaging, the applications serve as a unique and customizable pathology educational platform.

Outcomes of Remote Pathology Instruction in Student Performance and Course Evaluation

The coronavirus disease 2019 (COVID-19) pandemic has disrupted undergraduate medical education, including preclinical class-based courses, by requiring social distancing and essentially eliminating in-person teaching. The aim of this study was to compare student performance and satisfaction before and after implementation of remote instruction in a first-year introductory pathology course. Assessments (3 quizzes, 1 practical exam, and 1 final) were compared between courses given before (January 2020) and during (January 2021) the COVID-19 pandemic, in terms of mean scores, degree of difficulty, and item discrimination, both overall and across different question types. Students’ evaluations of the course (Likert scale-based) were also compared between the 2 years. Significantly higher mean scores were observed during remote instruction (compared to the prior, in-person year) on verbatim-repeated questions (94.9 ± 8.8 vs 89.4 ± 12.2; P = .002) and on questions incorporating a gross specimen image (88.4 ± 7.5 vs 84.4 ± 10.3; P = .007). The percentage of questions that were determined to be moderate/hard in degree of difficulty and good/very good in item discrimination remained similar between the 2 time periods. In the practical examination, students performed significantly better during remote instruction on questions without specimen images (96.5 ± 7.0 vs 91.2 ± 15.2; P = .004). Finally, course evaluation metrics improved, with students giving a higher mean rating value in each measured end point of course quality during the year of remote instruction. In conclusion, student performance and course satisfaction generally improved with remote instruction, suggesting that the changes implemented, and their consequences, should perhaps inform future curriculum improvements.

A Program to Improve Digital Access and Literacy Among Community Stakeholders: Cohort Study

BACKGROUND

For many research teams, the role of community stakeholders is critical. However, community stakeholders, especially those in low-income settings, are at risk of being excluded from research and community engagement initiatives during and after the COVID-19 pandemic because of the rapid transition to digital operations.

OBJECTIVE

We aimed to describe the implementation and feasibility of a program called Addressing the Digital Divide to Improve Patient-Centered Outcomes Research, which was designed to address barriers to technology use, and to examine changes in participants' perceived comfort with digital technology before and after the program.

METHODS

To promote full engagement, we worked with 20 existing community leaders to cocreate a training course on using digital technology. We assessed the frequency of technology use and comfort with technology through an adapted 8-item version of the Functional Assessment of Comfort Employing Technology Scale and used the Wilcoxon signed-rank test for survey analysis. We also conducted a focus group session with 10 participants and then performed reflective journaling and content analysis to determine emergent themes.

RESULTS

We found that the program was feasible to implement and worthwhile for participants (15/16, 94%). After the program, the participants perceived an increase in the frequency of technology use (z=2.76, P=.006). The participants reported that the program was successful because of the technology training program, but recommended that the program have a slower pace and include a helpline number that they could call with questions.

CONCLUSIONS

Future programs should consider that populations with low literacy view technology training as a core element to decreasing technology disparity. This study demonstrates that through low-cost input, community members can be provided the resources and training needed to virtually participate in research studies or community engagement initiatives.

Excellence Available Everywhere: The Virtual Pathology Grand Rounds Experience

OBJECTIVES

The goal is to describe the use of a virtual platform in the delivery of Virtual Pathology Grand Rounds (VPGR) and discuss the overall experience from the perspective of hosts, speakers, and participants.

METHODS

Zoom was a natural choice for an online format because virtual platforms had been increasingly used to conduct meetings and medical education. VPGR hosted 14 speakers on a variety of topics, including subspecialty anatomic pathology material, digital pathology, molecular pathology, and medical education.

RESULTS

There were 221 registrants and 114 participants for the first lecture, reaching a maximum of 1,268 registrants for the 12th lecture and the maximum limit of 300 participants during 3 lectures. Speakers stated that VPGR conveniently provided career-building opportunities through partnerships with host universities and remote attendance. Participants identified a lack of interpersonal communication and technical challenges as downsides.

CONCLUSIONS

VPGR serves as strong proof of concept for the feasibility and demand for high-quality, remote academic pathology talks.

Elevating Twitter-Based Journal Club Discussions by Leveraging a Voice-Based Platform: #HemepathJC Meets Clubhouse

PURPOSE OF REVIEW

Social media-based scientific journal clubs provide an opportunity to promote published literature to a broader audience and allow robust multi-disciplinary and inter-professional discussion. Hematopathology Journal Club (#HemepathJC) on Twitter has successfully conducted monthly sessions since November 2019, covering topics related to lymphoma and leukemia.

RECENT FINDINGS

To enhance connectivity, multitasking, and productivity, we present our experience of leveraging the voice-based platform Clubhouse concurrent with Twitter. The Twitter and Clubhouse partnership for #hemepathJC holds the potential to increase dissemination of scientific knowledge and further promote journal club format discussion.

The Relationship Between Dry Eye Disease and Digital Screen Use

Dry eye disease is characterized by tear film instability that can result in ocular surface damage. Patients with dry eye disease may experience ocular pain/discomfort and visual disturbances that may negatively impact quality of life. Increased use of digital screens for work, communication, and entertainment, especially during times of pandemic, may contribute to dry eye. Extensive cross-sectional studies have shown that digital screen use duration is associated with an increased risk of severe symptoms and clinical diagnosis of dry eye disease in adults. Smartphone use duration has also been found to be greater in school-age children with dry eye disease than in those without dry eye disease. A commonly accepted hypothesis for the relationship between digital screen use and dry eye disease is that digital screen use changes blinking dynamics, leading to ocular dryness. This review describes evidence that digital screen use is associated with dry eye disease, that digital device use alters blinking dynamics, and that dry eye affects mental health and work productivity in digital screen users. Helpful prevention and management strategies for dry eye disease exist for those who use digital screens.

Student Perception and the Effectiveness of Kahoot!: A Scoping Review in Histology, Anatomy, and Medical Education

The impact of the Covid-19 pandemic has presented challenges in medical education particularly, with development of online learning in a short time period. Notably there has been a significant increase in the use of digital technology applications to meet this challenge. For instance, in the first quarter of 2020 the game-based software Kahoot! reported a threefold increase in players and a fivefold increase in asynchronous learning globally. However, there is limited research into the use of game-based digital technology applications such as Kahoot! and the associated learning theories, particularly in histology, anatomy, and medical education. This scoping review explored the utilization, outcome scores, and student perceptions of learning with the application of Kahoot! in histology, anatomy, and medical education. Online databases were used to identify articles published between 2013 and 2021 from which 12 articles were included in the review. The majority of articles supported positive student outcomes including improved collaborative learning, improved knowledge of content, attendance, and participation. Minor negative aspects included increased time on task, overwhelming learning content, and distractions due to gadgets. None of the articles included a control group. The main educational theories identified were active learning followed by social and constructivism learning theory. In light of the Covid-19 pandemic a rapid and fundamental shift in how digital applications are being used in educational institutions has evolved. Further research on learning frameworks and studies with control groups is required to evaluate Kahoot! as a potentially valuable online application in histology, anatomy, and medical education.

The utility of digital pathology in improving the diagnostic skills of pathology trainees in commonly encountered pigmented cutaneous lesions during the COVID-19 pandemic: A single academic institution experience

Digital pathology has become an integral part of pathology education in recent years, particularly during the COVID-19 pandemic, for its potential utility as a teaching tool that augments the traditional 1-to-1 sign-out experience. Herein, we evaluate the utility of whole slide imaging (WSI) in reducing diagnostic errors in pigmented cutaneous lesions by pathology fellows without subspecialty training in dermatopathology. Ten cases of 4 pigmented cutaneous lesions commonly encountered by general pathologists were selected. Corresponding whole slide images were distributed to our fellows, along with two sets of online surveys, each composed of 10 multiple-choice questions with 4 answers. Identical cases were used for both surveys to minimize variability in trainees' scores depending on the perceived level of difficulty, with the second set being distributed after random shuffling. Brief image-based teaching slides as self-assessment tool were provided to trainees between each survey. Pre- and post-self-assessment scores were analyzed. 61% (17/28) and 39% (11/28) of fellows completed the first and second surveys, respectively. The mean score in the first survey was 5.2/10. The mean score in the second survey following self-assessment increased to 7.2/10. 64% (7/11) of trainees showed an improvement in their scores, with 1 trainee improving his/her score by 8 points. No fellow scored less post-self-assessment than on the initial assessment. The difference in individual scores between two surveys was statistically significant (p = 0.003). Our study demonstrates the utility of WSI-based self-assessment learning as a source of improving diagnostic skills of pathology trainees in a short period of time.

Evolution of pathology teaching for MBBS students during COVID-19 pandemic lockdown: Moving from a real to a virtual classroom

Background

The COVID-19 pandemic lockdown has forced university hospitals to forego traditional classes and embrace online teaching platforms as the sole modality of medical education. Herein, we describe our experience of shifting from the arena of a real to a virtual classroom during the lockdown phase. Materials and.

Methods

The institutional subscription of G-suite was used for creating a virtual Google classroom. Google Calendar, Google Meet, and Google Forms were used for notification of schedules, conducting theory and practical classes, and conducting assessments, respectively. The learner-centric SNAPPS model was adapted for an interactive case-based learning (CBL) program using multimedia tools. Students' perspective on online education was assessed based on their responses to a validated questionnaire.

Results

The conduction of online classes, particularly the live practical classes and the CBL program got the maximum affirmative (up to 85%) responses. Students of the same batch also performed better in a test following the online CBL (77.03% vs 73.3%, P = 0.03, paired t-test statistically significant) compared to a test before it. However, access to laptops and poor Internet connectivity were significant causes of concern for nearly 40% of students.

Conclusion

The use of virtual classroom has proved to be an efficient method for continuing teaching of Pathology to MBBS students in times of lockdown when face-to-face conventional teaching was not possible. The experience indicated that in the future a judicious mixture of traditional and online classes may be a more effective educational design for teaching Pathology to MBBS students.

Future of Education or Present Reality: MD Anderson Cancer Center Hematopathology Virtual Educational Platform under Coronavirus Disease 2019 (COVID-19) Pandemic

Context - The main focus of education in most pathology residency and subspecialty pathology fellowships is the light microscopic examination of pathology specimens. Classes with multiheaded scopes are the most popular among pathology trainees. Until recently, it was difficult to us to imagine that this educational approach could change. In the beginning of March 2020 our country faced a serious challenge, which all of us now known as coronavirus disease 2019 (COVID-19) pandemic. The rules of social distancing and work from home were applied. These types of restrictions were implemented in almost all parts of our life including work and pathology education. Objective - To share our experience in the Department of Hematopathology at The University of Texas MD Anderson Cancer Center during COVID-19 pandemic. We describe our experience in modifying our approaches to education. We show how we overcame many obstacles to learning by building one of the largest virtual hematopathology educational platforms via Cisco WebEx and using social media, in particular Twitter. These tools facilitated the learning of hematopathology by medical students, pathology trainees, and practicing pathologists from all over the world. Data Sources - During the three months of the pandemic (April, May and June 2020), we evaluated the visitors' attendance to MD Anderson Cancer Center Hematopathology Virtual Educational Platform using data collected by Cisco WebEx website. For examination of the impact of the hematopathology community on Twitter on medical education the analytic metrics obtained from Symplur LLC (www.symplur.com, 04/27/2020) were used via its Symplur Signals program. Conclusions - Our experience using the MD Anderson Hematopathology Virtual Platform showed that there is substantial, global interest and desire for virtual hematopathology education, especially during the pandemic time.

Teaching and Learning during the COVID-19 Pandemic: A Topic Modeling Study

The coronavirus disease 2019 (COVID-19) pandemic caused significant disruption to teaching and learning activities at all levels. Faculty, students, institutions, and parents have had to rapidly adapt and adopt measures to make the best use of available resources, tools and teaching strategies. While much of the online teaching pedagogies have been theoretically and practically explored to a limited extent, the scale at which these were deployed was unprecedented. This has led a large number of researchers to share challenges, solutions and knowledge gleaned during this period. The main aim of this work was to thematically model the literature related to teaching and learning during, and about, COVID-19. Abstracts and metadata of literature were extracted from Scopus, and topic modeling was used to identify the key research themes. The research encompassed diverse scientific disciplines, including social sciences, computer science, and life sciences, as well as learnings in support systems, including libraries, information technology, and mental health. The following six key themes were identified: (i) the impact of COVID-19 on higher education institutions, and challenges faced by these institutions; (ii) the use of various tools and teaching strategies employed by these institutions; (iii) the teaching and learning experience of schools and school teachers; (iv) the impact of COVID-19 on the training of healthcare workers; (v) the learnings about COVID-19, and treatment strategies from patients; and (vi) the mental health of students as a result of COVID-19 and e-learning. Regardless of the key themes, what stood out was the inequities in education as a result of the digital divide. This has had a huge impact not only in middle- and low-income nations, but also in several parts of the developed world. Several important lessons have been learned, which, no doubt, will be actively incorporated into teaching and learning practices and teacher training. Nonetheless, the full effect of these unprecedented educational adaptions on basic education, expert training, and mental health of all stakeholders is yet to be fully fathomed.

Laboratory Medicine and Pathology Education During the COVID-19 Pandemic-Lessons Learned

The rapidly spreading COVID-19 pandemic demanded immediate organizational pivots in departments of laboratory medicine and pathology, including development and implementation of severe acute respiratory syndrome coronavirus 2 diagnostics in the face of unprecedented supply chain shortages. Laboratory medicine and pathology educational programs were affected in numerous ways. Here, we overview the effects of COVID-19 on the large, academic Department of Laboratory Medicine and Pathology educational practice at Mayo Clinic, highlighting lessons learned for the post-pandemic era and planning for the possibility of a future pandemic.

A Novel "Work from Home Setup" for Telepathology Second Opinion of Oral Lesions

The advent of smartphones with high-resolution cameras has opened up new possibilities in the field of telepathology for a second opinion especially in the COVID-19 era. The aim of this study was to evaluate the intraobserver concordance of a novel “work from home setup” with conventional microscopy diagnosis taken as the gold standard. A total of 90 cases of oral biopsies diagnosed by one pathologist were photographed with a smartphone camera. The static images were transferred via Google Drive and viewed on a 40-inch LED television screen connected by an HDMI cable to a laptop by the same pathologist. A wash-off period of 4 months was provided to avoid recall bias. The intraobserver concordance of Google Drive transfer and conventional microscopy was calculated. The cases in which the conventional slide microscopy and smartphone image diagnosis (SPID) via Google Drive were concordant constituted 98.9% (89/90), and the ones with discordant diagnoses made up 1.1% (01/90). Smartphone-assisted telepathology can be useful for a second opinion. The images can be stored on a Google Drive and then downloaded to a personal computer and viewed on large-screen television to attain high levels of diagnostic accuracy.

Lessons from the impact of COVID-19 on medical educational continuity and practices

The COVID-19 crisis necessitated abrupt transition to remote learning in medical schools. We aimed to assess the impact of COVID-19 on French undergraduate students and teachers, to identify practice changes, and to evaluate successes and areas for improvement of this remote learning experience. Data from 2 online questionnaires were analyzed with 509 participants among students and 189 among teachers from Sorbonne University. Responses to multiple choice, Likert response scale, and open-ended questions were evaluated. COVID-19 had negative impact on teaching continuity. Sixty-seven percent of students were in a dropout situation, and many suffered from psychological stress, leading to set up of a psychological support unit. Although most teachers (81%) and students (72%) had limited knowledge of digital resources, distance learning was quickly implemented, with a predominant use of Zoom. The analysis of several parameters revealed that students were significantly more satisfied than teachers by remote learning. Nevertheless, both students and teachers agreed to replace classical lectures by digital media and to promote in-person teaching in small interactive groups. This paper shares tips for faculty rapidly establishing remote learning. This comparative study of the students' and teachers' points of view underlines that new medical curricula should include more digital contents. We make recommendations regarding general university organization, equipment, and curricular development for long-term implementation of digital resources with reinforced relationships between faculty and students.

The "Make Surgical Pathology Easy" project: learning Pathology through tailored digital infographics - the case for renovation of an old teaching method

The term ‘infographics’ is a blend of the two words “information” and “graphics”. Infographics can be described as ‘information visualizations’, conceived as visual translation of data including text, numbers, graphs, charts, drawings and so on. Visual representations are a fundamental part of scientific communication. They match the need to organize different pieces of information in a coherent and synthetic structure and constitute one of the most effective methods scientists rely on to divulge their findings. In particular, infographics provide an overview of key points regarding specific topics in a form that promotes quick learning and knowledge retention. They can be presented in printed or digital formats, being the latter particularly suitable for a global-scale diffusion via social media or websites.

In recent years, many pathologists have started developing digital infographics as a strategy for providing free educational contents on Facebook, Twitter or websites. In the present review, we focus on the value of digital infographics to summarize various aspects of Surgical and General Pathology. They shed light on diagnostic criteria, differentials and predictive/prognostic markers for many diseases, being a useful learning tool both for residents and practicing pathologists. In this paper, the model of infographics ideation, processing and sharing to an online audience is described and the impact of infographics on knowledge processes in Pathology is investigated.

Next-Generation Scholarship: Rebranding Hematopathology Using Twitter: The MD Anderson Experience

Hematopathologists are witnessing very exciting times, as a new era of unsurpassed technological advances is unfolding exponentially, enhancing our understanding of diseases at the genomic and molecular levels. In the evolving field of precision medicine, our contributions as hematopathologists to medical practice are of paramount importance. Social media platforms such as Twitter have helped facilitate and enrich our professional  interactions and collaborations with others in our field and in other medical disciplines leading to a more holistic approach to patient care. These platforms also have created a novel means for instantaneous dissemination of new findings and recent publications, and are proving to be increasingly useful tools that can be harnessed to expand our knowledge and amplify our presence in the medical community. In this Editorial, we share our experience as hematopathologists with Twitter, and how we leveraged this platform to boost scholarly activities within and beyond our subspecialty, and as a powerful medium for worldwide dissemination of educational material and to promote our remote teaching activities during the COVID-19 pandemic.

Virtual Pathology Elective Provides Uninterrupted Medical Education and Impactful Pathology Education During the COVID-19 Pandemic

As students do not qualify as essential health care workers, medical education faced severe disruptions during the COVID-19 pandemic including initial suspension of all in-person lectures and on-site rotations. Our Pathology Department was among the first at Northwestern to offer a completely virtual rotation with the goals of: (1) providing a comprehensive introduction to the practice of anatomic and clinical pathology, (2) emphasizing uninterrupted and continued excellence in education, and (3) minimizing exposure risk during the pandemic. The innovative 2-week curriculum incorporated diverse teaching modalities including live and recorded lectures; live and recorded video demonstrations; interactive small group discussions; interactive virtual sign-outs; and written and multimedia assignments, quizzes, and projects. The virtual elective ran from March to July 2020 with 52 total participating medical students. On post-rotation evaluations, students rated the pathology virtual elective 4.7/5.0 compared to other virtual rotations and 4.0/5.0 compared to all rotations (including in-person and virtual). Furthermore, continual improvements were made to the established framework based on rotation feedback such that curriculum content was more abundant and more favorably rated by the last cohort when compared to the first. Finally, although students identified interest in over 10 different medical specialties, all participants expressed increased interest in choosing pathology as a specialty and better understanding of pathology's role in patient care. We hope our detailed description of creating and evaluating a completely virtual elective rotation serves as a model for other departments to improve pathology education and visibility.

Perceptions of a Remote Learning Pathology Elective for Advanced Clinical Medical Students

In mid-March 2020, our institution removed most medical students from in-person clinical clerkships due to the COVID-19 pandemic. The Department of Pathology responded by transitioning a fourth-year clinical elective to an all-remote format composed of synchronous didactics, daily clinical sign-out utilizing digital microscopy, and asynchronous learning materials. Thirty-seven medical students completed 2- or 4-week anatomic pathology electives tailored to meet their career goals and allowing them to progress toward graduation. Institutional Review Board approval was granted to survey students’ perceptions of engagement in the remote learning environment. Quantitative and qualitative data were collected using a standardized school-wide end-of-rotation survey, an online survey developed by the authors, and students’ self-directed learning goals. End-of-rotation data showed the remote pathology course performed well (4.88 of possible 5) when compared to all advanced clinical clerkships (4.51, n = 156 courses), all elective rotations (4.41, n = 50 courses), and the traditional in-person pathology elective (4.73). Core strengths in the virtual environment included high educational value, flexibility of content and schedule, organization, tailoring to an individual’s learning goals, and a positive education environment. Deficits included the inability to gross surgical specimens, inadequate observation or feedback about students’ skills, and impaired social connections. Areas for improvement included requests for in-person experiences and development of themed tracks for career exploration. Many aspects of anatomic pathology appear well-suited to the remote learning environment. While the remote model may not be sufficient for students pursuing careers in pathology, it can be adapted to increase nonpathologists’ understanding of interdisciplinary clinical collaboration with pathologists.

The Implementation and Effectiveness of PathElective.com

The COVID-19 pandemic put most in-person pathology electives on-hold as departments adapted to changes in education and patient care. To address the subsequent void in pathology education, we created a free, virtual, modular, and high-quality pathology elective website. Website traffic from June 1, 2020, to October 1, 2020, was monitored using the built-in analyses on Squarespace. Twitter engagement was analyzed using Twitter analytics and the Symplur Social Graph Score. A voluntary satisfaction survey was sent to all PathElective users and results were analyzed. During this time, the site saw 25 467 unique visitors, over 34 988 visits, 181 302 page views, and 4449 subscriptions from 99 countries. Countries with the highest traffic are the United States (14 682), India (5210), and the Philippines (2195). PathElective’s Twitter social graph score increased from 63.59 to 89.3 with the addition of 1637 followers. Data from surveyed users (n = 177) show most to be pathology residents (41%). Most subscribers (89%) are committed to a career in pathology. The majority heard of the website via Twitter (55%). Almost half of those surveyed engaged with the PathTwitter community on Twitter and of those who participated, 99% found that interaction useful. In all survey questions surrounding satisfaction and usefulness, a large majority of the users were either satisfied or very satisfied. PathElective is a novel pathology elective that offers a unique opportunity to educate medical students and residents from around the globe and demonstrates high effectiveness and satisfaction among users.

Using Dynamic Virtual Microscopy to Train Pathology Residents During the Pandemic: Perspectives on Pathology Education in the Age of COVID-19

The COVID-19 pandemic has forced educational programs, including pathology residency, to move to a physically distanced learning environment. Tandem microscopic review (also known as “double-scoping”) of pathology slides is a traditional cornerstone of pathology education. However, this requires the use of a double- or multi-headed optical light microscope which is unfortunately not amenable to physical distancing. The loss of double-scoping has forced educational innovation in order to continue teaching microscopy. Digital pathology options such as whole slide imaging could be considered; however, financial constraints felt by many departments often render this option cost-prohibitive. Alternatively, a shift toward teaching via dynamic virtual microscopy offers a readily available, physically distanced, and cost-conscious alternative for pathology education. Required elements include a standard light microscope, a mounted digital camera, computers, and videoconferencing software to share a slide image with the learner(s). Through survey data, we show immediate benefits include maintaining the essence of the traditional light microscope teaching experience, and additional gains were discovered such as the ability for educators and learners to annotate images in real time, among others. Existing technology may not be initially optimized for a dynamic virtual experience, resulting in lag time with image movement, problems focusing, image quality issues, and a narrower field of view; however, these technological barriers can be overcome through hardware and software optimization. Herein, we share the experience of establishing a dynamic virtual microscopy educational system in response to the COVID-19 pandemic, utilizing readily available technology in the pathology department of a major academic medical center.

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.

The Network That Never Sleeps

This review describes how Twitter is currently used by laboratory professionals for education, research, and networking. This platform has a global audience. It enables users to post information publicly, easily, rapidly, and free of charge. The absence of hierarchies enables interactions that may not be feasible offline. Laboratory professionals teach thousands of people using text, images, polls, and videos. Academic discussion flourishes without paywalls. Published research is shared faster than ever before, articles are discussed in online journal clubs, and research collaborations are facilitated. Pathologists network globally and make new friends within and beyond their specialty. Pathology departments and residency programs showcase trainees and faculty and celebrate graduations. As users in one time zone go to bed, others who are just waking up begin to read and tweet, creating a 24/7/365 live global online conference. We encourage others to plug into the power of Twitter, the network that never sleeps.

Pushed Across the Digital Divide: COVID-19 Accelerated Pathology Training onto a New Digital Learning Curve

Bringing digital teaching materials into residency training programs has seen slow adoption, expected for many new technologies. The COVID-19 pandemic dramatically shifted the paradigm for many resident teaching modalities as institutions instituted social distancing to prevent spread of the novel coronavirus. The impact of this shift on pathology trainee education has not been well studied. We conducted an online survey of pathology trainees, program directors, and faculty to assess pre- and post-COVID-19 use of, and response to, various digital pathology modalities. Responses were solicited through both social media and directed appeals. A total of 261 respondents (112 faculty, 52 program directors, and 97 trainees) reported a dramatic and significant increase in the use of digital pathology-related education tools. A significant majority of faculty and program directors agreed that this shift had adversely affected the quality (59% and 62%, respectively) and effectiveness (66%) of their teaching. This perception was similar among learners relative to the impact on quality (59%) and effectiveness (64%) of learning. Most respondents (70%-92%) anticipate that their use of digital pathology education tools will increase or remain the same post-COVID. The global COVID-19 pandemic created a unique opportunity and challenge for pathology training programs. Digital pathology resources were accordingly readily adopted to continue supporting educational activities. The learning curve and utilization of this technology was perceived to impair the quality and effectiveness of teaching and learning. Since the use of digital tools appears poised to continue to grow post-COVID19, challenges due to impaired quality and effectiveness will need to be addressed.

Transition From a Standard to a Hybrid On-Site and Remote Anatomic Pathology Training Model During the Coronavirus Disease 2019 (COVID-19) Pandemic

CONTEXT.—

As teaching hospitals institute social distancing and defer nonemergent procedures to cope with the coronavirus disease 2019 pandemic, the need for daily on-site presence, unless necessary, has been reduced for all medical staff, including trainees. Pathology training programs must adapt to these changes to ensure overall safety without significantly compromising training and the educational mission of the institution.

OBJECTIVE.—

To describe the hybrid on-site and remote anatomic pathology training model in response to the coronavirus disease 2019 pandemic that was implemented in our pathology department and report the clinical fellows' responses to the survey about their experiences.

DESIGN.—

The hybrid model was implemented March 25, 2020. Fellows alternate weekly between working on site and working remotely. On site, fellows wear personal protective equipment and maintain social distancing. Remotely, fellows use digital pathology to review cases and supplement with online educational activities. Virtual "coffee breaks," meditation, and exercise are part of the curriculum. Online platforms, including WebEx, Google Classroom, and Canvas, are used to continue educational activities. The survey was open May 19 through June 8, 2020.

RESULTS.—

Twenty-eight of the 29 clinical fellows (96%) responded. Many of the respondents indicated substantial increase in their skill with using digital pathology and online platforms during the pandemic. The top most helpful resources were the United States and Canadian Academy of Pathology interactive microscopy courses (found very or somewhat helpful by 22 of 23 clinical fellows; 96%), ExpertPath (19 of 23; 82%), the College of American Pathologists virtual learning series (18 of 23; 78%), the World Health Organization Blue Books (16 of 23; 70%), the American Society of Cytopathology webinars (14 of 23; 61%), and our institutional digital slide collection (12 of 23; 52%).

CONCLUSIONS.—

Hybrid on-site and remote training can maximize anatomic pathology learning opportunities while maintaining the safety of trainees, hospital personnel, and the community.

Optimizing Synchronous Online Teaching Sessions: A Guide to the "New Normal" in Medical Education

In response to the COVID-19 pandemic, the medical education community was forced to transition to the virtual space seemingly overnight, with little time to prepare. As such, many medical educators are actively seeking ways to improve delivery of online content and utilize features of different technologies. This View from the APPD, informed by existing literature and author experience, was created to guide medical teachers in their transition to hosting synchronous learning sessions in the virtual space. We hope to empower medical educators with the confidence and skills needed to teach effectively from a distance.

Designing and Implementing a Virtual Anatomic Pathology Elective During the COVID-19 Pandemic

The COVID-19 pandemic transformed conventional undergraduate medical education, converting previously in-person clerkships into virtual experiences. In order to allow students to gain exposure to the field of pathology, make connections with pathologists, and provide opportunities for letters of recommendation, the authors quickly developed a Virtual Anatomic Pathology Elective at the University of Minnesota. We succeeded in developing the foundation of a Virtual Anatomic Pathology Elective that allows for the rotation to be accessible not only to our medical students but also to international medical graduates and medical students from different programs. In 1 month, we were able to create a 4-week elective that was available before the start of the 2021 residency application season. We provided students with the closest possible experience to an in-person Anatomic Pathology Elective by developing an introductory week of lectures and assignments that provided structure for the rotation, introduced the field of anatomic pathology, and demonstrated the role of pathologists in health care. Furthermore, students attended virtual resident lectures and grand rounds, participated in virtual sign-out sessions, and presented an interesting case to the faculty at the end of their rotation. The goal was ultimately to customize the curriculum to students' interests by making the rotation applicable to those applying to pathology as well as to other specialties (eg, general surgery, internal medicine, dermatology). Overall, we were able to design and implement a novel Virtual Anatomic Pathology Elective which we know can be effectively reproduced by other medical schools.

Histopathology during the COVID-19 pandemic: resilience through adaptation and innovation

Histopathology departments have adapted to the challenges posed by the COVID-19 pandemic by a variety of changes including working pattern alterations, technology adoptions and incorporation of techniques. This article summarizes these adaptations and provides references to guide pathologists through the continuing pandemic.