Medical Education in Pathology: General Concepts and Strategies for Implementation

A comparison of students' preferences for face-to-face and online laboratory sessions: insights from students' perception of their learning experiences in an immunology course

The COVID-19 global pandemic has prompted educators in universities to reconsider their teaching methods, mainly due to the social distancing measures imposed within the classroom settings. On the other hand, the growing importance of continuing education opportunities for adult learners after graduation has seen the need to transform traditional teaching modes that primarily depend on face-to-face interaction into virtual modes, which are deemed more time- and cost-efficient. These major shifts in social and economic developments have a significant impact on the evolution of curriculum planning in higher education. Education that has scientific inquiry components inevitably comes into question, as conventional beliefs that experiments should be hands-on and will not be as effective if conducted virtually cast doubts on the move to the online space. This paper discusses the background of an impending shift in a university's approach to more online-based laboratory classes in an immunology course, as well as the exploration of the potential of conducting online laboratory experiments based on student perceptions.

Investigating the learning self-efficacy of a fully online teaching environment among undergraduate Chinese medical students: a cross-sectional study

BACKGROUND

Fully online learning has become a common option in many universities worldwide in the post-COVID-19 era. The study aimed to evaluate the dimensions and characteristics of the fully online learning self-efficacy among Chinese undergraduate medical and nonmedical students.

METHODS

A cross-sectional study was conducted from January to August 2023 at Xihua University in China. A stratified cluster sampling method was used to enroll participants of undergraduate students. The Chinese version of the online learning self-efficacy scale (OLSES) was used to collect the demographic information. Cronbach's alpha coefficient, exploratory factor analyses, confirmatory factor analyses, and linear regression analyses were conducted in the study.

RESULTS

A total of 203 college students were included in the study. One hundred and twenty (59.1%) of the participants were medical students and 83 (40.9%) were nonmedical students, and most of them (64.5%) were from rural areas. The Cronbach's alpha coefficients were determined to be 0.90, 0.86, 0.87, and 0.95 for the learning in a fully online environment, time management, technology use subscales, and the whole scale, respectively. Exploratory factor analysis revealed the justifiability of factor analysis. In the confirmatory factor analysis, the majority of the goodness-of-fit indices reached an acceptable threshold (χ2/df = 3.14, RMR = 0.06, RMSEA = 0.10, NFI = 0.84, RFI = 0.80, IFI = 0.89, TLI = 0.85, CFI = 0.90). More than half of the students reported insufficient self-efficacy for learning in a fully online environment and time management, whereas 55.7% showed good self-efficacy for technology use. Although more medical students than non-medical students had higher self-efficacy scores in the three domains of self-efficacy, the proportion of students with good self-efficacy was slightly lower among medical students than non-medical students, with no significant differences between the medical students and nonmedical students.

CONCLUSIONS

Most Chinese university students' that participated to our study found self-efficacy for fully online learning as insufficient (results on the three domains, ranging from 36.5 to 55.7%) and had a good level of fully online learning self-efficacy. Medical students and nonmedical students are not differences in the self-efficacy of fully online learning. Thus, pedagogues should take measures to help students including medical and nonmedical improve their self-efficacy in online environment learning, time management and technology use, ultimately enhancing their academic success.

Extending the gift-utilizing residual human anatomical materials for training Pathologists' Assistants in surgical pathology techniques

This study investigates the effectiveness of using residual human anatomical materials, obtained from a gross anatomy course, for training Pathologists' Assistant (PathA) students in surgical pathology techniques. We utilized two surveys to assess the perceived efficacy of this approach: one survey targeted PathA students to evaluate their training experiences with both human and animal tissues, while the other assessed the impact of specimen collection on the educational experiences of gross anatomy course students.

Enhancing hematopathology peripheral blood smear education through asynchronous video material: A pilot report

This study explores the effectiveness of asynchronous video material as a supplementary educational tool for trainees in hematopathology. Traditional pedagogical methods often rely heavily on faculty involvement, potentially limiting the breadth of information trainees receive due to constraints in faculty time and the variety of cases covered in a limited time interval/rotation. Asynchronous video-based learning presents a potential solution to these challenges. This concept has been utilized effectively in various fields of medical education. In this study, we describe our implementation of an educational program utilizing asynchronous video material to supplement traditional learning methods for peripheral blood smear interpretation for learners on a hematopathology clerkship. Following a pre-test/post-test assessment with 13 trainees, we analyzed the correlation between video viewing percentage and changes in test scores. The results indicate an improvement in test scores following exposure to video content, supporting the positive impact of asynchronous video material on hematopathology education. Trainees had positive feedback regarding this new educational tool. This study suggests that such self-directed learning could enhance traditional teaching methods, ensuring broader and more consistent coverage of hematopathology concepts.

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.

An interactive e-learning module on peripheral blood smear analysis is an effective option for teaching pathology trainees

OBJECTIVES

This study compares the effectiveness of an interactive e-learning module with a traditional text-based method for teaching peripheral blood smear analysis.

METHODS

Pathology trainees at Accreditation Council for Graduate Medical Education residency programs were asked to participate. Participants completed a multiple-choice test on peripheral blood smear findings. Trainees were randomized into completing an e-learning module or a PDF reading exercise with the same educational content. Respondents rated their experience and completed a postintervention test composed of the same questions.

RESULTS

In total, 28 participants completed the study; 21 improved their score in the posttest (mean, 21.6 correct answers) compared with the pretest (19.8; P < .001). This improvement was seen in both the PDF (n = 19) and interactive (n = 9) groups, with no difference in performance between the 2 groups. Trainees with less clinical hematopathology experience showed a trend of having the largest performance improvement. Most participants completed the exercise within 1 hour, rated the exercise as easy to navigate, were engaged, and reported learning new information about peripheral blood smear analysis. All participants indicated that they would likely complete a similar exercise in the future.

CONCLUSIONS

This study suggests that e-learning is an effective tool for hematopathology education and equivalent to traditional narrative-based methods. This module could easily be incorporated into a curriculum.

Virtual Models Using Augmented Reality May Provide a Suitable Supplement, Although Not a Physical Specimen Replacement, in Pathology Education

There is a growing trend towards using virtual models within medical programs. In some disciplines, the use of human samples or cadavers is increasingly being replaced by technology-enhanced modes of delivery. Although this transition can occur with some success, the impact of virtual representations to replace depictions of disease states from dissected samples displayed in acrylic pathological specimen jars has never been investigated. This study assessed medical student perceptions of replacing teaching through physical specimens (i.e. specimen jars or real tissue) with virtual models across cardiovascular, neural, musculoskeletal, haematology, endocrine and immunological pathology curricula. Seventy-four year 2 (n = 31) and year 5 (n = 43) medical students participated in the study. After being provided with a demonstration of a potential tablet-based lesson on lung pathology using augmented reality, participants completed a Likert-scale survey and provided written feedback. Questions requested thoughts on the usefulness of the 3D-virtual model compared to physical specimens and whether current teaching in pathology could be replaced by technology-enhanced practices. Most students (58.15%) disagreed on the replacement of physical specimens with virtual models. Furthermore, over half the students (55.4%) indicated that the replacement of physical specimens with augmented reality models would not be beneficial for pathology learning. Nearly two-thirds of students believed that the absence of physical specimens would negatively impact their knowledge. Nonetheless, many students would appreciate the opportunity to revise pathology away from the labs with virtual options. As such, an overwhelming number of students (89.2%) would prefer having both physical specimens and virtual models for learning. This study identifies that technology-enhanced learning may be a suitable supplement alongside traditional hands-on teaching but should not replace the use of pathological specimens within a medical curriculum.

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.

Incorporating Mixed Reality for Knowledge Retention in Physiology, Anatomy, Pathology, and Pharmacology Interdisciplinary Education: A Randomized Controlled Trial

Disease education is a fundamental component in health science and medicine curricula, as it prepares students for their progression into health profession careers. However, this requires an ability to integrate concepts across multiple disciplines. Technology-enhanced interventions may bridge this gap, and this study assessed the effectiveness of a textbook-style or a three-dimensional mixed reality (MR, a hybrid of augmented and virtual reality) HoloLens resource for student learning and knowledge retention using asthma as a model of disease. Sixty-seven first-year undergraduate health science and medical students were randomized into two groups to complete a lesson on the physiology, anatomy, pathology, and pharmacology of asthma, delivered through either a textbook-style (n = 34) or MR (n = 33) resource. Participants took part in the study in small groups and completed the intervention and surveys in separate areas of a large laboratory space. A pre-test prior to the lesson included multiple-choice questions, with the post-test having additional multiple-choice questions to assess learning. A follow-up test to assess retention was performed two weeks later. Pre- and post-test scores revealed increased learning across both the textbook (p = 0.001) and MR (p = 0.05) interventions, although higher test results were obtained by those using the textbook-style resource (p < 0.05). There was no difference between groups in knowledge retention scores. Although the textbook-style resource was more effective for increasing test results, participants perceived MR as more favorable, highlighting the experience as enjoyable and useful. This study presents MR as an option for integration in cases where educators wish to enhance student enjoyment of the learning experience. However, the results suggest that traditional text-based resources persist as a fundamental delivery mode within a modern curriculum.

Virtual Pathology Education in Medical Schools Worldwide during the COVID-19 Pandemic: Advantages, Challenges Faced, and Perspectives

The COVID-19 pandemic shifted pathology education in medical schools worldwide towards online delivery. To achieve this goal, various innovative platforms were used by pathology educators and medical students, facilitating both synchronous and asynchronous learning. The aim of this study was to review the published evidence regarding remote pathology teaching at the medical school level during this period, present our own experience, and provide some perspectives regarding the best mode of pathology teaching post-pandemic. Among its advantages, virtual pathology education was considered among students and educators as convenient, flexible, and engaging, while learning outcomes were met and students’ academic performance was in general satisfactory. However, several challenges were faced. For instance, suboptimal internet connection compromised the flow of classes and was even associated with a lower academic performance. The lack of hands-on laboratory activities, such as operating the light microscope and tissue grossing, and the reduced student interactions among themselves and their instructors, were also pointed out as significant drawbacks of remote pathology education. Whereas online education has multiple advantages, experiencing the physical university environment, in-person interactions and teamwork, exposure to the “hidden curriculum”, and hands-on activities are vital for medical school education and future student development. In conclusion, the implementation of a blended approach in pathology education—where online and face-to-face sessions are jointly used to promote students’ engagement, interaction with their instructors and peers, and learning—could be the most optimal approach to pathology teaching in medical schools post-pandemic.

Pathology Residency Curricula

OBJECTIVES

To perform a systematic review of the published literature on pathology graduate medical education, with a focus on novel educational curricula.

METHODS

We systematically searched the PubMed and Embase databases for relevant articles published between 2000 and 2021.

RESULTS

We analyzed 612 articles and selected 19 peer-reviewed, full-length, English language articles published between 2003 and 2021 describing unique curricula for final review. Details on the general characteristics, conceptualization, design, implementation, and assessment were collected and discussed.

CONCLUSIONS

This systematic review highlights a recent increase in published curricular endeavors specifically addressing topics of educational need that are otherwise not commonly taught in traditional residency training. Curricula are diverse in their teaching methods, implementation, and originating institutions. The lack of meaningful evaluated outcomes and available curricular materials may hinder wider use of such curricula; these should be considered by future pathology educators undertaking their design.

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.