Transition to Effective Online Anatomical Sciences Teaching and Assessments in the Pandemic Era of COVID-19 Should be Evidence-Based

The world has changed rapidly since the emergence of the COVID-19 pandemic, and the education community has not been immune to these changes. With abrupt school closings and a rapid transition to online teaching and learning, the educational technologies have been stretched to their limits and pedagogic approaches blossomed. As the world strives to reestablish normalcy, it will be under the influence of the long-lasting impact of the pandemic. This manuscript provides recommendations for the online conversion of anatomical sciences curricula in health sciences programs. Strategic guidelines are emerging for building on these changes to enhance teaching and learning in the current pandemic era.

Voice in Digital Education: The Impact of Instructor's Perceived Age and Gender on Student Learning and Evaluation

Instructor evaluations are influenced by implicit age and gender bias, with lower ratings and negative feedback given to instructors believed to stray from stereotypical age and gender norms. Female instructors exhibiting typically male-associated qualities such as leadership and authority, are often negatively impacted. Implicit bias also influences evaluation of digital resources and instructors, regardless of students' positive learning outcomes. As digital learning resources become the norm in education, it is crucial to explore the impact of implicit bias at various educational levels. In this study, undergraduate and graduate students were randomly exposed to one of five digital tutorials; four experimental tutorials presenting identical anatomy content with narrators of different gender and age, and a control tutorial featuring origami (paper folding) instructions without audio. Learning outcomes were measured by pre-quiz vs. post-quiz comparisons using repeated measures MANOVA. Implicit bias was analyzed by evaluation response comparisons using repeated measures MANOVA and three-way MANOVA. Post-quiz scores increased significantly in the four experimental groups (P < 0.05) but not in the control (P = 0.99). The increased performance was not statistically different across the four experimental groups (P > 0.26), suggesting that learning occurred irrespective of the instructor gender and age. Students' evaluations were consistently higher for the experimental resources than the control. There was no significant difference in evaluations across the four experimental groups but compared to the control, younger male and younger female narrators received significantly higher ratings for approachability, acceptance, inclusivity, and care for student learning. The study highlights important considerations for digital resources development and interpretation of student evaluations.

An Expert Derived Feedforward Histology Module Improves Pattern Recognition Efficiency in Novice Students

Histology is a visually oriented, foundational anatomical sciences subject in professional health curricula that has seen a dramatic reduction in educational contact hours and an increase in content migration to a digital platform. While the digital migration of histology laboratories has transformed histology education, few studies have shown the impact of this change on visual literacy development, a critical competency in histology. The objective of this study was to assess whether providing a video clip of an expert's gaze while completing leukocyte identification tasks would increase the efficiency and performance of novices completing similar identification tasks. In a randomized study, one group of novices (n = 9) was provided with training materials that included expert eye gaze, while the other group (n = 12) was provided training materials with identical content, but without the expert eye gaze. Eye movement parameters including fixation rate and total scan path distance, and performance measures including time-to-task-completion and accuracy, were collected during an identification task assessment. Compared to the control group, the average fixation duration was 13.2% higher (P < 0.02) and scan path distance was 35.0% shorter in the experimental group (P = 0.14). Analysis of task performance measures revealed no significant difference between the groups. These preliminary results suggest a more efficient search performed by the experimental group, indicating the potential efficacy of training using an expert's gaze to enhance visual literacy development. With further investigation, such feedforward enhanced training methods could be utilized for histology and other visually oriented subjects.

A Guide to Competencies, Educational Goals, and Learning Objectives for Teaching Medical Histology in an Undergraduate Medical Education Setting

Horizontal and vertical integration within medical school curricula, truncated contact hours available to teach basic biomedical sciences, and diverse assessment methods have left histology educators searching for an answer to a fundamental question-what ensures competency for medical students in histology upon completion of medical school? The Liaison Committee for Medical Education (LCME) and the Commission on Osteopathic College Accreditation (COCA) advocate faculty to provide medical students with a list of learning objectives prior to any educational activities, regardless of pedagogy. It is encouraged that the learning objectives are constructed using higher-order and measurable action verbs to ensure student-centered learning and assessment. A survey of the literature indicates that there is paucity of knowledge about competencies, goals, and learning objectives appropriate for histology education in preclinical years. To address this challenge, an interactive online taskforce, comprising faculty from across the United States, was assembled. The outcome of this project was a desired set of competencies for medical students in histology with educational goals and learning objectives to achieve them.

The virtual microscopy database-sharing digital microscope images for research and education

Over the last 20 years, virtual microscopy has become the predominant modus of teaching the structural organization of cells, tissues, and organs, replacing the use of optical microscopes and glass slides in a traditional histology or pathology laboratory setting. Although virtual microscopy image files can easily be duplicated, creating them requires not only quality histological glass slides but also an expensive whole slide microscopic scanner and massive data storage devices. These resources are not available to all educators and researchers, especially at new institutions in developing countries. This leaves many schools without access to virtual microscopy resources. The Virtual Microscopy Database (VMD) is a new resource established to address this problem. It is a virtual image file-sharing website that allows researchers and educators easy access to a large repository of virtual histology and pathology image files. With the support from the American Association of Anatomists (Bethesda, MD) and MBF Bioscience Inc. (Williston, VT), registration and use of the VMD are currently free of charge. However, the VMD site is restricted to faculty and staff of research and educational institutions. Virtual Microscopy Database users can upload their own collection of virtual slide files, as well as view and download image files for their own non-profit educational and research purposes that have been deposited by other VMD clients. Anat Sci Educ 11: 510-515. © 2018 American Association of Anatomists.

Dissecting the voice: Health professions students' perceptions of instructor age and gender in an online environment and the impact on evaluations for faculty

Gender and age bias is well-documented in academia with many studies demonstrating bias in students' evaluations of instructors. Failure of an instructor to meet gender or age-based expectations can translate to lower scores or negative comments on evaluations. While there is some evidence of bias in students' evaluations of online instructors, current studies have not fully examined the relationship between bias and instructor vocal characteristics. First-year dental students at two institutions were randomly assigned one of four videos on spinal cord anatomy to view. Videos contained identical content but were narrated by individuals of different gender and age (younger man, younger woman, older man, older woman). Students completed a content-based prequiz, watched the video, completed a postquiz, and answered a questionnaire evaluating the video and instructor. Students at Institution A rated the younger man and younger woman highest for nearly every evaluation category. At Institution B students rated the older man and younger woman highest. Results reveal that the older woman's voice received the lowest rankings for nearly every question in both samples. This report confirms the presence of gender and age bias in student evaluations of instructors in an online environment and demonstrates that bias may surface in response to vocal characteristics. Bias may impact older women more significantly than other groups. Differences in results from Institution A and Institution B suggest that factors affecting student perceptions of instructors, and the roles that gender and age bias may play in student evaluations, are complex and may be contextual. Anat Sci Educ 9: 537-544. © 2016 American Association of Anatomists.

Embryology and histology education in North American dental schools: the Basic Science Survey Series

As part of the Basic Science Survey Series (BSSS) for Dentistry, members of the American Dental Education Association (ADEA) Anatomical Sciences Section surveyed faculty members teaching embryology and histology courses at North American dental schools. The survey was designed to assess, among other things, curriculum content, utilization of laboratories, use of computer-assisted instruction (CAI), and recent curricular changes. Responses were received from fifty-nine (88.1 percent) of the sixty-seven U.S. and Canadian dental schools. Findings suggest the following: 1) a trend toward combining courses is evident, though the integration was predominantly discipline-based; 2) embryology is rarely taught as a stand-alone course, as content is often covered in gross anatomy, oral histology, and/or in an integrated curriculum; 3) the number of contact hours in histology is decreasing; 4) a trend toward reduction in formal laboratory sessions, particularly in embryology, is ongoing; and 5) use of CAI tools, including virtual microscopy, in both embryology and histology has increased. Additionally, embryology and histology content topic emphasis is identified within this study. Data, derived from this study, may be useful to new instructors, curriculum and test construction committees, and colleagues in the anatomical sciences, especially when determining a foundational knowledge base.

The educational value of online mastery quizzes in a human anatomy course for first-year dental students

The purpose of this study was to evaluate the effectiveness of online mastery quizzes in enhancing dental students' learning and preparedness for anatomy examinations. First-year dental students taking an integrated anatomy course at The Ohio State University were administered online mastery quizzes, made available for five days before each examination. The mastery quizzes were comprised of ten multiple-choice questions representative of the upcoming examination in content and difficulty. The students were allowed to access this resource as many times as they desired during the five-day window before each examination; the highest score for each student was added to his or her final course grade. The results indicate that almost all the students took advantage of this resource to reinforce content, clarify concepts, and prepare for the examinations. Statistical analyses of the students' exam performance showed that the mastery quizzes neither improved nor reduced their exam scores, but multiple regression analyses showed that the initial mastery quiz scores had a predictive value for their examination performance, suggesting a potential for mastery quizzes as an intervention tool for such a course. Online mastery quizzes, when used effectively, may be an effective resource to further engage dental and other students in educational endeavors and examination preparation and as a predictor of success.

ER-α36, a novel isoform of ER-α66, is commonly over-expressed in apocrine and adenoid cystic carcinomas of the breast

BACKGROUND

ER-α36 is a novel 36 kDa isoform of the full-length oestrogen receptor alpha (ER-α66). ER-α36 primarily localises to the cytoplasm and the plasma membrane, and responds to membrane-initiated oestrogen and antioestrogen signalling pathways.

AIM

To examine the expression of ER-α36 in apocrine and adenoid cystic carcinoma of the breast, both of which are consistently ER-α66 negative and currently lack effective targeted therapeutic options.

METHODS

19 pure apocrine carcinomas (17 invasive and two in-situ carcinomas) and 11 adenoid cystic carcinomas of the breast were evaluated for ER-α36 expression, along with expressions of ER-α66, progesterone receptor (PR) and androgen receptor (AR) using immunohistochemical methods.

RESULTS

All pure apocrine carcinomas showed a characteristic steroid receptor expression profile (ER-α66 and PR negative, AR strongly positive). ER-α36 expression was detected in 18/19 pure apocrine carcinomas (94.7%, 95% CI 75.1 to 98.7) in predominantly membranous and cytoplasmic distribution. When positive, pure apocrine carcinomas uniformly (100% of cells) expressed ER-α36. All adenoid cystic carcinomas were uniformly negative for all three classic steroid receptors, but ER-α36 was detected in 8/11 cases (72.7%, 95% CI 42.8 to 90) with the similar sub-cellular pattern of expression as in the pure apocrine carcinomas. When positive, adenoid cystic carcinomas expressed ER-α36 in the majority of cells (average 76%).

CONCLUSION

ER-α36, a novel isoform of ER-α66, is frequently over-expressed in apocrine and adenoid cystic carcinomas of the breast. These results indicate a potential for a novel targeted treatment in these cancers.

Adenoid cystic carcinomas of the breast have low Topo IIα expression but frequently overexpress EGFR protein without EGFR gene amplification

Adenoid cystic carcinoma of the breast is a rare subtype of breast cancer with basal-like features. Published studies on breast adenoid cystic carcinoma are limited, resulting in relatively scarce information on the value of predictive tumor markers. We studied 20 primary cases of adenoid cystic carcinoma of the breast for expression of estrogen receptor, progesterone receptor, androgen receptor, epidermal growth factor receptor, HER-2/neu, and topoisomerase IIα using immunohistochemistry and fluorescent in situ hybridization methods. Estrogen and progesterone receptor expression were detected in 1 case each. All tumors were uniformly negative for Her-2/neu expression. Androgen receptor and topoisomerase IIα expression were weakly positive in three cases and 7 cases, respectively. Epidermal growth factor receptor overexpression was detected in 13 cases (65% of all cases). Amplification of TOP2A or HER-2/neu gene was not detected in any of the cases. Our study shows that the majority of adenoid cystic carcinomas of the breast do not overexpress Her-2/neu, topoisomerase IIα, or estrogen receptor, and thus, they are unlikely to respond to therapies targeting these proteins. However, these tumors frequently over-express epidermal growth factor receptor, indicating a potential benefit from anti-epidermal growth factor receptor therapy for patients with advanced adenoid cystic carcinomas of the breast.

ER-alpha36, a novel variant of ER-alpha, is expressed in ER-positive and -negative human breast carcinomas

BACKGROUND

The status of estrogen receptor-alpha (ER-alpha) expression is one of the most important diagnostic and prognostic factors of breast cancer. ER-alpha is a 66-kDa, ligand-induced transcription factor, characteristically detected in the cell nucleus by immunohistochemistry (IHC) in breast cancer specimens. Recently, we identified and cloned a 36-kDa novel variant of ER-alpha, ER-alpha36, which lacks both transactivation domains and functions as a dominant-negative effector of transactivation activities of the full-length ER-alpha (ER-alpha66) and ER-beta. ER-alpha36 primarily localizes to the cytoplasm and plasma membrane, and responds to both estrogens and antiestrogens by transducing membrane-initiated signaling cascades, stimulating proliferation and possibly contributing to a more aggressive phenotype in breast carcinomas. ER-alpha36 is expressed in established ER-positive and -negative breast cancer cell lines. However, its expression and localization in breast cancer specimens have not been evaluated. As ER-alpha36 may play important roles in breast cancer tumorigenesis, it is of clinical importance to examine the expression pattern of ER-alpha36, in addition to that of ER-alpha66, for more comprehensive molecular profiling of breast carcinomas.

PATIENTS AND METHODS

Thirty-one breast cancer patient tissues were evaluated for ER-alpha36 and ER-alpha66 protein expression status by IHC and six additional patient tissue samples were analyzed by Western blot analysis using antibodies specific to ER-alpha66 or ER-alpha36.

RESULTS

Our experiments reveal a cytoplasmic and plasma-membrane-associated expression pattern of ER-alpha36 in both ER-alpha66-positive and -negative breast cancer samples. Furthermore, ER-alpha36 expression appears to be associated with decreasing nuclear and/or cytoplasmic ER-alpha66 expression, suggesting its potential use as a diagnostic and prognostic marker.

CONCLUSION

ER-alpha36 is a novel isoform of ER-alpha, frequently expressed in ER-alpha66-negative cancers, whose detection may provide additional information for better diagnosis and prognosis.

PIK3CA and PTEN mutations in adenoid cystic carcinoma of the breast metastatic to kidney

Adenoid cystic carcinoma (ACC) of the breast rarely metastasizes and has been associated with excellent prognosis. We describe a patient with renal metastasis of primary breast ACC 5 years after the mastectomy. A detailed molecular genetic analysis of the primary and metastatic tumors demonstrated somatic mutations in 2 well-known cancer genes associated with regulation of PI3K/AKT signaling pathway: (1) PIK3CA, which encodes the catalytic alpha subunit of the phosphoinositide-3-kinase, and (2) PTEN, which encodes phosphatase and tensin homolog. The mutation identified in PIK3CA (Ex1+169 A>C) predicts an amino acid change from isoleucine to methionine at codon 31 (I31M) and resides in the p85-binding domain of exon 1. The mutation identified in PTEN (IVS4-3 C>T) resides in intron 4 near the splice acceptor site of exon 5 and was associated with an aberrant PTEN transcript lacking exon 5, which is necessary for protein tyrosine phosphatase function and tumor suppressor properties of PTEN. Increased promoter methylation of PTEN was present in renal metastasis, coinciding with the decrease in the level of normal PTEN transcript. These coexistent mutations/epigenetic inactivations in PI3K/AKT pathway may be responsible for the unusually aggressive course of ACC.

The fate of human malignant melanoma cells transplanted into zebrafish embryos: assessment of migration and cell division in the absence of tumor formation

Certain aggressive melanoma cell lines exhibit a dedifferentiated phenotype, expressing genes that are characteristic of various cell types including endothelial, neural, and stem cells. Moreover, we have shown that aggressive melanoma cells can participate in neovascularization in vivo and vasculogenic mimicry in vitro, demonstrating that these cells respond to microenvironmental cues and manifest developmental plasticity. To explore this plasticity further, we transplanted human metastatic melanoma cells into zebrafish blastula-stage embryos and monitored their behavior post-transplantation. The data show that human metastatic melanoma cells placed in the zebrafish embryo survive, exhibit motility, and divide. The melanoma cells do not form tumors nor integrate into host organs, but instead become scattered throughout the embryo in interstitial spaces, reflecting the dedifferentiated state of the cancer cells. In contrast to the fate of melanoma cells, human melanocytes transplanted into zebrafish embryos most frequently become distributed to their normal microenvironment of the skin, revealing that the zebrafish embryo contains possible homing cues that can be interpreted by normal human cells. Finally, we show that within the zebrafish embryo, metastatic melanoma cells retain their dedifferentiated phenotype. These results demonstrate the utility of the zebrafish embryonic model for the study of tumor cell plasticity and suggest that this experimental paradigm can be a powerful one in which to investigate tumor-microenvironment interactions.