Evaluation of virtual microscopy in medical histology teaching

Histology stands as a major discipline in the life science curricula, and the practice of teaching it is based on theoretical didactic strategies along with practical training. Traditionally, students achieve practical competence in this subject by learning optical microscopy. Today, students can use newer information and communication technologies in the study of digital microscopic images. A virtual microscopy program was recently introduced at Ghent University. Since little empirical evidence is available concerning the impact of virtual microscopy (VM) versus optical microscopy (OM) on the acquisition of histology knowledge, this study was set up in the Faculty of Medicine and Health Sciences. A pretest‐post test and cross‐over design was adopted. In the first phase, the experiment yielded two groups in a total population of 199 students, Group 1 performing the practical sessions with OM versus Group 2 performing the same sessions with VM. In the second phase, the research subjects switched conditions. The prior knowledge level of all research subjects was assessed with a pretest. Knowledge acquisition was measured with a post test after each phase (T1 and T2). Analysis of covariance was carried out to study the differential gain in knowledge at T1 and T2, considering the possible differences in prior knowledge at the start of the study. The results pointed to non‐significant differences at T1 and at T2. This supports the assumption that the acquisition of the histology knowledge is independent of the microscopy representation mode (VM versus OM) of the learning material. The conclusion that VM is equivalent to OM offers new directions in view of ongoing innovations in medical education technology. Anat Sci Educ 6: 307–315. © 2013 American Association of Anatomists.     

Histology education in an integrated,time-restricted medical curriculum: Academic outcomes and students' study adaptations

In an ever-changing medical curricular environment, time dedicated for anatomical education has been progressively reduced. This happened at the University of Michigan Medical School starting in 2016–2017 when preclinical medical education was condensed to one year. Histology instruction remained integrated in organ system courses but reduced to a lecture-only format without scheduling time for laboratory exercises, requiring students to study virtual histology slides on their own time. In accordance with the shortened instructional time, the number of histology examination questions was reduced more than twofold. This study analyzed students' histology examination results and assessed their motivation to learn histology and use of educational opportunities before and after these curricular changes were implemented. Students' motivation to learn histology and their evaluation of histology lectures increased in the new curriculum. However, students devoted less study time to studying histology. Students' cumulative histology examination scores were significantly lower in the new curriculum and the number of students with overall scores <75%, defined as a substandard performance, increased more than 15-fold. Academically weaker students' histology scores were disproportionately more affected. As medical educational strategies, priorities, and curricular frameworks continue to evolve, traditional didactic topics like histology will need to adapt to continue providing educational value to future health care providers.     

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

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

Integration of virtual microscopy podcasts in the histology discipline in osteopathic medical school: Learning outcomes

Virtual microscopy podcasts (VMPs) are narrative recordings of digital histology images. This study evaluated the outcomes of integrating the VMPs into teaching histology to osteopathic medical students. The hypothesis was that incorporating virtual microscopy podcasts as supplementary histology resources to the curriculum would have a positive impact on student performance and satisfaction. Sixty-one podcasts of dynamic microscopic images were created using screen recordings of the digital slides. The VMPs were integrated as supplementary histology resources in multiple courses during the first and second years of the medical curriculum for three classes, a total of 477 osteopathic medical students. A voluntary and anonymous survey was obtained from the students using a questionnaire that included two open-ended questions. The overall performance of the three classes on the histology content of the preclinical course examinations was compared to historical controls of the previous two classes that did not have access to the VMPs. Most students indicated that the podcasts enabled more efficient study time and improved their confidence in the histology content on examinations. The findings indicated a positive association between podcast viewing and efficient study time utilization and class performance. The class average scores of the three consecutive cohorts that used the VMPs progressively increased by 7.69%, 14.88%, and 14.91% compared to the controls. A summary of students' feedback and academic performance supported that integration of the VMPs into Histology teaching improved the learning experience. The findings align with previous studies on the effectiveness of multimedia-based teaching in histology laboratory modules.     

Evaluation of usage of virtual microscopy for the study of histology in the medical,dental, and veterinary undergraduate programs of a UK University

This article describes the introduction of a virtual microscope (VM) that has allowed preclinical histology teaching to be fashioned to better suit the needs of approximately 900 undergraduate students per year studying medicine, dentistry, or veterinary science at the University of Bristol, United Kingdom. Features of the VM implementation include: (1) the facility for students and teachers to make annotations on the digital slides; (2) in‐house development of VM‐based quizzes that are used for both formative and summative assessments; (3) archiving of teaching materials generated each year, enabling students to access their personalized learning resources throughout their programs; and (4) retention of light microscopy capability alongside the VM. Student feedback on the VM is particularly positive about its ease of use, the value of the annotation tool, the quizzes, and the accessibility of all components off‐campus. Analysis of login data indicates considerable, although variable, use of the VM by students outside timetabled teaching. The median number of annual logins per student account for every course exceeded the number of timetabled histology classes for that course (1.6–3.5 times). The total number of annual student logins across all cohorts increased from approximately 9,000 in the year 2007–2008 to 22,000 in the year 2010–2011. The implementation of the VM has improved teaching and learning in practical classes within the histology laboratory and facilitated consolidation and revision of material outside the laboratory. Discussion is provided of some novel strategies that capitalize on the benefits of introducing a VM, as well as strategies adopted to overcome some potential challenges. Anat Sci Educ 7: 389–398. © 2013 American Association of Anatomists.     

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

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

A prospective,randomized crossover study comparing direct inspection by light microscopy versus projected images for teaching of hematopathology to medical students

Instruction in hematopathology at Mayo Medical School has evolved from instructor‐guided direct inspection under the light microscope (laboratory method), to photomicrographs of glass slides with classroom projection (projection method). These methods have not been compared directly to date. Forty‐one second‐year medical students participated in this pilot study, a prospective, randomized, crossover study measuring educational performance during a hematology pathophysiology course. The students were randomized to one of two groups. All students received the same didactic lectures in the classroom and subsequent case‐based review of peripheral blood smears using either laboratory or projection methods, on day one with a crossover to the other method on day two. Pre‐ and post‐test examinations centered on morphology recognition measured educational performance on each day, followed by a questionnaire identifying the student's favored method. There was no significant difference in the pre‐test and post‐test scores between the two teaching methods (rank‐sum P = 0.43). Students overwhelmingly preferred the projection method and perceived it as superior (76%), although post‐test scores were not significantly different. Student's recommended method was split with 50% favoring the projection method, 43% favoring a combined approach, and 23% noting logistical challenges to the laboratory. In this study, the laboratory and projection method were equivalent in terms of educational performance for hematopathology among medicals students. A classroom‐based approach such as the projection method is favored, given the large class sizes in undergraduate medical education, as well as the ergonomic challenges and additional resources required for large group instruction in a laboratory setting. Anat Sci Educ 7: 130–134. © 2013 American Association of Anatomists.     

Keeping dissection alive for medical students

Traditional dissection teaching is being reduced in a number of medical schools, particularly in the United Kingdom. In response to this, 12 medical students from Warwick University, UK, traveled to the Island of Grenada for an intensive extracurricular dissection course at St. George's University. This course not only benefited the host university through the creation of prosections for teaching but also allowed the participants to completely immerse themselves in anatomical study, by developing their dissection skills and consolidating anatomical knowledge. We believe that similar courses could be easily implemented by other medical schools, thereby allowing future students to keep traditional dissection alive. Anat Sci Educ 2: 302–303, 2009. © 2009 American Association of Anatomists.     

Virtual Microscopy as a Learning Tool in Brazilian Medical Education

Virtual microscopy (VM) is a widely used teaching method in Medical Education in many developed countries. In Brazil, however, this is not the case for most medical schools, considering Brazilian social inequality and uneven access to technology. Recently, the Covid-19 pandemic has also challenged Universities to seek and make a transition toward more effective methods of full-time online education. Thus, the main goal of this work was to verify student's perception and academic performance, assessed upon VM implementation in a Brazilian Medical School. Ribeirao Preto Medical School students answered a 26-question survey with regards to optical microscopy (OM) and VM. Academic performance was compared between participants that were (year of 2019) or were not (year of 2015) exposed to VM. Taken the results together, subjective impressions such as handling, suitability, learning effectiveness, and pleasure using the tools, have shown a higher score for virtual microscopy (median = 29), when compared to optical microscopy (median = 24) with a P-value < 0.001 by Wilcoxon rank test, upon measurement using an ordinal scale. Regarding academic performance, no statistically significant differences were found between groups (P-value = 0.38, Cohen's d = 0.19). Therefore, VM proved to be adequate to the Brazilian medical education in light of Brazilian social contexts and Covid-19 pandemic.     

The impact of interactive,computerized educational modules on preclinical medical education

Interactive computerized modules have been linked to improved retention of material in clinical medicine. This study examined the effects of a new series of interactive learning modules for preclinical medical education, specifically in the areas of quiz performance, perceived difficulty of concepts, study time, and perceived stress level. We randomly allocated 102 medical student volunteers into control and experimental groups. All participants studied selected anatomical and physiologic concepts using existing material (lecture notes, textbooks, etc.), while those in the experimental groups used the new interactive modules as well. All participants completed a quiz to test their knowledge of the assigned concepts and a survey to assess their subjective experiences in studying with the modules. We found a trend toward higher quiz scores in the experimental group relative to the control group, though it did not reach statistical significance (P = 0.31). Perceived concept difficulty was significantly reduced among those who studied with the modules (P < 0.001), and the number of hours spent studying the concepts was significantly increased (P = 0.028). Of those who used the modules, 83% rated them as “very helpful” or “extremely helpful.” No significant differences existed between participants' reported stress levels during the course of the study (P = 0.44). Our data suggest that medical students may learn more effectively and feel less intimidated by difficult concepts when interactive modules supplement traditional instruction. Anat Sci Ed 1:247–251, 2008. © 2008 American Association of Anatomists.     

Collaborative development of anatomy workshops for medical and dental students in Cambodia

After Phnom Penh was liberated from the Khmer Rouge in 1979, health science education in Cambodia had to be completely rebuilt. In this article, the authors report the results of a teaching collaboration between the University of Melbourne (Australia), the International University (Cambodia), and the University of Health Sciences (Cambodia). The main objectives in this collaboration were to provide the opportunity for dental and medical students in Cambodia to attend resourced anatomy workshops and to provide an opportunity for anatomy teachers in Cambodia to gain experience in implementing anatomy workshops of the style that are routinely used in the medical and dental curricula at the University of Melbourne. Experienced anatomy educators from the Department of Anatomy and Cell Biology, University of Melbourne, designed and resourced a series of workshops and then delivered these in collaboration with Cambodian teaching staff in Phnom Penh. The Cambodian students who participated in the workshops were incredibly engaged and enthusiastic. The students' evaluations (by questionnaire) indicated a very positive response to the workshops. All of the workshop resources were donated to the two universities so that the staff could continue to implement similar workshops, and plans were developed to continue our collaboration by developing more resourced workshops for this purpose in the future. Two staff members from Cambodia will travel to Melbourne to participate in anatomy workshops and dissection classes at the University of Melbourne. We hope that this extension of the collaboration provides further support and impetus for the development of anatomy education in Cambodia in the future.     

Perceptions of junior doctors and undergraduate medical students as anatomy teachers: Investigating distance along the near‐peer teaching spectrum

Near‐peer teaching involves more experienced students acting as tutors and has been widely used in anatomy education. This approach has many advantages for the learner due to the social and cognitive congruence they share with the teacher, however, the influence of distance between the teacher and learner on these congruences has yet to be explored. The aim of this study was to compare the attitudes and perceptions of the student learner towards neuroanatomy review sessions taught by either a senior medical student or a junior doctor. The students were randomly assigned to an allocated tutor. All tutors used standardized material and had access to identical resources. The type of allocated tutor was swapped between the two teaching sessions and 99 student feedback forms were collected in total. The rating for the overall quality of the teaching session was not significantly different between the junior doctors and senior medical students (P = 0.11). However, criteria closely relating to social and cognitive congruence such as “enjoyment of the session,” “delivery of the teaching,” and “was it a good use of time” were all rated significantly higher for the senior medical students (P < 0.05). The results of this study suggest that small increases in distance along the near‐peer teaching spectrum have an impact upon the student's perception of their learning experience. While all teachers were suitable role models it appears that junior doctors are too far removed from their own undergraduate experiences to share congruences with pre‐clinical medical students. Anat Sci Educ 7: 242–247. © 2013 American Association of Anatomists.     

Anatomists debate the value of a teaching credential

Fewer and fewer programs are training graduate students and postdoctoral fellows in the classical anatomical disciplines. Nonetheless, there remains a need at all levels of clinical and basic science education for skilled instructors of anatomy, histology, and embryology. Two sessions at the 2006 annual meeting of the American Association of Anatomists (AAA) explored whether a system of accreditation would benefit students, institutions, and training programs. Although the value of accreditation was controversial, three challenges for the various anatomical societies emerged from these discussions: (1) To identify the skills and knowledge that should be shared among all anatomists, and the more specific skills and knowledge needed for the diverse settings in which anatomists work. (2) To address the historical inattention of institutions to the training of educators. (3) To develop strategies to lobby institutions and national organizations to support the training and work of educators in the anatomical sciences. One approach to meeting these challenges would be to develop guidelines for training programs. These guidelines would help graduate students seek the training they need, provide institutions with a benchmark to assess or develop training programs, and provide the basis for focusing lobbying efforts targeted at institutions or existing accreditation bodies. Anat Sci Ed 1:60–67, 2008. © 2008 American Association of Anatomists.     

Properties of publications on anatomy in medical education literature

Publications on anatomy in medical education appear to be largely anecdotal. To explore this, we investigated the literature on anatomy in medical education, aiming first to evaluate the contribution of the literature on anatomy in medical education to "best evidence medical education" (BEME) and second to evaluate the development of this literature toward more "best evidence" between 1985 and 2009. Four databases were searched for publications on anatomy in medical education published between 1985 and 2009, resulting in 525 references. Hundred publications were characterized by five variables (journal category, paper subject, paper category, author perspective, and paper perspective). Statements from these publications were characterized by two variables (category and foundation). The publications contained 797 statements that involved the words "anatomy," "anatomical," or "anatomist." Forty-five percent of the publications contained no explicit research question. Forty percent of the statements made were about "teaching methods" and 17% about "teaching content," 8% referred to "practical value," and 10% to "side effects" of anatomy education. Ten percent of the statements were "positional," five percent "traditional," four percent "self-evident," and two percent referred to "quality of care." Fifty-six percent of the statements had no foundation, 17% were founded on empirical data, and 27% by references. These results substantiated the critical comments about the anecdotal nature of the literature. However, it is encouraging to see that between 1985 and 2009 the number of publications is rising that these publications increasingly focus on teaching methods and that an academic writing style is developing. This suggests a growing body of empirical literature about anatomy education.     

Learning and study strategies correlate with medical students' performance in anatomical sciences

Much of the content delivered during medical students' preclinical years is assessed nationally by such testing as the United States Medical Licensing Examination^® (USMLE^®) Step 1 and Comprehensive Osteopathic Medical Licensing Examination^® (COMPLEX‐USA^®) Step 1. Improvement of student study/learning strategies skills is associated with academic success in internal and external (USMLE Step 1) examinations. This research explores the strength of association between the Learning and Study Strategies Inventory (LASSI) scores and student performance in the anatomical sciences and USMLE Step 1 examinations. The LASSI inventory assesses learning and study strategies based on ten subscale measures. These subscales include three components of strategic learning: skill (Information processing, Selecting main ideas, and Test strategies), will (Anxiety, Attitude, and Motivation) and self‐regulation (Concentration, Time management, Self‐testing, and Study aid). During second year (M2) orientation, 180 students (Classes of 2016, 2017, and 2018) were administered the LASSI survey instrument. Pearson Product‐Moment correlation analyses identified significant associations between five of the ten LASSI subscales (Anxiety, Information processing, Motivation, Selecting main idea, and Test strategies) and students' performance in the anatomical sciences and USMLE Step 1 examinations. Identification of students lacking these skills within the anatomical sciences curriculum allows targeted interventions, which not only maximize academic achievement in an aspect of an institution's internal examinations, but in the external measure of success represented by USMLE Step 1 scores. Anat Sci Educ 11: 236–242. © 2017 American Association of Anatomists.     

National survey on anatomical sciences in medical education

The drivers for curricular change in medical education such as the addition of innovative approaches to teaching, inclusion of technology and adoption of different assessment methods are gaining momentum. In an effort to understand how these changes are impacting and being implemented in gross anatomy, microscopic anatomy, neuroanatomy/neuroscience, and embryology courses, surveys were sent out to course directors/discipline leaders at allopathic Medical Schools in the United States during the 2016‐2017 academic year. Participants in the study were asked to comment on course hours, student experiences in the classroom and laboratory, amount of faculty participation, the use of peers as teachers in both the classroom and laboratory, methods used for student assessment and identification of best practices. Compared to data published from a similar survey in 2014, a number of changes were identified: (1) classroom hours in gross anatomy increased by 24% and by 29% in neuroanatomy/neuroscience; (2) laboratory hours in gross anatomy decreased by 16%, by 33% in microscopic anatomy, and by 38% in neuroanatomy/neuroscience; (3) use of virtual microscopy in microscopic anatomy teaching increased by 129%; and (4) the number of respondents reporting their discipline as part of a partially or fully integrated curriculum increased by greater than 100% for all four disciplines. Anat Sci Educ 11: 7–14. © 2017 American Association of Anatomists.     

Perceptions of anatomy education—A student's view

Changes in anatomy education over the last two decades have, in large part, led to less emphasis on gross anatomy in the medical curriculum. This has led many to question whether streamlined anatomy courses truly provide adequate preparation for medical practice. Rather than wondering about the effects of these changes, we should be actively seeking answers and promoting understanding between professors, clinicians, and students about what anatomy education is and what it should be. Anat Sci Ed 1:133–134, 2008. © 2008 American Association of Anatomists.     

Clay-Based Modeling in the Anatomist's Toolkit: A Systematic Review

Anatomical education has suffered from reduced teaching time and poor availability of staff and resources over the past thirty years. Clay-based modeling (CBM) is an alternative technique for teaching anatomy that can improve student knowledge and experience. This systematic review aimed to summarize and appraise the quality of the literature describing the uses, advantages, and limitations of CBM compared to alternative methods of teaching human gross anatomy to students or qualified healthcare professionals. A systematic search of Embase, MEDLINE, Scopus, and Web of Science databases was conducted, and the Medical Education Research Quality Instrument (MERSQI) was used to assess study quality. Out of the 829 studies identified, 12 papers met the inclusion criteria and were eligible for this review. The studies were of high quality, with a mean MERSQI score of 11.50/18. Clay-based modeling can be used to teach all gross anatomical regions, and 11 studies demonstrated a significant improvement in short-term knowledge gain in students who used CBM in comparison to other methods of learning anatomy. Eight studies that included subjective assessment showed that CBM is rated highly. However, some studies showed that students viewed CBM as juvenile and experienced difficulty making the models. Additionally, there is no evidence to suggest that CBM improves long-term knowledge. Clay-based modeling is an effective learning method for human gross anatomy and should be incorporated into the anatomists' toolkit. In the future, more randomized controlled studies with transparent study designs investigating the long-term impact of CBM are needed.     

Spatial Abilities Training in Anatomy Education: A Systematic Review

Spatial abilities have been correlated to anatomy knowledge assessment and spatial training has been found to improve spatial abilities in previous systematic reviews. The objective of this systematic review was to evaluate spatial abilities training in anatomy education. A literature search was done from inception to 3 August 2017 in Scopus^® and several databases on the EBSCOhost platform. Citations were reviewed and those involving anatomy education, an intervention, and a spatial abilities test were retained and the corresponding full-text articles were reviewed for inclusion. Before and after training studies, as well as comparative training programs, relating a spatial training intervention to spatial abilities were eligible. Of the 2,405 citations obtained, 52 articles were identified and reviewed, yielding eight eligible articles. Instruction in anatomy and mental rotations training were found to improve spatial abilities. For the seven studies retained for the meta-analysis that included the effect of interventions on spatial abilities test scores, the pooled treatment effect difference was 0.49 (95% CI [0.17; 0.82]; n = 11) improvement. For the two studies that included the practice effect on spatial abilities test scores in a control group, the pooled treatment effect difference was 0.47 (95% CI [−0.03; 0.97]; n = 2) improvement. In these two studies, the impact of the intervention on spatial abilities test scores was found despite the practice effect. Evidence was found for improvement of spatial abilities in anatomy education using instruction in anatomy and mental rotations training.     

An evaluation of outcomes following the replacement of traditional histology laboratories with self‐study modules

Changes in medical school curricula often require educators to develop teaching strategies that decrease contact hours while maintaining effective pedagogical methods. When faced with this challenge, faculty at the University of Cincinnati College of Medicine converted the majority of in‐person histology laboratory sessions to self‐study modules that utilize multiple audiovisual modalities and a virtual microscope platform. Outcomes related to this shift were investigated through performance on in‐house examinations, results of the United States Medical Licensing Examination^® (USMLE^®) Step 1 Examination, and student feedback. Medical School College Admissions Test^® (MCAT^®) scores were used as a covariate when comparing in‐house examinations. Results revealed no significant change in performance on in‐house examinations when the content being assessed was controlled (F(2, 506) = 0.676, P = 0.51). A significant improvement in overall practical examination grade averages was associated with the self‐study modules (F(6, 1164) = 10.213, P < 0.01), but gradual changes in examination content may explain this finding. The histology and cell biology portion of USMLE Step 1 Examination remained consistent throughout the time period that was investigated. Student feedback regarding the self‐study modules was positive and suggested that features such as instructor narrated videos were an important component of the self‐study modules because they helped recreate the experience of in‐person laboratory sessions. Positive outcomes from the student perspective and no drop in examination performance suggests that utilizing self‐study modules for histology laboratory content may be an option for educators faced with the challenge of reducing contact hours without eliminating content. Anat Sci Educ 10: 276–285. © 2016 American Association of Anatomists.