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.     

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 new paradigm for teaching Histology laboratories in Canada's first distributed medical school

To address the critical problem of inadequate physician supply in rural British Columbia, The University of British Columbia (UBC) launched an innovative, expanded and distributed medical program in 2004–2005. Medical students engage in a common curriculum at three geographically distinct sites across B.C.: in Vancouver, Prince George and Victoria. The distribution of the core Histology course required a thorough revision of our instructional methodology. We here report our progress and address the question “How does one successfully distribute Histology teaching to remote sites while maintaining the highest of educational standards?” The experience at UBC points to three specific challenges in developing a distributed Histology curriculum: (i) ensuring equitable student access to high quality histological images, (ii) designing and implementing a reliable, state‐of‐the‐art technological infrastructure that allows for real‐time teaching and interactivity across geographically separate sites and (iii) ensuring continued student access to faculty content expertise. High quality images—available through any internet connection—are provided within a new virtual slide box library of 300 light microscopic and 190 electron microscopic images. Our technological needs are met through a robust and reliable videoconference system that allows for live, simultaneous communication of audio/visual materials across the three sites. This system also ensures student access to faculty content expertise during all didactic teaching sessions. Student examination results and surveys demonstrate that the distribution of our Histology curriculum has been successful. Anat Sci Ed 1:95–101, 2008. © 2008 American Association of Anatomists.     

Optical versus virtual: teaching assistant perceptions of the use of virtual microscopy in an undergraduate human anatomy course

Many studies that evaluate the introduction of technology in the classroom focus on student performance and student evaluations. This study focuses on instructor evaluation of the introduction of virtual microscopy into an undergraduate anatomy class. Semi-structured interviews were conducted with graduate teaching assistants (TA) and analyzed through qualitative methods. This analysis showed that the teaching assistants found the virtual microscope to be an advantageous change in the classroom. They cite the ease of use of the virtual microscope, access to histology outside of designated laboratory time, and increasing student collaboration in class as the primary advantages. The teaching assistants also discuss principal areas where the use of the virtual microscope can be improved from a pedagogical standpoint, including requiring students to spend more time working on histology in class.     

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.     

Development and evaluation of an interactive electronic laboratory manual for cooperative learning of medical histology

This article describes the development of an interactive computer‐based laboratory manual, created to facilitate the teaching and learning of medical histology. The overarching goal of developing the manual is to facilitate self‐directed group interactivities that actively engage students during laboratory sessions. The design of the manual includes guided instruction for students to navigate virtual slides, exercises for students to monitor learning, and cases to provide clinical relevance. At the end of the laboratory activities, student groups can generate a laboratory report that may be used to provide formative feedback. The instructional value of the manual was evaluated by a questionnaire containing both closed‐ended and open‐ended items. Closed‐ended items using a five‐point Likert‐scale assessed the format and navigation, instructional contents, group process, and learning process. Open‐ended items assessed student's perception on the effectiveness of the manual in facilitating their learning. After implementation for two consecutive years, student evaluation of the manual was highly positive and indicated that it facilitated their learning by reinforcing and clarifying classroom sessions, improved their understanding, facilitated active and cooperative learning, and supported self‐monitoring of their learning. Anat Sci Educ 6: 342–350. © 2013 American Association of Anatomists.     

Quantitative and qualitative changes in teaching histology by means of virtual microscopy in an introductory course in human anatomy

This study compares overall laboratory averages and individual test scores along with a student survey to determine the effects of using virtual microscopy in place of optical microscopes in a large undergraduate human anatomy course. T‐tests revealed that the first two laboratory examinations (of four) and the overall laboratory averages were significantly increased compared with the previous year. We hypothesize that this is due to students' ability to use and understand the technology quickly as opposed to learning how to maneuver an optical microscope. Students also responded positively in a survey about the virtual microscope, indicating that increased accessibility, ease of use, and the ability to understand the material were important components of the virtual microscope. In addition, an increase in student collaboration was noted because multiple students were able to view the image at a time. This level of acceptance of virtual microscopy has been reported in previous studies, though this level of increased examination scores is rare. We attribute this to differences between the medical students, with whom this technology has been researched in the past, and undergraduate introductory students. Anat Sci Educ 2:218–226, 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.     

Active learning: A small group histology laboratory exercise in a whole class setting utilizing virtual slides and peer education

Histology laboratory instruction is moving away from the sole use of the traditional combination of light microscopes and glass slides in favor of virtual microscopy and virtual slides. At the same time, medical curricula are changing so as to reduce scheduled time for basic science instruction as well as focusing on student‐centered learning approaches such as small group active learning and peer‐instruction. It is important that medical schools resist the temptation to respond to this conjunction of events by turning histology into a self‐study activity. This article describes a lymphoid histology laboratory exercise, occurring in a specially equipped Learning Studio housing an entire medical class that utilizes virtual slides in the context of small group active learning and peer instruction. Anat Sci Educ © 2012 American Association of Anatomists.     

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.     

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.     

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.     

Evaluating a technology supported interactive response system during the laboratory section of a histology course

Monitoring of student learning through systematic formative assessment is important for adjusting pedagogical strategies. However, traditional formative assessments, such as quizzes and written assignments, may not be sufficiently timely for making adjustments to a learning process. Technology supported formative assessment tools assess student knowledge, allow for immediate feedback, facilitate classroom dialogues, and have the potential to modify student learning strategies. As an attempt to integrate technology supported formative assessment in the laboratory section of an upper‐level histology course, the interactive application Learning Catalytics^TM, a cloud‐based assessment system, was used. This study conducted during the 2015 Histology courses at Cornell University concluded that this application is helpful for identifying student misconceptions “on‐the‐go,” engaging otherwise marginalized students, and forming a new communication venue between students and instructors. There was no overall difference between grades from topics that used the application and grades from those that did not, and students reported that it only slightly helped improve their understanding of the topic (3.8 ± 0.99 on a five‐point Likert scale). However, they highly recommended using it (4.2 ± 0.71). The major limitation was regarding the image display and graphical resolution of this application. Even though students embrace the use of technology, 39% reported benefits of having the traditional light microscope available. This cohort of students led instructors to conclude that the newest tools are not always better, but rather can complement traditional instruction methods. Anat Sci Educ 10: 328–338. © 2016 American Association of Anatomists.     

Improved learning efficiency and increased student collaboration through use of virtual microscopy in the teaching of human pathology

The implementation of virtual microscopy in the teaching of pathology at the Bloomington, Indiana extension of the Indiana University School of Medicine permitted the assessment of student attitudes, use and academic performance with respect to this new technology. A gradual and integrated approach allowed the parallel assessment with respect to both the virtual and optical microscopes. Student survey data indicated that the virtual imaging technology was enthusiastically received, and aggregate grade comparisons with the previous classes showed no decrease in content mastery. Survey questions assessing a variety of parameters reveal improved time and resource utilization, as well as increased student collaboration. Even so, 50% of the respondents indicated having both optical and virtual microscopes available was preferable. Anat Sci Ed 1:240–246, 2008. © 2008 American Association of Anatomists.     

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.     

The “flipped classroom” approach: Stimulating positive learning attitudes and improving mastery of histology among medical students

Traditional medical education methodologies have been dramatically impacted by the introduction of new teaching approaches over the past few decades. In particular, the “flipped classroom” format has drawn a great deal of attention. However, evidence regarding the effectiveness of the flipped model remains limited due to a lack of outcome‐based studies. In the present study, a pilot histology curriculum of the organ systems was implemented among 24 Traditional Chinese Medicine (TCM) students in a flipped classroom format at Jinan University. As a control, another 87 TCM students followed a conventional histology curriculum. The academic performance of the two groups was compared. In addition, a questionnaire was administered to the flipped classroom group. The test scores for the flipped classroom participants were found to be significantly higher compared to non‐participants in the control group. These results suggest that students may benefit from using the flipped classroom format. Follow‐up questionnaires also revealed that most of the flipped classroom participants undertook relatively more earnest preparations before class and were actively involved in classroom learning activities. The teachers were also found to have more class time for leading discussions and delivering quizzes rather than repeating rote didactics. Consequently, the increased teaching and learning activities contributed to a better performance among the flipped classroom group. This pilot study suggests that a flipped classroom approach can be used to improve histology education among medical students. However, future studies employing randomization, larger numbers of students, and more precise tracking methods are needed before definitive conclusions can be drawn. Anat Sci Educ 10: 317–327. © 2016 American Association of Anatomists.     

The effectiveness of virtual and augmented reality in health sciences and medical anatomy

Although cadavers constitute the gold standard for teaching anatomy to medical and health science students, there are substantial financial, ethical, and supervisory constraints on their use. In addition, although anatomy remains one of the fundamental areas of medical education, universities have decreased the hours allocated to teaching gross anatomy in favor of applied clinical work. The release of virtual (VR) and augmented reality (AR) devices allows learning to occur through hands‐on immersive experiences. The aim of this research was to assess whether learning structural anatomy utilizing VR or AR is as effective as tablet‐based (TB) applications, and whether these modes allowed enhanced student learning, engagement and performance. Participants (n = 59) were randomly allocated to one of the three learning modes: VR, AR, or TB and completed a lesson on skull anatomy, after which they completed an anatomical knowledge assessment. Student perceptions of each learning mode and any adverse effects experienced were recorded. No significant differences were found between mean assessment scores in VR, AR, or TB. During the lessons however, VR participants were more likely to exhibit adverse effects such as headaches (25% in VR P < 0.05), dizziness (40% in VR, P < 0.001), or blurred vision (35% in VR, P < 0.01). Both VR and AR are as valuable for teaching anatomy as tablet devices, but also promote intrinsic benefits such as increased learner immersion and engagement. These outcomes show great promise for the effective use of virtual and augmented reality as means to supplement lesson content in anatomical education. Anat Sci Educ 10: 549–559. © 2017 American Association of Anatomists.     

Ethnographies across virtual and physical spaces: a reflexive commentary on a live Canadian/UK ethnography of distributed medical education

This article draws on an ongoing ethnography of distributed medical education (DME) provision in Canada in order to explore the methodological choices of the researchers as well as the wider pluralisation of ethnographic frameworks that is reflected within current research literature. The article begins with a consideration of the technologically mediated ways in which the researchers do their work, a way of work that is paralleled within the DME curriculum that forms the focus of the ethnography. The article goes on to problematise relationships amongst the researchers and between the researchers and the field of research, and to consider the ways in which methodological choices are mediated. In so doing, the article proposes an acceptance of methodological pluralism that is tempered by the need to acknowledge the sometimes-slight differences that distinguish ethnographic paradigms.