Introduction

Traditionally pathology courses were taught as lectures aided by a lab class where microscopic examination took place. This labs are based on the use of histological glass slides of the diverse pathologies that require the student to use a microscope to be able to observe and study the slide. Furthermore, this kind of laboratory is restricted by the amount of material and microscopes available, also the course instructor is bounded by the physical limitations of this method to help one student at a time, during specific lab hours. This type of traditional observance does not ensure that the fundamental microscopic alterations for the diagnosis of this disease processes taught by the instructor are the characteristic the student is observing during his time at the microscope. In other words, there was no effective manner to know with accuracy the exact learning and comprehension obtained by the student.

For this reasons the idea of the Virtual Pathology Lab was conceived thinking in a new way to provide a more interactive approach to teach pathology to our medical students, and at the same time, use technology as and aid to motivate students.
Using a standard digital slide scanner and a free web resource developed by Microsoft named “Deep Zoom Composer”, we were able to create a set of digital slides specific for each of the four courses of pathology at our university. They were uploaded to an educational platform, and clinical cases were constructed to match the pathological slides and the courses learning objectives. Students have access to the platform and to the virtual pathology lab on off-school hours giving them resource availability to reinforce knowledge and key concepts at home without all the limitations mentioned before.

Synopsis

Objective

Increase student motivation and engagement in their own learning with innovative and mobile technology. With better resource availability so students can access pathological cases at any time and in any place for self- and/or peer-study, promoting collaborative learning and facilitating the teaching-learning process. It gives the students the ability to freely manipulate to different zoom levels the digitized images and freely signalize cells or tissues and if necessary indicate their specific doubts to their peers and teacher. This new approach is a promising tool for the students to expand their learning skills, promote critical thinking and improve their knowledge construction and permanent retention.
The project also reduces lab costs by reducing the need of special facilities, the amount of glass slide copies, microscopes and human resources (professors, lab technicians, cleaning personal).

Approach

The digital scanner was provided by the Institution for the specific design of a Virtual pathology Lab. A team of pathology teachers, residents and students was built in order to create a pool of pathology cases necessary for the courses. Thousands of glass slides were examined in order to select the ones that best demonstrated the corresponding pathology. Microsoft “Deep Zoom Composer” software was selected to handle all the scanned digital images. Afterwards the images were placed on a server and a friendly platform was created in order to form a good virtual image that could be handled easily and intuitive.
Students are provided with a weekly activity (“lab practice”) based on five clinical-histopathological cases with digitized slides. Each lab practice is designed to support and reinforce the learning goals for that week. Using small teams and problem cases we create scenarios where students need to use collaborative techniques as well as interpretation and analysis to draw diagnostic conclusions. After observing real-life histopathological images (digitized slides) and “made up” clinical cases, students can integrate their theoretical and practical knowledge.
All cases are available in the course technological platform during the entire semester and they can be seen in mobile technology. Students can take screen-shots of their tablets or screen captures clips of the laptop and save the images to later build a PowerPoint presentation with all the criteria specified for that activity. They receive tutoring by their professor during class and/or by email. Students can send their images signalized (circles, arrows, etc.) having an accurate communication of their doubts. Evaluation rubrics for each lab practice are also found in the platform.

Engagament

The scope of this project will impact 600 medical students annually (300 per semester), who are studying any of the four courses of Morphological and Functional Pathology. The project was executed initially in one course (150 students) and then extended to cover all four courses of pathology.
Teachers were able to integrate the virtual laboratory cases with their teaching process without the need to search for special material. New and different activities can be design with the digital slides, as well as assessment with instruments such on-line quizzes and exams.
School administrators supported the technological innovation, the cost reduction, but especially enjoyed the student acceptance and engagement to the new pathology courses.
Students were exited to use the pathology slides at their own time and place, and manipulate the images with their tablets or smartphones. Using real-life slides associated with “made-up” clinical cases, gave the students the responsibility needed to resolve real-life cases, improving their motivation and enthusiasm towards learning.

Impact

The first semester that it was implemented we got excellent results. Initially, images were only visible in our campus network, but during the second semester they were web based. Acceptance to the project was good at the beginning and so much greater when it was available off-campus.

A feedback survey was answered by 83 of 100 students registered in our Pathology course. They were asked: “How useful was the Virtual Pathology Lab to study and learn pathology?” 82% said very useful. “If the Learning Activities Design for the Virtual Pathology Lab were useful on motivating them to study?” 75% said they were useful, 21% said somewhat useful, while 4% said they were not useful. About Student Satisfaction the survey showed that using the Lab in and off campus increased significantly student satisfaction in resource availability, time invested using slides, schedule assigned for slide revision and selection of place assigned for slide revision. 83% of students felt the lab was very useful as an aid to achieve the learning goals and to improve outcome.

Next Steps

To important next steps, one is being done prior to every course and that is to revise, actualize and enrich our clinical-pathological cases, the digitized slides and the learning activities. The other step is to have further research on the impact not only on our students’ perception of acquisition of learning objectives but on the improvement of their final grades.
We will also like to encourage other institutions to strengthen pathology teaching, not only as a slide interpretation process, but as an integral clinical-physiopathological and histopathological science that explains and demonstrates what is happening with our patients’ health.

Other Information

PDF - Click to download
PowerPoint Presentation - Click to download
PowerPoint Presentation - Click to download
YouTube Video - Using different technology based activities
YouTube Video - Innovative pathology teaching
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