Mark W. Braun

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.

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. Anat Sci Educ.

A comparison of student performance on discipline-specific versus integrated exams in a medical school course

Curricular reform is a widespread trend among medical schools. Assessing the impact that pedagogical changes have on students is a vital step in review process. This study examined how a shift from discipline-focused instruction and assessment to integrated instruction and assessment affected student performance in a second-year medical school pathology course. We investigated this by comparing pathology exam scores between students exposed to traditional discipline-specific instruction and exams (DSE) versus integrated instruction and exams (IE). Exam content was controlled, and individual questions were evaluated using a modified version of Blooms taxonomy. Additionally, we compared United States Medical Licensing Examination (USMLE) step 1 scores between DSE and IE groups. Our findings indicate that DSE students performed better than IE students on complete pathology exams. However, when exam content was controlled, exam scores were equivalent between groups. We also discovered that the integrated exams were composed of a significantly greater proportion of questions classified on the higher levels of Blooms taxonomy and that IE students performed better on these questions overall. USMLE step 1 exam scores were similar between groups. The finding of a significant difference in content complexity between discipline-specific and integrated exams adds to recent literature indicating that there are a number of potential biases related to curricular comparison studies that must be considered. Future investigation involving larger sample sizes and multiple disciplines should be performed to explore this matter further.

Virtual microscopy is a superior and reputable pedagogical tool for histology learning: response to Xu.

To the Editors, Anatomical Sciences Education My co-authors and I have read Dr. Xu’s letter to the editor (Xu, 2013) published in Anatomical Sciences Education about his concerns regarding virtual microscopy and address them below. Xu (2013) makes the assumption that with virtual microscopy, only perfect slides will be selected for observation, and this removes the opportunity to visualize variation and abnormality. This assumption is unfounded and not supported by the literature. We and others have scanned our entire optical microscope slide collections, so students visualize the same slides (imperfections and all) as they would with the optical microscope (Braun and Kearns, 2008; Husmann et al., 2009, Collier et al., 2012). Virtual microscopy has allowed others to expand their collections so they may access thousands of slides through collaborative networks or through commercial programs (e.g., Triola and Holloway, 2011; Nelson et al., 2012). Thus, rather than limiting the number of histology samples, virtual microscopy may actually increase the number of slides any one student may observe and so improve their understanding of the subject matter. Many studies have shown that virtual microscopy provides better opportunity for collaborative and team-based learning than optical microscopy. Improved collaboration among students using the virtual microscope has been documented by many (Braun and Kearns, 2008; Husmann et al., 2009, Paulsen et al., 2010; Triola and Holloway, 2011). In fact, we (Collier et al., 2012) noted that optical microscopy may inhibit collaborative learning (because only one student at a time may observe a structure through the microscope), whereas virtual microscopy allows multiple students and instructors to observe the same specific structures simultaneously. In addition, this collaborative learning may take place outside the classroom, as a student can access these digital slides anywhere s/he has an internet connection (Braun and Kearns, 2008; Husmann et al., 2009; Paulsen et al., 2010). These pedagogical advantages may account for the increase in the use of virtual microscopy in medical classrooms. Drake et al. (2009) noted that over 44% of US medical school survey respondents solely use virtual microscopy in their histology curricula, up from 14% in a similar 2002 survey (Drake et al., 2002). Contrary to popular belief, virtual microscopy does not mean greater improper use of computers in the classroom. That was an original concern of ours, but our research with both undergraduate anatomy students (Husmann et al., 2009) and graduate teaching assistants (Collier et al., 2012) demonstrated that students stayed on task and did not use the computer for non-classroom related work. In fact, the computer allowed students to take screen captures of histology slides and label the images on their own in PowerPoint or Photoshop, tasks that they would not have been able to do with the optical microscope. Xu (2013) was concerned that the use of virtual microscopy would represent a conflict between training and practice. However, virtual microscopy is increasingly being used in pathology clinical practice. Telepathology (the ability for different pathologists to examine the same glass slide over a distance) was first used in the 1980s, but its use has expanded to virtual slide analysis over the internet (Evans et al., 2009). Virtual slide telepathology allows for more rapid, accurate diagnosis, and collaboration among clinicians, and is becoming a popular method for pathologists in North America (Evans et al., 2009; Lopez et al., 2009). In fact, some residency programs are now assessing their surgical pathology residents using virtual microscopy (Bruch et al., 2009). As virtual microscopy is becoming more prominent in residency training and clinical practice, it is essential that we train our students using this innovative pedagogical tool. Virtual microscopy has proven to be an excellent learning tool in both undergraduate and medical education and has been shown to be superior to optical microscopy in many respects. We agree with Pratt (2009) and Xu (2013) that optical microscopy should not be abandoned, and we have stated before (Collier et al., 2012) that students should be given an opportunity to use the optical microscope, if possible. However, there is abundant evidence that virtual microscopy is an excellent learning tool in both undergraduate and medical education and we applaud its increased use in these curricula (Drake et al., 2002, 2009).

Does team-based learning (TBL) format and administration influence second year medical students' attitudes toward this teaching modality?

Previous studies have examined team-based learning (TBL) efficacy in medical curricula, yet little research has been done to compare differences in TBL modalities (implementation and design). This study examines student perceptions of differing TBL modalities in two second-year medical courses (pathology and introduction to medicine) at Indiana University School of Medicine, Bloomington (IUSM-Bloomington). The medicine TBLs were traditional, standardized TBLs that use assigned groups and graded individual readiness assurance tests (IRATs) and group readiness assurance tests (GRATs), while the pathology TBLs were non-traditional in their use of self-selected groups and lack of graded IRATs and GRATs. At the end of the academic year, students were invited to complete an anonymous survey comparing and contrasting the two specific TBL designs. The survey contained both quantifiable Likert-scale questions and open-ended (qualitative) questions allowing students to provide feedback. Written comments were examined for common themes. Participants showed no preference for a specific TBL modality but did indicate preferences for particular aspects of each modality. Specifically, students preferred to be assigned to TBL groups, to have a non-graded IRAT/GRAT component, and they found TBLs the most effective when used as a review of material as opposed to a first exposure experience.