Virtual Microscopy in Undergraduate Pathology Education: An early transformative experience in clinical reasoning

Abstract

Objectives: Whole-slide imaging and virtual microscopy (VM) have revolutionised teaching, diagnosis and research in histopathology. This study aimed to establish the feasibility of achieving early integration of clinical reasoning with undergraduate pathology teaching on a VM platform and to determine its student-centricity through student feedback.

Methods: This study was conducted at the Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates, between August and December 2017. A total of 38 VM-centred clinical cases were introduced to 49 students in an integrated undergraduate medical curriculum. The cases were aligned to curricular objectives, reinforced the pathologic basis of disease with critical thinking and were delivered across 15 interactive small-group sessions. A simulated cross-disciplinary integration and judicious choice of pertinent diagnostic investigations were linked to principles of management. Feedback was obtained through a mixed-methods approach.

Results: User-friendliness, gradual learning curve of VM and annotation-capacity were scored as 4-5 (on a Likert scale of 1-5) by 91.84%, 87.76% and 83.67% of the participants, respectively. Most students agreed that the content matched the stage of learning (81.63%), theme of the week (91.84%) and development of a strong clinical foundation (77.55%). Integration (85.71%) and clinico-pathological correlation (83.67%) were the strengths of this educational effort. High student attendance (~100%) and improved assessment scores on critical thinking (80%) were observed. Software lacunae included frequent logouts and lack of note-taking tools. Easy access was a significant student-centric advantage.

Conclusion: A VM-centred approach with a clinico-pathological correlation has been successfully introduced to inculcate integrated learning. Using the pathologic basis of disease as a fulcrum and critical reasoning as an anchor, a digitally-enabled generation of medical students have embraced this educational tool for tutor-guided, student-centred learning.

Keywords: Digital Technology; Medical Education; Microscopy; Pathology; United Arab Emirates.

Figure 1

Composite illustration of a VM-centred prototype case (1 of 25 clinical scenarios) showing acute appendicitis. A clinical vignette integrates the anatomical basis of location of pain and the gross appearance of the operated appendix. Microscopic comparison of a normal (blue arrow) and diseased (red arrow) appendix at low magnification (upper right) and transmural neutrophilic infiltration at a higher magnification is possible.

Figure 2

An interactive virtual microscopy session in progress in the computer laboratory at the Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates. Students dynamically manipulate the virtual microscope and discuss the questions and annotations with the tutor.

Figure 3

Quantitative responses of students’ experience with virtual microscopy on a Likert scale of 1–5 where 1 is lowest and 5 is highest (N = 49).

Figure 4

Student feedback on case content during a virtual microscopy course scaled quantitatively as ‘agree’, ‘partly agree’ and ‘disagree’ (N = 49).

Figure 5

Example of the virtual microscopy software output showing a question that integrates clinical reasoning with disease morphology.