Teaching Cellular Architecture: The Global Status of Histology Education.

Histology or microanatomy is the science of the structure and function of tissues and organs in metazoic organisms at the cellular level. By definition, histology is dependent on a variety of microscope techniques, usually light or more recently virtual, as well as electron microscopy. Since its inception more than two centuries ago, histology has been an integral component of biomedical education, specifically for medical, dental, and veterinary students. Traditionally, histology has been taught in two sequential phases, first a didactic transfer of information to learners and secondly a laboratory segment in which students develop the skill of analyzing micrographic images. In this chapter, the authors provide an overview of how histology is currently taught in different global regions. This overview also outlines which educational strategies and technologies are used, and how the local and cultural environment influences the histology education of medical and other students in different countries and continents. Also discussed are current trends that change the teaching of this basic science subject.

Virtual Microscopy Goes Global: The Images Are Virtual and the Problems Are Real.

For the last two centuries, the scholarly education of histology and pathology has been based on technology, initially on the availability of low-cost, high-quality light microscopes, and more recently on the introduction of computers and e-learning approaches to biomedical education. Consequently, virtual microscopy (VM) is replacing glass slides and the traditional light microscope as the main instruments of instruction in histology and pathology laboratories. However, as with most educational changes, there are advantages and disadvantages associated with a new technology. The use of VM for the teaching of histology and pathology requires an extensive infrastructure and the availability of computing devices to all learners, both posing a considerable financial strain on schools and students. Furthermore, there may be valid reasons for practicing healthcare professionals to maintain competency in using light microscopes. In addition, some educators may be reluctant to embrace new technologies. These are some of the reasons why the introduction of VM as an integral part of histology and pathology instruction has been globally uneven. This paper compares the teaching of histology and pathology using traditional or VM in five different countries and their adjacent regions, representing developed, as well as developing areas of the globe. We identify general and local roadblocks to the introduction of this still-emerging didactic technology and outline solutions for overcoming these barriers.

Histology as a paradigm for a science-based learning experience: Visits by histology education spirits of past, present, and future.

The term "histology" was coined a little over 200 years ago and the subject has always relied on microscopy as its defining technology. Microscopy was and still is an essential approach for the description of cellular components and their arrangements in living organisms. For more than a century and a half, histology or microanatomy has also been part of the basic science education for biomedical students. Traditionally, it has been taught in two major components, a didactic transfer of information, either in a lecture or self-learning format, and in active-learning laboratory sessions. These two modes of histology instruction conform with the dual-processing theory of learning, one being more automatic and depending mainly on rote memorization, whereas the other is analytical, requiring more advanced reasoning skills. However, these two components of histology education are not separate and independent, but rather complementary and part of a multi-step learning process that encourages a scientific analysis of visual information and involves higher-level learning skills. Conventional, as well as modern electronic instruction methods (e-learning) have been used in complementary ways to support the integrated succession of individual learning steps as outlined in this manuscript. However, as recent curricular reforms have curtailed instructional time, this traditional format of teaching histology is no longer sustainable and a reflective reassessment of the role of histology in modern biomedical education is a timely necessity.

The freedom to teach (at the best).

Over the past decades, biomedical education has changed considerably, mostly by the introduction of novel didactic strategies, as well as the addition of technology. As a consequence, the centuries-old lecture-style presentation has come under criticism for providing only a one-directional transfer of information. However, the delivery of traditional lectures has also seen considerable changes such as the use of Microsoft PowerPoint slides which can be projected and serve as lecture handouts to learners. Electronic technologies and the internet now allow for the permanent recording of lectures and the distribution of video recordings to students who are unable or choose not to attend lectures in person. This off-site consumption of lecture presentations can either be synchronous or, if the recorded videos are made available online, asynchronous. At the beginning of the Covid-19 pandemic, most schools were forced to change all lecture-style instruction to an online format. With students returning to classroom teaching, schools, and educators have to make a decision whether to offer online lecture recordings permanently, reintroduce in-person lecture presentations, or compromise on a combination of both. Each solution has its own advantages and disadvantages, some of which are discussed in this article. However, there appears to be no single 'best solution' to serve all learners, educators, and educational needs.

The Michigan Histology website as an example of a free anatomical resource serving learners and educators worldwide.

With anatomical education becoming a global endeavor, free online resources offered via the Internet or other electronic venues are of increasing importance for teaching and learning communities worldwide. Students and instructors from developing countries, often limited in access to modern instructional resources by infrastructural and financial constraints, are frequent users of such online learning tools. During the recent Covid-19 pandemic when all academic institutions were forced to quickly switch to a non-contact mode of teaching, free online instructional resources were often essential for continuing the educational mission. However, there are a number of obstacles and issues that need to be considered when creating and offering such learning resources. These include the type, quality, and completeness of the content, their educational purpose, access to technical and financial resources, copyright and ethical issues, and more. Educators, who plan to generate and maintain free online resources, should also be aware that such projects usually require a considerable long-term time commitment. In this article, these issues are discussed using the Michigan Histology website as an example. The discussion also addresses how e-learning resources like the Michigan Histology website supported online learning during the recent Covid-19 pandemic.

Teaching Histology Using Self-Directed Learning Modules (SDLMs) in a Blended Approach.

Introduction: New technologies like virtual microscopy have revolutionized histology education. However, first-year students often require additional assistance with virtual slides. Online self-directed learning modules (SDLMs) were developed to provide such support to learners by offering them short instructional videos that are uploaded to YouTube and the instructional website. The purpose of this study was to determine the effectiveness of SDLMs and to sample students' opinions about SDLMs. Method: Over a 3-year time span, SDLMs were used to augment histology lessons, and their effectiveness (on learning outcomes) was measured by using traditional steeple-chase and/or virtual slide assessments. Average percentage scores for both methods of assessment were compared using paired or independent t-tests. Student opinions about SDLMs were collected using an anonymous survey. The survey results were analyzed by average scores and thematic analysis of the narrative responses. Results: Using SDLMs in a blended approach showed significant improvement in students' academic performance - irrespective of the method of assessment. There was a strong positive correlation with the performance when students were assessed using the virtual slide method. However, a standalone approach using SDLMs did not positively impact learning outcomes. Survey results indicated that most students perceived the videos as helpful for understanding the subject better and as quick review opportunities. Conclusion: The results support the use of SDLMs in a blended instructional approach and as an adjunct resource to conventional microscopy. This use of SDLMs was positively received by learners and significantly improved the learning outcome. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-022-01669-9.

Brave new E-world: Medical students' preferences for and usage of electronic learning resources during two different phases of their education.

E-learning strategies have become an important part of biomedical education. However, why and how medical students select hardware tools and software formats during their preclinical education has not been sufficiently evaluated. These aspects should be considered when designing or offering new e-learning modalities to learners. Two medical school classes at a major US medical school were surveyed about their use of e-learning resources during their first year of medical school or their preparation for their first licensing examination (USMLE® Step 1), respectively. Their responses were analyzed for patterns and significant changes. Students' answers indicated that computers and tablets were considered the most important hardware devices to support students' learning. During the first year, students often preferred resources that were tailored to the specific courses in their curriculum. In contrast, some preferences changed when students prepared for the USMLE Step 1, with students shifting almost exclusively to a solitary learning strategy using commercial e-learning resources. Across all phases of medical school education queried, peer advice was the major determinant influencing e-learning resource selection with faculty only playing a minor role. Videos were the most popular e-learning modality, and students cited efficient acquisition of knowledge and preparation for examinations as major reasons for e-learning tool utilization. These factors should be considered when offering e-learning resources to medical students during different phases of their preclinical training.

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.

Digital information and communication technologies on histology learning: What to expect?-An integrative review.

This integrative review summarizes the scientific evidence about the use of information and communication technologies in the teaching of histology and discusses its implications. The authors used the descriptors 'Educational Technology', 'Information Technology', 'Histology', 'Teaching', 'Learning', and their corresponding Portuguese translation for a comprehensive search of the published literature. This research was performed in May 2020 and targeted the PubMed, SciELO, LILACS, WOS, and SCOPUS databases. Studies published between 2010 and 2020 in Portuguese, English, and Spanish were included in the analysis. After excluding dissertations, reports, and duplicate reviews, 11 articles were identified for an in-depth analysis, which discussed the use of different technologies, such as digital platforms, mobile apps, virtual microscopy, and video classes for the teaching of histology. All studies concluded that these technologies could have a considerable impact, both positive and negative, on academic performance, the correct interpretation of histological structures, as well as students' motivation and satisfaction. The authors' analysis indicates that the use of the above-mentioned technologies in combination with traditional methods has the potential of transforming the teaching and learning process for histology. However, how such technologies impact students' learning success needs to be carefully considered.

ObGyn Delivered: Social Media Serving Medical Students' Learning Needs.

The availability of social media in biomedical education is rapidly expanding. However, there is little information comparing the utility of different social media platforms. The authors sought to describe and evaluate a student-led medical education tool, ObGyn Delivered, that uses three social media platforms (Facebook, Instagram, and Twitter) in order to understand each platform's potential roles, benefits, and barriers and describe their advantages and limitations. Medical educators utilizing social media tools may benefit from focusing their efforts on the strengths of each platform to communicate different messages, provide unique content, and to reach a maximal number of potential users.

What faculty write versus what students see? Perspectives on multiple-choice questions using Bloom's taxonomy.

BACKGROUND: Using revised Bloom's taxonomy, some medical educators assume they can write multiple choice questions (MCQs) that specifically assess higher (analyze, apply) versus lower-order (recall) learning. The purpose of this study was to determine whether three key stakeholder groups (students, faculty, and education assessment experts) assign MCQs the same higher- or lower-order level. METHODS: In Phase 1, stakeholders' groups assigned 90 MCQs to Bloom's levels. In Phase 2, faculty wrote 25 MCQs specifically intended as higher- or lower-order. Then, 10 students assigned these questions to Bloom's levels. RESULTS: In Phase 1, there was low interrater reliability within the student group (Krippendorf's alpha = 0.37), the faculty group (alpha = 0.37), and among three groups (alpha = 0.34) when assigning questions as higher- or lower-order. The assessment team alone had high interrater reliability (alpha = 0.90). In Phase 2, 63% of students agreed with the faculty as to whether the MCQs were higher- or lower-order. There was low agreement between paired faculty and student ratings (Cohen's Kappa range .098-.448, mean .256). DISCUSSION: For many questions, faculty and students did not agree whether the questions were lower- or higher-order. While faculty may try to target specific levels of knowledge or clinical reasoning, students may approach the questions differently than intended.

How students choose E-learning resources: The importance of ease, familiarity, and convenience.

Electronic learning resources are popular with today's students. However, how students choose their favorite e-learning resources is not well-understood. The popular SecondLook TM histology self-review tool was offered in three different interfaces to students participating in two histology courses (Cell and Developmental Biology [CDB] 450/550 and DENT 510). These interfaces included PowerPoint files, an online website, and a mobile application (app). Identical in content, each interface had specific advantages and disadvantages with respect to compatible devices, user features, and access limitations. Upon the conclusion of the courses, students were surveyed about their interface preference, reasons for their selection, and general usage of the SecondLook TM resource. With a 91.4% overall survey participation rate, only 3 out of 213 participating students never used the resource. Many students (46.3% CDB 450/550, 62.9% DENT 510) tried only one interface, with PowerPoint being the most popular final choice (56.5% CBD 450/550, 65.7% DENT 510). Although the interactive website and mobile app offered additional user-friendly features, they only garnered between 16% and 24% final popularity. "Convenience," "larger screen," and "easy to use" were most often reported as reasons for students' interface preference. The accessibility of where and when the SecondLook TM resource can be used was also frequently cited. This availability encouraged some students to forgo other learning resources and to use the mobile app in distractive environments. The results of this study suggest that today's students are in fact less motivated to seek out high-tech e-learning resources than commonly believed and instead often select interfaces with which they are already familiar.

The road taken - changing one's professional focus at a large research university.

The scientific endeavor has many facets, extending well beyond the experimental research bench. However, in most fields, especially in the biomedical sciences, the traditional career pathway for scientists is first joining and later leading an experimental research laboratory or program. As a result, scientific education is often focused on training new bench researchers. My own journey from a traditional bench scientist to that of an educator and educational researcher will be discussed in the context of a large research university environment. Being a scientist with an educational focus at such an institution poses significant challenges, but also opens new opportunities. In my opinion, these two professional pathways are not exclusive or alternative choices, but rather are complementary, both representing important and essential elements of scientific progress.

How to Make Educational Lemonade Out of a Didactic Lemon: The Benefits of Listening to Your Students.

When educators develop and introduce new learning approaches or resources, they usually have specific didactic goals in mind that they want to achieve. However, these goals may not always match the needs of their students, who often confound such plans by finding new and different uses for the educational tools that are offered to them. Originating from the author's work as the histology component director at the University of Michigan, the experience described here provides an example of a learning resource being reappropriated by the learning community. In order to encourage dental students to study histological micrographs after faculty-guided laboratory sessions were eliminated, the author prepared and offered them a series of PowerPoint files with histology images and some corresponding questions. However, instead of increasing their motivation to use the online virtual microscopy resources, students adapted this new tool for reviewing the material and for self-evaluation whether they were prepared for upcoming examinations. Although the product did not succeed as originally devised, it turned into a very popular review resource for the author's students. Students' feedback and critical input, as well as their active participation in producing additional, similar learning tools were the deciding factors for this successful change of purpose and the further development and refinement of this new learning resource.

Overcoming Barriers in a Traditional Medical Education System by the Stepwise, Evidence-Based Introduction of a Modern Learning Technology.

INTRODUCTION: Histology teaching in India and in other developing countries has not changed much over the past decades and has not joined the global movement of using virtual microscopy (VM). Many factors may have contributed to this academic inertia-including curricular requirements for traditional microscopy (TM) skills, assessments that are heavily based on TM, and unfamiliarity with modern technology among faculty, as well as infrastructural shortcomings. This study is aimed at overcoming these roadblocks by using a blended approach combining VM with TM in a tradition-centered curricular setting. METHODS: For validation of this approach, the authors conducted a non-randomized controlled trial with a crossover design on first year medical students at the Government Medical College, Thiruvananthapuram, India. Examination scores and responses of a student group taught with VM as an adjunct to TM were compared with a student group taught with TM only. RESULTS: The test group had significantly better results when compared to the control group for knowledge-based tests (p = 0.012; analysis of co-variance) and for an unannounced visual-based test conducted 1 month later (p = 0.001; Mann-Whitney U test). Feedback collected from students showed highly favorable responses to the use of VM for teaching histology. CONCLUSION: This study should encourage Indian medical colleges and schools in other developing countries to start using VM as a supplementary approach for their histology education programs. Furthermore, as the Medical Council of India recommends the introduction of new competency-based integrated curriculum in India starting in 2019, the use of VM may facilitate more effective learning in the new scenario. TRIAL REGISTRATION: CTRI/2018/04/012928.

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.

The interrupted learner: How distractions during live and video lectures influence learning outcomes.

New instructional technologies have been increasingly incorporated into the medical school learning environment, including lecture video recordings as a substitute for live lecture attendance. The literature presents varying conclusions regarding how this alternative experience impacts students' academic success. Previously, a multi-year study of the first-year medical histology component at the University of Michigan found that live lecture attendance was positively correlated with learning success, while lecture video use was negatively correlated. Here, three cohorts of first-year medical students (N = 439 respondents, 86.6% response rate) were surveyed in greater detail regarding lecture attendance and video usage, focusing on study behaviors that may influence histology learning outcomes. Students who reported always attending lectures or viewing lecture videos had higher average histology scores than students who employed an inconsistent strategy (i.e., mixing live attendance and video lectures). Several behaviors were negatively associated with histology performance. Students who engaged in "non-lecture activities" (e.g., social media use), students who reported being interrupted while watching the lecture video, or feeling sleepy/losing focus had lower scores than their counterparts not engaging in these behaviors. This study suggests that interruptions and distractions during medical learning activities-whether live or recorded-can have an important impact on learning outcomes. Anat Sci Educ 11: 366-376. © 2017 American Association of Anatomists.