Outcomes of Remote Pathology Instruction in Student Performance and Course Evaluation

Virtual biopsies: Proof of concept for a novel quantitative approach to liver biopsy adequacy and pathology education

OBJECTIVES

To quantitatively measure liver biopsy adequacy requirements and the effect of a teaching intervention that uses a virtual biopsy platform.

METHODS

A library of virtual liver biopsies was created using digital whole-slide, trichrome-stained tissue sections from liver resection material and QuPath image analysis software. Blinded participants staged fibrosis on the virtual biopsies before and after a teaching intervention.

RESULTS

This platform both modeled adequacy requirements for cirrhosis diagnosis on biopsy material and measured the effect of a teaching intervention on participant performance. Using this platform, diagnostic accuracy for cirrhosis could be modeled according to the function y = λ(1 ‒ e‒x/γ). The platform demonstrated that the relationship between biopsy size and diagnostic accuracy was statistically significant and that biopsies smaller than 6 mm long and 0.8 mm wide were insufficient to diagnosis cirrhosis. The platform also measured improvement in fibrosis staging accuracy among participants following a teaching intervention.

CONCLUSIONS

These results provide proof of concept for a virtual biopsy method by which outstanding questions in anatomic pathology can be addressed quantitatively using open source software. Future work is needed to validate these findings in clinical practice.

Are We Where We Want to Be in Undergraduate Pathology Education?

OBJECTIVE

This review which aims to examine the recent and current status of pathology education in medical schools, and covers the publications related to undergraduate pathology education published between 2010 January and June 2023.

MATERIAL AND METHOD

A search was performed through PubMed, Google Scholar, Semantic Scholar, and Ulakbim search engines for the Science Citation Index, Science Citation Index Expanded, Emerging Sources Citation Index, Directory of Open Access Journals, Scopus, PubMed as well as TR Dizin indexed articles. The findings are categorized into two periods as 2010 January - 2020 April (pre-COVID-19 pandemic) and May 2020 - 2023 June. A total of 24 reviews/editorials/letters to the editor and 63 research articles in the pre-pandemic period and 11 reviews/ editorials/ letters to the editor and 35 research articles between 2020 May and 2023 June are included in the analysis.

RESULTS

Currently, medical education generally depends on core education programs with defined learning objectives and outcomes. Moreover, problem-based, case-based, and team-based interactive learning are being used along with traditional didactic courses. Additionally, digital/ web-based/remote education methods have gained prominence after the COVID-19 pandemic. The virtual or augmented reality and 3D drawing applications are offered as a solution for the autopsy and macroscopy courses. A scarce number of publications are found on measuring and evaluating the effectiveness of learning.

CONCLUSION

Artificial intelligence in pathology education is a topic that looks likely to become important in the near future. National and international comprehensive standardization is a necessity. A joint effort and collective intelligence are needed to achieve the desired goals in undergraduate pathology education.

Medical Education During COVID-19 Pandemic: A Comparative Effectiveness Study of Face-to-Face Traditional Learning Versus Online Digital Education of Basic Sciences for Medical Students

BACKGROUND

During the coronavirus disease 2019 (COVID-19) pandemic, internet-based learning modalities and online classes became a tool for the continuous learning process for medical students. The aim of this study was to compare medical student performance in both online versus offline instructional methods.

METHODS

The study was conducted on 213 medical students of the basic science program at the American University of Antigua, College of Medicine (AUACOM), who completed the four semesters consecutively between Spring 2018 and Fall 2020. Two cohorts of students were considered in the study: cohort 1 (those who completed years 1 and 2 using traditional offline teaching modality) and cohort 2 (those who completed year 1 offline and year 2 online). The years 1 and 2 National Board of Medical Examiners (NBME) summative assessment scores of the students were used to determine which instructional modality generated better student performance outcomes for the two groups. Additionally, we evaluated the score variabilities between genders to determine if teaching modality had an impact on a specific group. All statistical comparisons were done using two-tailed t-tests.

RESULTS

The study involves 213 students (112 in cohort 1, 101 in cohort 2). There was no significant difference in student performance between offline and online learners overall (74 ± 2.3 vs. 73 ± 1.3; p = 0.537) or with respect to gender (73 ± 3.8 vs. 73 ± 3.0; p = 0.709).

CONCLUSION

In this comparative effectiveness study of traditional offline education versus online instructional modality, we observed no statistical difference in student performance evaluated with NBME summative assessment scores. Online classes were well-accepted by our students. These data show a significant and promising potential for the future of medical education using online teaching modalities. Remote online teaching could be used again in the future without detriment to student education if face-to-face (F2F) learning is not possible.

Design and Transition of an Emergency E-Learning Pathology Course for Medical Students-Evaluation of a Novel Course Concept

BACKGROUND

Around the world, the emergency brought about by the COVID-19 pandemic forced medical schools to create numerous e-learning supplements to provide instruction during this crisis. The question now is to determine a way in which to capitalize on this momentum of digitization and harness the medical e-learning content created for the future. We have analyzed the transition of a pathology course to an emergency remote education online course and, in the second step, applied a flipped classroom approach including research skills training.

METHODS

In the summer semester of 2020, the pathology course at the Technical University of Munich was completely converted to an asynchronous online course. Its content was adapted in winter 2021 and incorporated into a flipped classroom concept in which research skills were taught at the same time.

RESULTS

Screencasts and lecture recordings were the most popular asynchronous teaching formats. Students reported developing a higher interest in pathology and research through group work. The amount of content was very challenging for some students.

CONCLUSION

Flipped classroom formats are a viable option when using pre-existing content. We recommend checking such content for technical and didactic quality and optimizing it if necessary. Content on research skills can be combined very well with clinical teaching content.

A systematic review of videoconferencing in health professions education: the digital divide revisited in the COVID-19 era

OBJECTIVES

During the COVID-19 pandemic, educators shifted from traditional lectures to videoconferencing. This systematic review explored the use of videoconferencing as a teaching tool in response to the pandemic as well as issues related to digital equity and inclusion.

CONTENT

The review was conducted using the Joanna Briggs Institute for Systematic Reviews methodology and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement.

SUMMARY

A total of nine studies met eligibility criteria. The participants in the included studies were medical students from various parts of the world. Technical difficulties and lack of human interactions were identified as barriers to learning through videoconferencing.

OUTLOOK

To achieve full success, pedagogical videoconferencing must prioritize digital equity and a universal design for learning. Although useful for maintaining education during the pandemic, in the future, videoconferencing will present challenges related to the digital divide as well as opportunities as a teaching tool for nurse educators globally.

Virtual Pathology Education in Medical Schools Worldwide during the COVID-19 Pandemic: Advantages, Challenges Faced, and Perspectives

The COVID-19 pandemic shifted pathology education in medical schools worldwide towards online delivery. To achieve this goal, various innovative platforms were used by pathology educators and medical students, facilitating both synchronous and asynchronous learning. The aim of this study was to review the published evidence regarding remote pathology teaching at the medical school level during this period, present our own experience, and provide some perspectives regarding the best mode of pathology teaching post-pandemic. Among its advantages, virtual pathology education was considered among students and educators as convenient, flexible, and engaging, while learning outcomes were met and students’ academic performance was in general satisfactory. However, several challenges were faced. For instance, suboptimal internet connection compromised the flow of classes and was even associated with a lower academic performance. The lack of hands-on laboratory activities, such as operating the light microscope and tissue grossing, and the reduced student interactions among themselves and their instructors, were also pointed out as significant drawbacks of remote pathology education. Whereas online education has multiple advantages, experiencing the physical university environment, in-person interactions and teamwork, exposure to the “hidden curriculum”, and hands-on activities are vital for medical school education and future student development. In conclusion, the implementation of a blended approach in pathology education—where online and face-to-face sessions are jointly used to promote students’ engagement, interaction with their instructors and peers, and learning—could be the most optimal approach to pathology teaching in medical schools post-pandemic.

Educational adaptation to clinical training during the COVID-19 pandemic: a process analysis

BACKGROUND

The COVID-19 pandemic is unprecedented in terms of the extent and rapidity of the disruption forced upon formal clinical education, most notably the extensive transition of clinical skills learning to interactive video-based clinical education.

METHODS

In a phenomenologic study, we used thematic analysis to explore the COVID-19 disruption to clinical training and understand processes relating to adaptation in a large academic medical center. We conducted semi-structured interviews with 14 clinical teachers and 16 trainees representing all levels of clinical learning. Interviews occurred within the initial three months of the crisis, and data were analyzed following a thematic analysis coding process.

RESULTS

We constructed eight themes synthesizing our participants' perceptions of the immediate unanticipated disruption, noting in the process their alignment with a change management framework. These included: urgency in adapting, with an obvious imperative for change; overcoming inconsistent involvement and support through the formation of self-organized frontline coalitions; attempts to develop strategy and vision via initially reactive but eventually consistent communication; empowering a volunteer army through co-creation and a flattened hierarchy; and efforts to sustain improvement and positive momentum with celebration of trial, error, and growth. The majority of participants found positive outcomes resulting from the tumultuous change process. Moreover, they were now more readily accepting of change, and tolerant of the ambiguous and iterative nature inherent in the education change process. Many anticipated that some innovation would, or would at least deserve to, continue post- crisis.

CONCLUSIONS

The COVID-19 pandemic afforded an opportunity to study the content and process of change during an active crisis. In this case of clinical education, our findings provide insight into the ways an academic medical system adapts to unanticipated circumstances. We found alignment with broader organizational change management models and that, compared with crisis management models (and their shorter term focus on resolving such crises), stakeholders self-organized in a reliable manner that carries the potential advantage of preserving such beneficial change.