Comparing the performance of artificial intelligence learning models to medical students in solving histology and embryology multiple choice questions

INTRODUCTION

The appearance of artificial intelligence language models (AI LMs) in the form of chatbots has gained a lot of popularity worldwide, potentially interfering with different aspects of education, including medical education as well. The present study aims to assess the accuracy and consistency of different AI LMs regarding the histology and embryology knowledge obtained during the 1st year of medical studies.

METHODS

Five different chatbots (ChatGPT, Bing AI, Bard AI, Perplexity AI, and ChatSonic) were given two sets of multiple-choice questions (MCQs). AI LMs test results were compared to the same test results obtained from 1st year medical students. Chatbots were instructed to use revised Bloom's taxonomy when classifying questions depending on hierarchical cognitive domains. Simultaneously, two histology teachers independently rated the questions applying the same criteria, followed by the comparison between chatbots' and teachers' question classification. The consistency of chatbots' answers was explored by giving the chatbots the same tests two months apart.

RESULTS

AI LMs successfully and correctly solved MCQs regarding histology and embryology material. All five chatbots showed better results than the 1st year medical students on both histology and embryology tests. Chatbots showed poor results when asked to classify the questions according to revised Bloom's cognitive taxonomy compared to teachers. There was an inverse correlation between the difficulty of questions and their correct classification by the chatbots. Retesting the chatbots after two months showed a lack of consistency concerning both MCQs answers and question classification according to revised Bloom's taxonomy learning stage.

CONCLUSION

Despite the ability of certain chatbots to provide correct answers to the majority of diverse and heterogeneous questions, a lack of consistency in answers over time warrants their careful use as a medical education tool.

Transfer of learning in histology: Insights from a longitudinal study

All anatomical educators hope that students apply past training to both similar and new tasks. This two-group longitudinal study investigated the development of such transfer of learning in a histology course. After 0, 10, and 20 sessions of the 10-week-long course, medical students completed theoretical tasks, examined histological slides trained in the course (retention task), and unfamiliar histological slides (transfer task). The results showed that students in the histology group gradually outperformed the control group in all tasks, especially in the second half of the course, η2  = 0.268 (p < 0.001). The best predictor of final transfer performance was students' retention performance after 10 sessions, β = 0.32 (p = 0.028), and theoretical knowledge after 20 sessions, β = 0.46 (p = 0.003). Results of eye tracking methodology further revealed that the histology group engaged in greater "visual activity" when solving transfer tasks, as indicated by an increase in the total fixation count, η2  = 0.103 (p = 0.014). This longitudinal study provides evidence that medical students can use what they learn in histology courses to solve unfamiliar problems but cautions that positive transfer effects develop relatively late in the course. Thus, course time and the complex relationship between theory, retention, and transfer holds critical implications for anatomical curricula seeking to foster the transfer of learning.

Perceptions of medical students towards the role of histology and embryology during curricular review

BACKGROUND

The continuous changes in the medical education to prepare medical doctors for the future requires updates in medical curriculum. However, the perspectives of the medical students are not frequently considered during the revision of the medical curriculum. In parallel with the process of defining and adjusting the medical curriculum, a large survey was performed to inquire the perspectives of the medical students at the Faculty of Medicine of the University of Porto (FMUP), Portugal, about the role of Histology and of Embryology.

METHODS

Medical students at FMUP (Portugal) completed a structured and anonymous online questionnaire about the subjects Histology and Embryology. The questionnaire was prepared using questions of previous surveys performed in Europe, including another Portuguese medical school, and additional questions that were specifically prepared to this study. The questions referred to teaching methods, clinical relevance, use of virtual (digital) microscopes and association of Histology and Embryology with other subjects of the medical curriculum.

RESULTS

Four hundred and sixty-two students participated in the study. The students in clinical years were more likely to recognise the clinical relevance of Histology (p = 0.016) and Embryology (p < 0.001). Students agree that teaching of these subjects would benefit from a clinical orientation (89% for Histology; 90% for Embryology). Students highlighted that Histology is crucial to understand Biopathology and agree (75%) that an integration of Histology with Biopathology could be considered in the medical curriculum. Most students (55%) agree that slide microscopes are more useful than virtual microscopes.

CONCLUSIONS

Our study contributes to the debate about the evolution of medical curriculum. Gathering the medical students' perceptions using large surveys such as that performed in the present study may be useful to adapt the methods of teaching which may increase the motivation of the students. In the case of Histology and Embryology at the FMUP (Portugal) providing more clinically oriented teaching may be useful to motivate the students. Students of clinical years have strong clinical perspectives of Histology and Embryology and their enrolment in teaching of Histology and Embryology can also contribute to increase motivation of younger students. Consulting and involving medical students in the development of the medical curriculum can be positive and students should be more responsible and engaged in building their own education.

Integration of virtual microscopy podcasts in the histology discipline in osteopathic medical school: Learning outcomes

Virtual microscopy podcasts (VMPs) are narrative recordings of digital histology images. This study evaluated the outcomes of integrating the VMPs into teaching histology to osteopathic medical students. The hypothesis was that incorporating virtual microscopy podcasts as supplementary histology resources to the curriculum would have a positive impact on student performance and satisfaction. Sixty-one podcasts of dynamic microscopic images were created using screen recordings of the digital slides. The VMPs were integrated as supplementary histology resources in multiple courses during the first and second years of the medical curriculum for three classes, a total of 477 osteopathic medical students. A voluntary and anonymous survey was obtained from the students using a questionnaire that included two open-ended questions. The overall performance of the three classes on the histology content of the preclinical course examinations was compared to historical controls of the previous two classes that did not have access to the VMPs. Most students indicated that the podcasts enabled more efficient study time and improved their confidence in the histology content on examinations. The findings indicated a positive association between podcast viewing and efficient study time utilization and class performance. The class average scores of the three consecutive cohorts that used the VMPs progressively increased by 7.69%, 14.88%, and 14.91% compared to the controls. A summary of students' feedback and academic performance supported that integration of the VMPs into Histology teaching improved the learning experience. The findings align with previous studies on the effectiveness of multimedia-based teaching in histology laboratory modules.

The usefulness of histopathology examples in teaching practical histology for medical students: A CONSORT-compliant randomized crossover trial

BACKGROUND

Teaching histology as an image-intensive discipline is a major challenge to medical teachers. We compared knowledge retention and student preference after performing comparison-based and traditional methods of teaching practical histology.

METHODS

We performed a crossover randomized controlled trial. Eighty nine first-year and 37 second-year medical students were randomly assigned to comparison-based or traditional classes in which PowerPoint slides were used. Each teaching approach was then switched to another group for a second tissue set. Quantitative assessment was performed using multiple-choice questions and a questionnaire.

RESULTS

The first-year students' overall examination scores were significantly higher in the comparison-based approach compared to the traditional approach for both tissue sets, with a large effect size. Interestingly, even for the second-year students, a significantly higher overall score for one set of tissue samples was observed in the comparison-based approach compared to the traditional approach. The students' responses to all the elements in the questionnaire were significantly in favor of the comparison-based approach.

CONCLUSION

Our findings indicate that the simple implementation of a few histopathology examples can yield a tremendous improvement in first-year medical students' understanding, enjoyment, and engagement in practical histology classes.

Virtual Microscopy as a Learning Tool in Brazilian Medical Education

Virtual microscopy (VM) is a widely used teaching method in Medical Education in many developed countries. In Brazil, however, this is not the case for most medical schools, considering Brazilian social inequality and uneven access to technology. Recently, the Covid-19 pandemic has also challenged Universities to seek and make a transition toward more effective methods of full-time online education. Thus, the main goal of this work was to verify student's perception and academic performance, assessed upon VM implementation in a Brazilian Medical School. Ribeirao Preto Medical School students answered a 26-question survey with regards to optical microscopy (OM) and VM. Academic performance was compared between participants that were (year of 2019) or were not (year of 2015) exposed to VM. Taken the results together, subjective impressions such as handling, suitability, learning effectiveness, and pleasure using the tools, have shown a higher score for virtual microscopy (median = 29), when compared to optical microscopy (median = 24) with a P-value < 0.001 by Wilcoxon rank test, upon measurement using an ordinal scale. Regarding academic performance, no statistically significant differences were found between groups (P-value = 0.38, Cohen's d = 0.19). Therefore, VM proved to be adequate to the Brazilian medical education in light of Brazilian social contexts and Covid-19 pandemic.

Students´ preparedness, learning habits and the greatest difficulties in studying Histology in the digital era: A comparison between students of general and dental schools

INTRODUCTION

There are only sporadic references in literature regarding general medicine and dentistry student´s preparedness for Histology, study resources and how students might use them in the era of virtual microscopy.

METHODS

A structured questionnaire was used to evaluate students´ opinion, with 192 students of general medicine and 82 students of dentistry responding.

RESULTS

The dentistry students evaluate their previous knowledge of basic high school disciplines as less helpful when compared to their general medicine colleagues, but this difference diminishes during the first year of medical school studies. Students of dentistry display a better orientation in the amount of study resources (electronic vs printed) and also the ways of their use (practical vs theoretical preparation). The main problems surfacing in the study of Histology have been: the lack of time due to the high demands of Anatomy, problems with correct identification of structures in specimens and correct orientation in a large number of available study resources. Students indicate that they would appreciate the introduction of interactive exercise tests to verify practical and theoretical knowledge.

CONCLUSION

We revealed significant differences between students of general medicine and dentistry in terms of student´s preparedness and learning habits. According to our findings, it is still necessary to further develop teaching methods utilising virtual microscopy, taking into account the needs of both general medicine and dental school students.

A Web-Based Virtual Microscopy Platform for Improving Academic Performance in Histology and Pathology Laboratory Courses: A Pilot Study

Virtual microscopy (VM) has been utilized to improve students' learning experience in microscope laboratory sessions, but minimal attention has been given to determining how to use VM more effectively. The study examined the influence of VM on academic performance and teacher and student perceptions and compared laboratory test scores before and after VM incorporation. A total of 662 third-year students studying histology and 651 fourth-year students studying pathology were divided into two groups. The light microscopy (LM) group used a light microscope in 2014 and 2015, while the LM + VM group used the VM platform and a light microscope in 2016 and 2017. Four factors positively predict laboratory scores (R square, 0.323; P < 0.001): (i) the pathology course and test-enhanced learning, (ii) the VM platform and experience, (iii) medical students and lecture scores, and (iv) female students. The LM + VM group exhibited less score variability on laboratory examinations relative to their mean than the LM group. The LM + VM group was also associated with fewer failing grades (F grade; odds ratio, 0.336; P < 0.001) and higher scores (A grade; odds ratio, 2.084; P < 0.001) after controlling for sex, school, course, and lecture grades. The positive effect of the VM platform on laboratory test grades was associated with prior experience using the VM platform and was synergistic with more interim tests. Both teachers and students agreed that the VM platform enhanced laboratory learning. The incorporation of the VM platform in the context of test-enhanced learning may help more students to master microscopic laboratory content.

Histology and Embryology Education in China: The Current Situation and Changes Over the Past 20 Years

In mainland China, histology and embryology (HE) are taught in one course as an essential component of medical curricula. The effectiveness of HE courses directly affects the quality of medical students. To determine the present situation and changes in HE teaching in Chinese medical schools, a nationwide survey was conducted among the HE departmental leaders. In total, 66 responses were included in the study, representing prominent Chinese mainland medical schools. The results revealed that most HE teachers have medical educational backgrounds; an increasing number of teaching staff with PhDs have joined the teaching staffs. A range of 71 to 90 HE curriculum contact hours is predominant. The ratio of theory to practice for HE contact hours is 1:1 at half of the surveyed medical schools. The numbers of students in each laboratory are less than 30 and from 31 to 60 at 23 and 36 medical schools, respectively. Virtual microscopy is employed in 40% of the surveyed medical schools. Didactic teaching is the most common strategy, although new teaching approaches are being employed gradually. During the past 20 years, both the total number of HE teachers and the number of HE teachers with medical educational backgrounds have been reduced in at least half of the surveyed schools. A total of 83.33% of the surveyed schools have reduced their HE contact hours. Almost half of the Chinese medical schools remained unchanged in both their ratio of theory to practice and the number of students in each laboratory. The data derived from this study help to understand the development of the HE discipline at Chinese medical schools.

Development of an interactive e-learning software "Histologie für Mediziner" for medical histology courses and its overall impact on learning outcomes and motivation

Objective: To develop and evaluate an interactive histology learning software for medical students in the preclinical study phase. The educational design of the software was based on current learning theory models, such as the Cognitive load theory, Cognitive theory of multimedia learning, and the ARCS model, so that the acquired knowledge can be repeated using a diversified design. Moreover, the learning effects achieved by using the software shall be evaluated. Apart from the software's usability, the influence of the learning theory principles on the students' motivation shall be assessed. Methodology: The software was evaluated using an experimental wait list control group with a pre-/post-test design (n=213). Depending on the group they were assigned to, students learned the histology contents of chapter "Liver, gall bladder, pancreas" using the traditional program of the Goethe University (n=65), the new interactive software (n=56), or without any of the two software versions (n=92). The influence of the different learning aids on the acquisition of knowledge was assessed with three questionnaires comprising four different multiple choice questions each. For the evaluation of the usability and motivational factors, a second test was added to the questionnaire of both software versions. Results: The interactive software was rated significantly better with regard to usability and motivational aspects than the traditional learning program (F(7, 113)=12.48, p<.001, partial η²=.436). Moreover, use of the interactive software resulted in a significant increase of knowledge acquisition as compared to the group of students who had learned without any of the two software versions (0.77, p=.001). Conclusion: With regard to the histology contents, usability was comparable to the official learning program. Interactive elements and the educational design contributed to an increase of the factors that are essential for intrinsic motivation. Thus, our program can be valuable tool to supplement the curriculum as an additional service.

An Expert Derived Feedforward Histology Module Improves Pattern Recognition Efficiency in Novice Students

Histology is a visually oriented, foundational anatomical sciences subject in professional health curricula that has seen a dramatic reduction in educational contact hours and an increase in content migration to a digital platform. While the digital migration of histology laboratories has transformed histology education, few studies have shown the impact of this change on visual literacy development, a critical competency in histology. The objective of this study was to assess whether providing a video clip of an expert's gaze while completing leukocyte identification tasks would increase the efficiency and performance of novices completing similar identification tasks. In a randomized study, one group of novices (n = 9) was provided with training materials that included expert eye gaze, while the other group (n = 12) was provided training materials with identical content, but without the expert eye gaze. Eye movement parameters including fixation rate and total scan path distance, and performance measures including time-to-task-completion and accuracy, were collected during an identification task assessment. Compared to the control group, the average fixation duration was 13.2% higher (P < 0.02) and scan path distance was 35.0% shorter in the experimental group (P = 0.14). Analysis of task performance measures revealed no significant difference between the groups. These preliminary results suggest a more efficient search performed by the experimental group, indicating the potential efficacy of training using an expert's gaze to enhance visual literacy development. With further investigation, such feedforward enhanced training methods could be utilized for histology and other visually oriented subjects.

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.

Students' Views on Difficulties in Learning Histology

The aim of this study was to provide a better understanding of the main difficulties hindering undergraduate biology students in learning histology. The study utilized a self-administered questionnaire which included three closed-ended and two open-ended questions: (1) if students had difficulty in learning about each tissue type; (2) what might be the problem in learning about the tissue at hand; (3) which topics were the most difficult; (4) what were the possible reasons that made image identification of tissue types difficult; and (5) how to improve the course curriculum from a student perspective. The survey was administered to 139 undergraduate biology students enrolled in a histology course, of which 101 surveys were completed and analyzed both qualitatively and quantitatively. The topics that students experienced the most difficulties with were: nervous tissue, plant tissues, bone tissues, and glandular epithelial tissue. The main reasons students experienced difficulties with these tissue types, according to the students themselves, were the nature of the topic, grasping the terminology used, and insufficient teaching time. Students suggested the adoption of strategies such as: teaching based on practical tasks; reducing the content of the histology curriculum; adding anatomy subjects; and making histology education more interesting.

Using online game-based platforms to improve student performance and engagement in histology teaching

BACKGROUND

Human morphology is a critical component of dental and medical graduate training. Innovations in basic science teaching methods are needed to keep up with an ever-changing landscape of technology. The purpose of this study was to investigate whether students in a medical and dental histology course would have better grades if they used gaming software Kahoot® and whether gamification effects on learning and enjoyment.

METHODS

In an effort to both evoke students' interest and expand their skill retention, an online competition using Kahoot® was implemented for first-year students in 2018 (n = 215) at the University of Eastern Finland. Additionally, closed (160/215) or open-ended (41/215) feedback questions were collected and analyzed.

RESULTS

The Kahoot® gamification program was successful and resulted in learning gains. The overall participant satisfaction using Kahoot® was high, with students (124/160) indicating that gamification increased their motivation to learn. The gaming approach seemed to enable the students to overcome individual difficulties (139/160) and to set up collaboration (107/160); furthermore, gamification promoted interest (109/160), and the respondents found the immediate feedback from senior professionals to be positive (146/160). In the open-ended survey, the students (23/41) viewed collaborative team- and gamification-based learning positively.

CONCLUSION

This study lends support to the use of gamification in the teaching of histology and may provide a foundation for designing a gamification-integrated curriculum across healthcare disciplines.

Evaluation of the effectiveness of the presentation of virtual histology slides by students during classes. Are there any differences in approach between dentistry and general medicine students?

INTRODUCTION

Virtual microscopy, used as a method to teach histology, has many undeniable advantages. However, the usefulness of this method is somewhat limited by the difficulties students face in finding their way through huge amounts of digital data, compounded by decreased interaction between students and teachers. We describe the results of a recent pilot project which combined the modern teaching methods of active learning, where students themselves present histological slides and make use of the virtual microscopy system.

METHODS

Students' responses to a structured questionnaire and examination results were evaluated.

RESULTS

We found that a combination of both electronic materials and textbooks was commonly used by students to prepare for practical teaching sessions, with electronic resources being used regularly by the majority of students. No statistically relevant differences were found between the approaches of dentistry vs general medicine students. Cooperation between students' groups during the preparation for individual presentations was seen to be beneficial by a majority of dentistry students; they reported that the introduction of student-led presentations improved their quality of preparation for practical lessons, as well as increasing their participation and activity level in the lessons themselves. These different approaches and motivations between students of dentistry and general medicine are reflected in the test results where dentistry students are more successful.

CONCLUSION

We confirm that there are differences in motivation, approaches and examination results between both groups of students, which should be taken into account and which could lead to differentiation of future curricula for both study courses.

Clinical Case-Based Image Portfolios in Medical Histopathology

This descriptive article describes the use of clinical case-based portfolios in histopathology teaching laboratories in conjunction with virtual microscopy not only to integrate histology and pathology disciplines for first and second year medical students but also to stimulate student engagement, promote self-directed and group-based learning and enhance student-to-student interaction in a structured manner. Portfolios consisted of PowerPoint files encompassing four to five clinical case studies relevant to the topics covered that week. Portfolios integrated study materials provided in the module-specific lectures, clinical skill lectures, and online interactive content. Two sets of portfolios, Individual and Group, were used. Individual Portfolios were completed by each student and uploaded prior to the laboratory session. Group Portfolios were completed by students working together in small groups during the laboratory session with minimal faculty assistance. The functional utility and acceptance of Individual and Group Portfolios among first- and second-year medical students was evaluated using electronic surveys and examination performances. Both first- and second-year students agreed that the use of portfolios in conjunction with virtual microscopy promoted understanding and encouraged discussion of the topics covered during the week and that group members worked well together and contributed to the completion of the portfolios. Performances on the Histology and Cell Biology and Pathology sections on the United States Medical Licensing Examination^® (USMLE^® ) remained consistent and in line with national averages. Overall, use of portfolios promoted peer teaching and contributed towards successful transition to the new system-based integrated curriculum with continued strong performance on the USMLE.

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.

A large drawing of a nephron for teaching medical students renal physiology, histology, and pharmacology

The purpose of this study is to see whether a large drawing of a nephron helped medical students in self-directed learning groups learn renal physiology, histology, and pharmacology before discussing clinical cases. The end points were the grades on the renal examination and a student survey. The classes in the fall of 2014 and 2015 used the drawing, but not those of 2012 and 2013. The Charles E. Schmidt College of Medicine at Florida Atlantic University is a newly formed Florida medical school, which enrolled its first class in the fall of 2011. The school relies on self-directed problem-based learning in year 1 and changes over to a case inquiry method in the latter part of year 1 and throughout year 2. At the start of the renal course, each student group received a poster of a nephron with the objective of learning the cell functions of the different nephron parts. During the first year of using the drawing, there was no improvement in grades. After a student suggested adjustment to the drawing, there was a statistically significant difference in the total test score in the second year ( P < 0.001). An unexpected finding was lower grades in all 4 yr in the area of acid-base balance and electrolytes compared with the other four areas tested. In the survey, the students found the drawing useful.

Climbing Bloom's taxonomy pyramid: Lessons from a graduate histology course

Bloom's taxonomy was adopted to create a subject-specific scoring tool for histology multiple-choice questions (MCQs). This Bloom's Taxonomy Histology Tool (BTHT) was used to analyze teacher- and student-generated quiz and examination questions from a graduate level histology course. Multiple-choice questions using histological images were generally assigned a higher BTHT level than simple text questions. The type of microscopy technique (light or electron microscopy) used for these image-based questions did not result in any significant differences in their Bloom's taxonomy scores. The BTHT levels for teacher-generated MCQs correlated positively with higher discrimination indices and inversely with the percent of students answering these questions correctly (difficulty index), suggesting that higher-level Bloom's taxonomy questions differentiate well between higher- and lower-performing students. When examining BTHT scores for MCQs that were written by students in a Multiple-Choice Item Development Assignment (MCIDA) there was no significant correlation between these scores and the students' ability to answer teacher-generated MCQs. This suggests that the ability to answer histology MCQs relies on a different skill set than the aptitude to construct higher-level Bloom's taxonomy questions. However, students significantly improved their average BTHT scores from the midterm to the final MCIDA task, which indicates that practice, experience and feedback increased their MCQ writing proficiency. Anat Sci Educ 10: 456-464. © 2017 American Association of Anatomists.

Anatomical sciences: A foundation for a solid learning experience in dental technology and dental prosthetics

Basic science courses are extremely important as a foundation for scaffolding knowledge and then applying it in future courses, clinical situations as well as in a professional career. Anatomical sciences, which include tooth morphology, oral histology, oral embryology, and head and neck anatomy form a core part of the preclinical courses in dental technology programs. In this article, the importance and relevance of anatomical sciences to dental personnel with no direct contact with patients (dental technicians) and limited discipline related contact with patients (dental prosthetists) is highlighted. Some light is shed on the role of anatomical sciences in the pedagogical framework and its significance in the educational process and interprofessional learning of dental technicians and prosthetists using oral biology as an example in the dental curriculum. To conclude, anatomical sciences allow dental technicians and prosthetists to a gain a better insight of how tissues function, leading to a better understanding of diagnosis, comprehensive treatment planning and referrals if needed. Patient communication and satisfaction also increases as a result of this deep understanding of oral tissues. Anatomical sciences bridge the gap between basic science, preclinical, and clinical courses, which leads to a holistic approach in patient management. Finally, treatment outcomes are positively affected due to the appreciation of the macro and micro structure of oral tissues. Anat Sci Educ 10: 395-404. © 2016 American Association of Anatomists.

The "flipped classroom" approach: Stimulating positive learning attitudes and improving mastery of histology among medical students

Traditional medical education methodologies have been dramatically impacted by the introduction of new teaching approaches over the past few decades. In particular, the "flipped classroom" format has drawn a great deal of attention. However, evidence regarding the effectiveness of the flipped model remains limited due to a lack of outcome-based studies. In the present study, a pilot histology curriculum of the organ systems was implemented among 24 Traditional Chinese Medicine (TCM) students in a flipped classroom format at Jinan University. As a control, another 87 TCM students followed a conventional histology curriculum. The academic performance of the two groups was compared. In addition, a questionnaire was administered to the flipped classroom group. The test scores for the flipped classroom participants were found to be significantly higher compared to non-participants in the control group. These results suggest that students may benefit from using the flipped classroom format. Follow-up questionnaires also revealed that most of the flipped classroom participants undertook relatively more earnest preparations before class and were actively involved in classroom learning activities. The teachers were also found to have more class time for leading discussions and delivering quizzes rather than repeating rote didactics. Consequently, the increased teaching and learning activities contributed to a better performance among the flipped classroom group. This pilot study suggests that a flipped classroom approach can be used to improve histology education among medical students. However, future studies employing randomization, larger numbers of students, and more precise tracking methods are needed before definitive conclusions can be drawn. Anat Sci Educ 10: 317-327. © 2016 American Association of Anatomists.

Evaluating a technology supported interactive response system during the laboratory section of a histology course

Monitoring of student learning through systematic formative assessment is important for adjusting pedagogical strategies. However, traditional formative assessments, such as quizzes and written assignments, may not be sufficiently timely for making adjustments to a learning process. Technology supported formative assessment tools assess student knowledge, allow for immediate feedback, facilitate classroom dialogues, and have the potential to modify student learning strategies. As an attempt to integrate technology supported formative assessment in the laboratory section of an upper-level histology course, the interactive application Learning Catalytics^TM , a cloud-based assessment system, was used. This study conducted during the 2015 Histology courses at Cornell University concluded that this application is helpful for identifying student misconceptions "on-the-go," engaging otherwise marginalized students, and forming a new communication venue between students and instructors. There was no overall difference between grades from topics that used the application and grades from those that did not, and students reported that it only slightly helped improve their understanding of the topic (3.8 ± 0.99 on a five-point Likert scale). However, they highly recommended using it (4.2 ± 0.71). The major limitation was regarding the image display and graphical resolution of this application. Even though students embrace the use of technology, 39% reported benefits of having the traditional light microscope available. This cohort of students led instructors to conclude that the newest tools are not always better, but rather can complement traditional instruction methods. Anat Sci Educ 10: 328-338. © 2016 American Association of Anatomists.

An evaluation of outcomes following the replacement of traditional histology laboratories with self-study modules

Changes in medical school curricula often require educators to develop teaching strategies that decrease contact hours while maintaining effective pedagogical methods. When faced with this challenge, faculty at the University of Cincinnati College of Medicine converted the majority of in-person histology laboratory sessions to self-study modules that utilize multiple audiovisual modalities and a virtual microscope platform. Outcomes related to this shift were investigated through performance on in-house examinations, results of the United States Medical Licensing Examination^® (USMLE^® ) Step 1 Examination, and student feedback. Medical School College Admissions Test^® (MCAT^® ) scores were used as a covariate when comparing in-house examinations. Results revealed no significant change in performance on in-house examinations when the content being assessed was controlled (F(2, 506) = 0.676, P = 0.51). A significant improvement in overall practical examination grade averages was associated with the self-study modules (F(6, 1164) = 10.213, P < 0.01), but gradual changes in examination content may explain this finding. The histology and cell biology portion of USMLE Step 1 Examination remained consistent throughout the time period that was investigated. Student feedback regarding the self-study modules was positive and suggested that features such as instructor narrated videos were an important component of the self-study modules because they helped recreate the experience of in-person laboratory sessions. Positive outcomes from the student perspective and no drop in examination performance suggests that utilizing self-study modules for histology laboratory content may be an option for educators faced with the challenge of reducing contact hours without eliminating content. Anat Sci Educ 10: 276-285. © 2016 American Association of Anatomists.

Using generalizability analysis to estimate parameters for anatomy assessments: A multi-institutional study

With integrated curricula and multidisciplinary assessments becoming more prevalent in medical education, there is a continued need for educational research to explore the advantages, consequences, and challenges of integration practices. This retrospective analysis investigated the number of items needed to reliably assess anatomical knowledge in the context of gross anatomy and histology. A generalizability analysis was conducted on gross anatomy and histology written and practical examination items that were administered in a discipline-based format at Indiana University School of Medicine and in an integrated fashion at the University of Alabama School of Medicine and Rush University Medical College. Examination items were analyzed using a partially nested design s×(i:o) in which items were nested within occasions (i:o) and crossed with students (s). A reliability standard of 0.80 was used to determine the minimum number of items needed across examinations (occasions) to make reliable and informed decisions about students' competence in anatomical knowledge. Decision study plots are presented to demonstrate how the number of items per examination influences the reliability of each administered assessment. Using the example of a curriculum that assesses gross anatomy knowledge over five summative written and practical examinations, the results of the decision study estimated that 30 and 25 items would be needed on each written and practical examination to reach a reliability of 0.80, respectively. This study is particularly relevant to educators who may question whether the amount of anatomy content assessed in multidisciplinary evaluations is sufficient for making judgments about the anatomical aptitude of students. Anat Sci Educ 10: 109-119. © 2016 American Association of Anatomists.

Presentation Pattern of Histology and Illustrations in the Histology Text Books Commonly Used by the Medical Undergraduates of Bangladesh

The teaching-learning and assessment of cell and histology have gone through remarkable changes in recent times. Histology text books recommended by renowned medical institutions should be good reflectors of these changes and the present trends. Cell and histology is categorically visual in nature. So, their presentation in text books is likely to show rational and meaningful use of illustrations. From July 2007 to June 2008, this descriptive observational study was done to analyze the presentation pattern of illustrations in two histology text books commonly recommended for the medical undergraduates of Bangladesh through: a) estimating the relative weights given to (i.e., proportions of printed area allotted to) illustrations and text; b) determining the frequencies of 12 'form's of illustration-defining each 'form' on the basis of how it has been created and how it looks like and c) determining the frequencies of 3 'categories' of illustration-on the basis of their utility as teaching-learning and assessment tools. Illustrations have been found to be allotted more than half of the printed area in the two books together. Regarding the 'form' of illustrations, 'schematic diagram and three-dimensional diagram' has the highest mean frequency (30.11%) and followed by 'photomicrograph - routine stain - high power' (17.56%). More than 90% of the illustrations could be categorized either as 'practically the best tool for the purpose' (70.21%) or as 'a complementary tool to another tool' (21.05%) for using in teaching-learning and assessment. By incorporating the findings of the present study with the present-day ideas and trends in cell and histology education in the renowned institutions of the world and with the understanding of the science of medical education, guidelines can be formulated for improving the methods of teaching and assessment in cell and histology for the medical undergraduates of Bangladesh.

Learning pathology using collaborative vs. individual annotation of whole slide images: a mixed methods trial

BACKGROUND

Students in biomedical disciplines require understanding of normal and abnormal microscopic appearances of human tissues (histology and histopathology). For this purpose, practical classes in these disciplines typically use virtual microscopy, viewing digitised whole slide images in web browsers. To enhance engagement, tools have been developed to enable individual or collaborative annotation of whole slide images within web browsers. To date, there have been no studies that have critically compared the impact on learning of individual and collaborative annotations on whole slide images.

METHODS

Junior and senior students engaged in Pathology practical classes within Medical Science and Medicine programs participated in cross-over trials of individual and collaborative annotation activities. Students' understanding of microscopic morphology was compared using timed online quizzes, while students' perceptions of learning were evaluated using an online questionnaire.

RESULTS

For senior medical students, collaborative annotation of whole slide images was superior for understanding key microscopic features when compared to individual annotation; whilst being at least equivalent to individual annotation for junior medical science students. Across cohorts, students agreed that the annotation activities provided a user-friendly learning environment that met their flexible learning needs, improved efficiency, provided useful feedback, and helped them to set learning priorities. Importantly, these activities were also perceived to enhance motivation and improve understanding.

CONCLUSION

Collaborative annotation improves understanding of microscopic morphology for students with sufficient background understanding of the discipline. These findings have implications for the deployment of annotation activities in biomedical curricula, and potentially for postgraduate training in Anatomical Pathology.

A practical hybrid model of application, integration, and competencies at interactive table conferences in histology (ITCH)

Significant changes have been implemented in the way undergraduate medical education is structured. One of the challenges for component courses such as histology in medical and dental curricula is to restructure and deliver training within new frameworks. This article describes the process of aligning the purpose and experience in histology laboratory to the goal of applying knowledge gained to team-based medical practice at Tulane University School of Medicine. Between 2011 and 2015, 711 medical students took either a traditional laboratory-based histology course (353 students) or a team-based hybrid histology course with active learning in laboratory (358 students). The key difference was in the laboratory component of the hybrid course - interactive table conferences in histology-during which students developed new competencies by working in teams, reviewing images, solving problems by applying histology concepts, and sharing learning. Content, faculty and online resources for microscopy were the same in both courses. More student-student and student-faculty interactions were evident during the hybrid course but student evaluation ratings and grades showed reductions following introduction of table conferences when compared to previous ratings. However, outcomes at National Board of Medical Examiners(®) (NBME(®) ) Subject Examination in Histology and Cell Biology showed significant improvement (72.4 ± 9.04 and 76.44 ± 9.36 for percent correct answers, traditional and hybrid courses, respectively, P < 0.0001). This model of table conferences to augment the traditional histology laboratory experience exemplifies the extent that restructuring enhancements can be used in currently taught courses in the undergraduate medical curriculum. Anat Sci Educ 9: 286-294. © 2016 American Association of Anatomists.

Remote histology learning from static versus dynamic microscopic images

Histology is the study of microscopic structures in normal tissue sections. Curriculum redesign in medicine has led to a decrease in the use of optical microscopes during practical classes. Other imaging solutions have been implemented to facilitate remote learning. With advancements in imaging technologies, learning material can now be digitized. Digitized microscopy images can be presented in either a static or dynamic format. This study of remote histology education identifies whether dynamic pictures are superior to static images for the acquisition of histological knowledge. Test results of two cohorts of second-year Bachelor in Medicine students at Ghent University were analyzed in two consecutive academic years: Cohort 1 (n = 190) and Cohort 2 (n = 174). Students in Cohort 1 worked with static images whereas students in Cohort 2 were presented with dynamic images. ANCOVA was applied to study differences in microscopy performance scores between the two cohorts, taking into account any possible initial differences in prior knowledge. The results show that practical histology scores are significantly higher with dynamic images as compared to static images (F (1,361) = 15.14, P < 0.01), regardless of student's gender and performance level. Several reasons for this finding can be explained in accordance with cognitivist learning theory. Since the findings suggest that knowledge construction with dynamic pictures is stronger as compared to static images, dynamic images should be introduced in a remote setting for microscopy education. Further implementation within a larger electronic learning management system needs to be explored in future research. Anat Sci Educ 9: 222-230. © 2015 American Association of Anatomists.

Teaching Veterinary Histopathology: A Comparison of Microscopy and Digital Slides

Virtual microscopy using digitized slides has become more widespread in teaching in recent years. There have been no direct comparisons of the use of virtual microscopy and the use of microscopes and glass slides. Third-year veterinary students from two different schools completed a simple objective test, covering aspects of histology and histopathology, before and after a practical class covering relevant material presented as either glass slides viewed with a microscope or as digital slides. There was an overall improvement in performance by students at both veterinary schools using both practical formats. Neither format was consistently better than the other, and neither school consistently outperformed the other. In a comparison of student appraisal of use of digital slides and microscopes, the digital technology was identified as having many advantages.

Actual drawing of histological images improves knowledge retention

Medical students have to process a large amount of information during the first years of their study, which has to be retained over long periods of nonuse. Therefore, it would be beneficial when knowledge is gained in a way that promotes long-term retention. Paper-and-pencil drawings for the uptake of form-function relationships of basic tissues has been a teaching tool for a long time, but now seems to be redundant with virtual microscopy on computer-screens and printers everywhere. Several studies claimed that, apart from learning from pictures, actual drawing of images significantly improved knowledge retention. However, these studies applied only immediate post-tests. We investigated the effects of actual drawing of histological images, using randomized cross-over design and different retention periods. The first part of the study concerned esophageal and tracheal epithelium, with 384 medical and biomedical sciences students randomly assigned to either the drawing or the nondrawing group. For the second part of the study, concerning heart muscle cells, students from the previous drawing group were now assigned to the nondrawing group and vice versa. One, four, and six weeks after the experimental intervention, the students were given a free recall test and a questionnaire or drawing exercise, to determine the amount of knowledge retention. The data from this study showed that knowledge retention was significantly improved in the drawing groups compared with the nondrawing groups, even after four or six weeks. This suggests that actual drawing of histological images can be used as a tool to improve long-term knowledge retention.

Collaborative Testing in Practical Laboratories: An Effective Teaching-Learning Method in Histology

This article presents an experimental teaching and learning program used in histology with first-year students in the second term in the Faculty of Biology at Huanghuai University, China. Eighty-six students were divided randomly into two groups (n=43 per group). Tests were conducted at the end of each practical laboratory (10 laboratories in total) in which collaborative testing was used in the experimental group and traditional testing in the control group. To assess achievement, a final examination in histology was carried out at the end of the course. To determine students' attitude to the teaching styles, a questionnaire survey was conducted at the end of the term. Results showed that students preferred the collaborative testing format. In the experimental group, students' scores were significantly higher than those of students in the control group in final examinations. These findings indicate that collaborative testing enhances student learning and understanding of the material taught, and suggest that collaborative testing is an effective teaching-learning method in histology.

Is a picture worth a thousand words: an analysis of the difficulty and discrimination parameters of illustrated vs. text-alone vignettes in histology multiple choice questions

BACKGROUND

Advances in cognitive load theory have led to greater understanding of how we process verbal and visual material during learning, but the evidence base with regard to the use of images within written assessments is still sparse. This study examines whether the inclusion of images within the stimulus format of multiple choice questions (MCQs) has a predictable or consistent influence on psychometric item properties, such as difficulty or discrimination.

METHODS

Item analysis data from three consecutive years of histology multiple choice examinations were included in this study. All items were reviewed and categorised according to whether their stem, or stimulus format, was purely textual or included an associated image.

RESULTS

A total of 195 MCQs were identified for inclusion and analysed using classical test theory; 95 used text alone and 100 included an image within the question stem. The number of students per examination ranged from 277 to 347, with a total of 60,850 student-question interactions. We initially examined whether the inclusion of an image within the item stem altered the item difficulty using Mann-Whitney U. The median item difficulty for images with purely textual stems was 0.77, while that for items incorporating an appropriate image was 0.80; this difference was not significant (0.77 vs. 0.80; p = 0.862, Mann-Whitney-U = 4818.5). Mean values showed that the Item Discrimination Index appeared unaffected by the inclusion of an image within the stem, and Item point biserial correlation also showed no difference in means between these two groups (Independent samples t-test; 2-tailed).

CONCLUSION

We demonstrate that the addition of illustrations within undergraduate histology Multiple Choice Question stems has no overall influence on item difficulty, or measures of item discrimination. We conclude that the use of images in this context is statistically uncritical, and suggest that their inclusion within item stems should be based upon the principles of constructive alignment. However, further research with respect to the effect of images within item stems on cognitive processing, particularly with regard to image complexity or type, would enable the development of more informed guidelines for their use.

A little healthy competition: using mixed methods to pilot a team-based digital game for boosting medical student engagement with anatomy and histology content

BACKGROUND

Digital games have been demonstrated to be beneficial for a range of non-recreational purposes, with a particular focus on their value for education. There is a limited amount of research supporting their use for medical education, but their are several studies on their use in areas such as surgical training, and life-support re-training. However, a significant gap exists in demonstrating how they engage with learners and games can be used most effectively in medical education. This pilot study assessed the value of digital games for teaching anatomy, by evaluating participant engagement and their attitudes towards a team-based strategy game.

METHODS

A digital game platform was designed, and then populated with anatomy questions developed by subject matter experts. Second year medical students were recruited to play three matches of the game. At the end of each match participants were asked to complete a Likert rating of their experiences of the game across five domains. Semi-structured interviews were conducted to assess engagement with the platform and perceived value to learners.

RESULTS

Sixteen participants volunteered to participate. Post-match ratings indicated that participants had a generally positive experience with the game, with 89 % of respondents agreeing the game was engaging, 93 % of respondents agreeing the game was challenging and 74 % indicating they would like to play the game again if given the opportunity. A total of fourteen participants agreed to be interviewed after playing three matches of the game. Interview responses supported the findings of the post-match ratings that the game was considered enjoyable and engaging. Participants noted they particularly enjoyed the competitive aspect of the game, particularly the opportunity to play against peers they consider their academic equals. In addition to finding the game engaging interview participants indicated they perceived the game impacted on their knowledge around anatomy. In particular, participants noted that the game provided them unique insight into their knowledge strengths and deficits.

CONCLUSIONS

This study demonstrated that digital games can engage medical students in traditionally-challenging areas such as anatomy and offer learners unique insights into their knowledge strengths and deficits.

When students struggle with gross anatomy and histology: A strategy for monitoring, reviewing, and promoting student academic success in an integrated preclinical medical curriculum

Gross anatomy and histology are now often taught as parts of an integrated medical or dental curriculum. Although this puts these foundational basic sciences into a wider educational context, students may not fully appreciate their importance as essential components of their medical education and may not develop a sufficient level of competency, as they are not stand-alone courses. The early identification of medical or dental students who struggle with anatomy or histology and the facilitation of adequate didactic support constitute a significant problem in an integrated curriculum. The timely intervention by an academic review board in combination with an individualized faculty-mediated counseling and remediation process may provide an effective solution to this problem.

Making large class basic histology lectures more interactive: The use of draw-along mapping techniques and associated educational activities

At Stellenbosch University, South Africa, basic histology is taught to a combination class of almost 400 first-year medical, physiotherapy, and dietetic students. Many students often find the amount of work in basic histology lectures overwhelming and consequently loose interest. The aim was to determine if a draw-along mapping activity would focus students during large class lectures. After each lecture on three basic histology tissues, a guided draw-along mapping session covering the work from the lecture was introduced in the form of a click-advance PowerPoint presentation which was used to demonstrate the unfolding of an "ideal" map. The lecturer simultaneously drew a similar map using an overhead projector allowing the students to draw their own maps on blank sheets of paper along with the lecturer. Students remained attentive during the activity and many participated in answering informal questions posed by the lecturer as the map-making session progressed. After the last session, students completed an anonymous, voluntary questionnaire (response rate of 78%). The majority of students found the draw-along maps useful (94%) and believed that its use should be continued in the future (93%). A significant increase (P < 0.001) was found in the test results of student cohorts who were given the current intervention compared to cohorts from previous years who were given mind maps as handouts only or had no intervention. The use of the draw-along mapping sessions were successful in focusing students during large class lectures while also providing them with a useful tool for their studies.

Learning histology - dental and medical students' study strategies

PURPOSE

Histology, the science of cells and tissues at the microscopic level, is an integral component of most dental and medical curricula and is often taught using both traditional and novel computer-based didactic approaches. The purpose of this study was to analyse the strategies used by dental and medical students when studying this very visual and challenging subject.

METHODS

Data were collected from 75 dental and 143 medical students, who had almost identical histology learning resources at their disposal.

RESULTS

When compared with their medical counterparts, dental students view histology as a more difficult subject and as less relevant for their future career. Whereas dental students, who are required to attend class unlike medical students, made more use of in-classroom learning opportunities, they did not take as much advantage of out-of-classroom resources. In addition, dental students reported a significantly higher tendency than medical students to work together, rather than to study alone.

DISCUSSION

Small differences in the dental versus the medical learning environment associate with several observed differences in learning strategies that are adopted by dental and medical students.

CONCLUSIONS

These differences should be considered when teaching the subject of histology to dental or to medical students.

Self-testing promotes superior retention of anatomy and physiology information

The testing effect shows that learning is enhanced by the act of recalling information after exposure. Although the testing effect is among the most robust findings in cognitive science, much of its empirical support is from laboratory studies and it has been applied as a strategy for enhancing learning in the classroom in a limited fashion. The purpose of this investigation was to replicate the testing effect in a university anatomy and physiology course and to extend the applicability of it to independent student study. Students repeatedly studied three sets of passages that described structures and concepts pertaining to (1) cardiac electrophysiology, (2) ventilation and (3) endocrinology. Each student was randomly assigned to study one of those three passage sets by reading it three consecutive times (R-R-R), another by reading and then rereading it while taking notes (R-R + N) and the third by reading it, recalling as much as possible (i.e., self-testing) and then rereading it (R-T-R). Retention assessed after 1 week was significantly greater following R-T-R (53.95 ± 1.72) compared to R-R-R (48.04 ± 1.83) and R-R + N (48.31 ± 1.78). Evidence is also presented that suggests students benefited from instructions to self-test when preparing for exams on their own. The testing effect, then, can be generalized to real-life settings such as university anatomy and physiology courses and to independent study situations.

Correlating students' educational background, study habits, and resource usage with learning success in medical histology

Histology is a traditional core basic science component of most medical and dental education programs and presents a didactic challenge for many students. Identifying students that are likely to struggle with histology would allow for early intervention to support and encourage their learning success. To identify student characteristics that are associated with learning success in histology, three first-year medical school classes at the University of Michigan (>440 students) were surveyed about their educational background, attitudes toward learning histology, and their use of histology learning strategies and resources. These characteristics were linked with the students' quiz and examination results in histology. Students who reported previous experience in histology or pathology and hold science or biomedical science college degrees usually did well in histology. Learning success in histology was also positively associated with students' perception that histology is important for their professional career. Other positive indicators were in-person participation in teacher-guided learning experiences, specifically lecture and laboratory sessions. In contrast, students who relied on watching histology lectures by video rather than going to lectures in-person performed significantly worse. These characteristics and learning strategies of students who did well in this very visual and challenging study subject should be of help for identifying and advising students early, who might be at risk of failing a histology course or component.

Positive impact of integrating histology and physiology teaching at a medical school in China

To modernize its stagnant, traditional curriculum and pedagogy, the Medical School of Wuhan University in China adopted (with modifications) the University of Chicago's medical curriculum model. The reform effort in basic sciences was integrating histology and physiology into one course, increasing the two subjects' connection to clinical medicine, and applying new pedagogies and assessment methods. This study assessed the results of the reform by comparing the attitudes and academic achievements of students in the reform curriculum (n = 41) and their traditional curriculum peers (n = 182). An attitude survey was conducted to obtain students' views of their respective histology and physiology instruction. Survey items covered lectures, laboratory teaching, case analyses and small-group case discussions, assessment of students, and overall quality of the courses and instruction. A knowledge test consisting of questions from three sources was given to measure students' mastery of topics that they had learned. Results showed that reform curriculum students were rather satisfied with their course and new teaching methods in most cases. When these students' attitudes were compared with those of their traditional curriculum peers, several significant differences favoring the reform were identified regarding physiology teaching. No other significant difference was found for physiology or histology teaching. Reform curriculum students outperformed their peers on four of five subcategories of the knowledge test questions. These findings support the benefits of integration and state-of-the-art teaching methods. Our study may offer lessons to medical schools in China and other countries whose medical education is in need of change.

Evaluation of usage of virtual microscopy for the study of histology in the medical, dental, and veterinary undergraduate programs of a UK University

This article describes the introduction of a virtual microscope (VM) that has allowed preclinical histology teaching to be fashioned to better suit the needs of approximately 900 undergraduate students per year studying medicine, dentistry, or veterinary science at the University of Bristol, United Kingdom. Features of the VM implementation include: (1) the facility for students and teachers to make annotations on the digital slides; (2) in-house development of VM-based quizzes that are used for both formative and summative assessments; (3) archiving of teaching materials generated each year, enabling students to access their personalized learning resources throughout their programs; and (4) retention of light microscopy capability alongside the VM. Student feedback on the VM is particularly positive about its ease of use, the value of the annotation tool, the quizzes, and the accessibility of all components off-campus. Analysis of login data indicates considerable, although variable, use of the VM by students outside timetabled teaching. The median number of annual logins per student account for every course exceeded the number of timetabled histology classes for that course (1.6–3.5 times). The total number of annual student logins across all cohorts increased from approximately 9,000 in the year 2007–2008 to 22,000 in the year 2010–2011. The implementation of the VM has improved teaching and learning in practical classes within the histology laboratory and facilitated consolidation and revision of material outside the laboratory. Discussion is provided of some novel strategies that capitalize on the benefits of introducing a VM, as well as strategies adopted to overcome some potential challenges.

Developing an audiovisual notebook as a self-learning tool in histology: perceptions of teachers and students

Videos can be used as didactic tools for self-learning under several circumstances, including those cases in which students are responsible for the development of this resource as an audiovisual notebook. We compared students' and teachers' perceptions regarding the main features that an audiovisual notebook should include. Four questionnaires with items about information, images, text and music, and filmmaking were used to investigate students' (n = 115) and teachers' perceptions (n = 28) regarding the development of a video focused on a histological technique. The results show that both students and teachers significantly prioritize informative components, images and filmmaking more than text and music. The scores were significantly higher for teachers than for students for all four components analyzed. The highest scores were given to items related to practical and medically oriented elements, and the lowest values were given to theoretical and complementary elements. For most items, there were no differences between genders. A strong positive correlation was found between the scores given to each item by teachers and students. These results show that both students' and teachers' perceptions tend to coincide for most items, and suggest that audiovisual notebooks developed by students would emphasize the same items as those perceived by teachers to be the most relevant. Further, these findings suggest that the use of video as an audiovisual learning notebook would not only preserve the curricular objectives but would also offer the advantages of self-learning processes.

Motivational component profiles in university students learning histology: a comparative study between genders and different health science curricula

BACKGROUND

The students' motivation to learn basic sciences in health science curricula is poorly understood. The purpose of this study was to investigate the influence of different components of motivation (intrinsic motivation, self-determination, self-efficacy and extrinsic -career and grade- motivation) on learning human histology in health science curricula and their relationship with the final performance of the students in histology.

METHODS

Glynn Science Motivation Questionnaire II was used to compare students' motivation components to learn histology in 367 first-year male and female undergraduate students enrolled in medical, dentistry and pharmacy degree programs.

RESULTS

For intrinsic motivation, career motivation and self-efficacy, the highest values corresponded to medical students, whereas dentistry students showed the highest values for self-determination and grade motivation. Genders differences were found for career motivation in medicine, self-efficacy in dentistry, and intrinsic motivation, self-determination and grade motivation in pharmacy. Career motivation and self-efficacy components correlated with final performance in histology of the students corresponding to the three curricula.

CONCLUSIONS

Our results show that the overall motivational profile for learning histology differs among medical, dentistry and pharmacy students. This finding is potentially useful to foster their learning process, because if they are metacognitively aware of their motivation they will be better equipped to self-regulate their science-learning behavior in histology. This information could be useful for instructors and education policy makers to enhance curricula not only on the cognitive component of learning but also to integrate students' levels and types of motivation into the processes of planning, delivery and evaluation of medical education.

Introducing evidence-based dentistry to dental students using histology

The expansion of evidence-based dentistry (EBD) is essential to the continued growth and development of the dental profession. Expanding EBD requires increased emphasis on critical thinking skills during dental education, as noted in the American Dental Education Association's Competencies for the New General Dentist. In order to achieve this goal, educational exercises must be introduced to increase the use of critical thinking skills early in the dental curriculum, with continued reinforcement as students progress through subsequent years. Described in this article is one approach to increasing student exposure to critical thinking during the early basic science curriculum-specifically, within the confines of a traditional histology course. A method of utilizing the medical and dental research literature to reinforce and enliven the concepts taught in histology is described, along with an approach for using peer-to-peer presentations to demonstrate the tools needed to critically evaluate research studies and their presentation in published articles. This approach, which could be applied to any basic science course, will result in a stronger foundation on which students can build their EBD and critical thinking skills.

Collaborative quiz-based teaching strategy in histology

In the present article we introduce a teaching strategy used in a histology course with first-year students in the first term of their studies at the Faculty of Veterinary Medicine at Huanghuai University, China. Forty students were randomly divided into two sections (n=20/section). Students in the first section were taught using a collaborative quiz-based strategy (the experimental section), and students in the second section were taught using a traditional teaching strategy (the control section). To assess achievement of learning, a final examination was carried out at the end of the course. To determine students' attitudes toward the teaching strategy used, a questionnaire was conducted at the end of the term. Results showed that students preferred the collaborative quiz-based teaching strategy. The final-examination scores of students in the experimental section were significantly higher than those of students in the control section (p<.05), which indicates that the collaborative quiz-based strategy results in better performance on examinations compared to the traditional histology course.

Integration of basic science and clinical medicine: the innovative approach of the cadaver biopsy project at the Boston University School of Medicine

PROBLEM

Curricular integration has emerged as a consistent theme in medical education reform. Vertical integration of topics such as pathology offers the potential to bring basic science content into the clinical arena, but faculty/student acceptance and curricular design pose challenges for such integration.

APPROACH

The authors describe the Cadaver Biopsy Project (CBP) at Boston University School of Medicine as a sustainable model of vertical integration. Faculty and select senior medical students obtained biopsies of cadavers during the first-year gross anatomy course (fall 2009) and used these to develop clinical cases for courses in histology (spring 2010), pathology (fall 2010-spring 2011), and radiology (fall 2011 or spring 2012), thereby linking students' first experiences in basic sciences with other basic science courses and later clinical courses. Project goals included engaging medical stu dents in applying basic science princi ples in all aspects of patient care as they acquire skills. The educational intervention used a patient (cadaver)-centered approach and small-group, collaborative, case-based learning.

OUTCOMES

Through this project, the authors involved clinical and basic science faculty-plus senior medical students-in a collaborative project to design and implement an integrated curriculum through which students revisited, at several different points, the microscopic structure and pathophysiology of common diseases.

NEXT STEPS

Developing appropriate, measurable out comes for medical education initiatives, including the CBP, is challenging. Accumu lation of qualitative feedback from surveys will guide continuous improvement of the CBP. Documenting longer-term impact of the curricular innovation on test scores and other competency-based outcomes is an ultimate goal.