Pathology Teaching in the Digital World: Lamborghini or Horse and Carriage?

Angelica Oviedo, MD; Assistant Professor of Pathology, IWK Health Centre and Dalhousie University Medical School

Last year, I was asked to run a wound healing session for approximately 70 students for one of our pathology courses. Although anatomical pathology is commonly taught with lectures and laboratory sessions, WSI are a much better way of transferring the information of this extremely visually oriented subject. One of the unique aspects of pathology is that a WSI can be reviewed by many people, and this type of teaching gives an immediate clinical relevance that simply cannot be replicated with lectures.

Most pathologists are familiar with the concept of whole slide images (WSI) for diagnosis. Here, I want to show how I have used WSI to make a leap in Anatomical Pathology education.

I first wrote introductory material that the students read prior to the class, and had them review WSI of normal skin and wound healing on a free hosting platform. During the class, I gave students scenarios with questions that could only be answered by looking at the WSI. Small groups had to choose one correct answer, prior to using scratch-off answer sheets to see if they had chosen correctly. There was a lot of discussion. Most educators will, of course, recognize these team-based learning methods that contribute to deeper understanding and long-term retention. I have recreated these methods while simply integrating WSI into the teaching material.

In the past, I have taught similar courses with glass slides. This was done by assigning microscopes and boxes of glass slides to students during laboratory sessions. Students would use booklets that described the slides and attempt to find the structures on the glass slides. Students would spend quite a bit of time just learning how to use the microscopes, and in order for me to see what the students were looking at, we would constantly switch back and forth on the oculars. If a student had difficulty finding a particular structure, such as a sub-mucosal gland, I would find it and put the ocular pointing needle on it as the student stared at the back of my head.  Then, they would look at it and say, “Ok, I see it.”  Now, I can sit next to the student and look at the WSI together on their computer. I will suggest they start at low power and systematically examine the image until they find the structure they are searching for.

I have received criticism that my preferred method of using digital slides robs students of learning how to use a microscope, which they may need to know if they go into the pathology field. My response is that as a practicing pathologist, there is no need to know how to use the small microscopes generally used in laboratory teaching. Nowadays, practicing pathologists use very expensive ergonomically designed microscopes that bear as much resemblance to the laboratory teaching scopes as a Lamborghini does to a horse and carriage. Also, I do get a few students who make requests to learn how to use a microscope. I generally have them come to my office and teach them how to use my microscope. Another option is to keep one high quality microscope in the teaching laboratory for this purpose.  Using WSI to teach pathology results in students learning and retaining significantly more, because they are much more involved in actually looking at the slides and properly engaging with pathology.

Disclaimer: In seeking to foster discourse on a wide array of ideas, the Digital Pathology Association believes that it is important to share a range of prominent industry viewpoints. This article does not necessarily express the viewpoints of the DPA, however we view this as a valuable point with which to facilitate discussion.

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