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Is a lab a must in histology courses?

  • 1.  Is a lab a must in histology courses?

    Posted 06-25-2014 11:00
    There is at least a handful of medical & dental programs that do not have a lab component in their histology courses.  Students seem to do fine on course exams and boards.  So is lab (virtual or optical microscopy) still a must for histology?  

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    Robert Ogilvie
    Professor Emeritus
    Medical University of South Carolina
    Mount Pleasant SC
    843-693-1065843-693-1065
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  • 2.  RE: Is a lab a must in histology courses?

    Posted 06-25-2014 13:22
    Speaking as one who initially resisted the conversion to virtual microscopy and became a convert, my own observations have been that student performance has not significantly suffered. The conversion took some time for us and by design is still not complete. In part this is due to the fact that our slides are scanned at 40X and there are certain structures and cells we feel are best viewed under oil at 100X. In addition, we still find it helpful to train our students to operate microscopes and understand the origin of the images they are studying. Thus as we begin studying histology with the cytology unit, students are issued microscopes and we combine a lab on their use with studies of assigned subcellular structures. As we progress through the basic tissue types, students retain their scopes and gradually transition their focus to the virtual slides. The scopes are again very important in labs related to blood and bone marrow. When we complete that unit as we move into the organ systems, we collect the scopes and the students complete their studies of the organ systems using the virtual slides. By then most of them are quite adept at using a microscope. As we transition to the virtual slides, attendance at the scheduled lab sessions dwindles. For each lab session, we begin with a 20-30 minute warmup on the lab monitors of the virtual slides and key features they will be required to identify on the examinations. By the end of the transition to virtual microscopy and throughout the rest of the histology coverage, we have excellent attendance at those warmup sessions after which nearly all the students depart. A couple of faculty can handle any remaining questions in the lab session and we provide Camtasia recordings of the warmups online for the students to review as they wish. Students can also schedule independent time with the faculty to ask any additional questions that may come up during their independent study. This approach has significantly reduced the amount of faculty time required for laboratory teaching with, as I indicated, no significant ill effects on student performance. I think one of the main reasons for my conversion to substantial reliance on virtual microscopy has been the observation that the students actually actually spend more time viewing the virtual slides on their own than they did when they had to either stay in lab, return to the lab, or carry the microscopes home with them to look at glass slides. I think there is likely a higher correlation between performance and the time spent looking at the slides, than where and how they do that. We have dispensed with the walk-around practicals and incorporate images, most of which have been captured from the virtual slides, on their integrated electronic examinations delivered on the ExamSoft platform. Reducing lab time from 3 hours to 30 minutes per lab has been welcomed by the students and faculty alike.
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    Douglas Paulsen
    Professor, Associate Dean
    Morehouse School of Medicine
    Atlanta GA
    404-752-1559
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  • 3.  RE: Is a lab a must in histology courses?

    Posted 06-26-2014 17:26

    Hello Douglas and Bob,

    You bring up an interesting question. I am afraid that there is no simple answer whether histology labs are necessary or not. That will depend on the students involved. Some students do not need faculty help and they will work things out by themselves. Other students will certainly benefit from a lab session. I recently investigated the role of various learning strategies and resources for histology and how they influence University of Michigan students' histology learning success as measured by examination results. The paper is available online on the Anatomical Sciences Education (ASE) website. Look for Selvig et al (2014). Michigan medical students are free to attend histology labs or not. A minority of students attends and those students perform significantly better when compared with students who do not attend the faculty-guided lab sessions. However, the students attending are also the students more motivated to learn histology. We have another interesting comparison here at the University of Michigan. Medical students are free to attend the lab sessions and the lectures or to watch the lecture videos and work with the virtual slides on their own time. Dental students are required to attend lectures but are not offered faculty-guided lab sessions. Most other histology learning resources and conditions are identical between the two groups. Although I am unable to directly compare histology knowledge and skills between dental and medical students, there are interesting differences and similarities between these two groups of histology learners. The results from this second study were also recently published online by the European Journal of Dental Education.  These two papers will not give a clear answer to your question, but they will provide interesting background material about the complexities of learning histology.

    Thank you for starting this discussion

    Michael



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    Michael Hortsch
    Associate Professor
    University of Michigan
    Ann Arbor MI
    734-647 2720
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  • 4.  RE: Is a lab a must in histology courses?

    Posted 06-27-2014 09:57
    Hi Michael,
    Yes, I think you make a key point here that students are all different in terms of their level of drive, interests, learning styles, and needs. That has been a perennial issue, along with determining how we can optimize the instruction we provide for all types of students in a way that equally optimizes the amount of faculty time and effort required. In my experience monomodal instruction is a poor answer, but so is providing so many different approaches for the students to choose from that they become overwhelmed and confused by their options. Involvement of committed faculty at each institution seems a requirement to allow ongoing dynamic assessment of the needs and variables in each class of students and provision of options that meet the needs of the more independent and more dependent learners alike. The use of virtual microscopy is an outstanding and flexible modality that allows a variety of learning needs to be met. Joy Reidenberg reminded me recently that another benefit of this approach to delivery of histology lab content is that it allows quicker and more effective peer interaction and peer teaching, as well as faculty consultation, than reliance on microscopes and glass slides alone. I think the value of peer teaching among students is often underestimated as we evaluate factors that enhance student learning and performance. Lab sessions provide opportunities to bring students and faculty together for this type of guided learning, but with virtual microscopy, these are clearly not the only opportunities for such interactions. The lab sessions benefit the students who are more dependent learners and benefit from an imposed structure. Virtual microscopy provides an excellent platform for use in these sessions as well as in independent self-instruction and student-organized group study.

    Doug

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    Douglas Paulsen
    Professor, Associate Dean
    Morehouse School of Medicine
    Atlanta GA
    404-752-1559
    -------------------------------------------




  • 5.  RE: Is a lab a must in histology courses?

    Posted 06-29-2014 21:35

    Hello Doug,

    I very much agree with your sentiment that our teaching is more effective when we offer alternative teaching options. However, as there are many time constrains on teachers, many of us may not be able to offer more than one learning modus. Besides the virtual microscope images, for each medical histology lab sessions we set up several real microscopes with glass slides. Very few students make use of that offer. However, those who do, appreciate the extra effort and time we put in to offer this additional resource.

    Another crucial question is which didactic goals we have in mind when teaching histology. I would like to teach more than a collection of facts and also to motivate my students to develop skills, such as being able to interpret micrograph images they have not seen before and to correlate tissue structures with tissue functions. That is very difficult or impossible to achieve without lab session or with motivated students, who are willing to do the work outside of scheduled instruction time.

    I think you are making a good point that lab sessions benefit specifically those students, who are more dependent learners. In my experience, more and more students tend to learn alone rather than together in a group of peers. I'd appreciate to hear how other teachers encourage group learning for histology.

    Michael


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    Michael Hortsch
    Associate Professor
    University of Michigan
    Ann Arbor MI
    734-647 2720
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  • 6.  RE: Is a lab a must in histology courses?

    Posted 07-01-2014 12:37
    Hi All,
    I agree there are a variety of ways that students can learn histology, but my own personal experience suggests that interacting with the  tissue sections either through virtual microscopy or actual microscopy in the lab setting is the best way to really understand the material.  I think we could make a valid comparison with clinical anatomy.  There are a variety of ways to be exposed to that material, but the one which is most effective, again from my experience, is gained from interacting directly with a body donor. 

    That said, I wanted to explore another idea.  Many of us now participate in integrated curricula where the systems histology is mixed in with material from other disciplines to address a particular body system.  This includes pathology.  In this setting, it would seem useful if those presenting histology and those presenting pathology would collaborate to emphasize how the pathologists understanding of normal microanatomy is applied to his examination and interpretation of slides obtained from pathological specimens.  Has anyone experienced this collaboration between those who teach histology and pathologists?  Let me provide an example form our experience.  So far in our new curriculum the pathologists show a lot of images of abnormal tissue, but rarely if ever throw in a slide of normal tissues as a touchstone for the students.  Presentation of the normal histology may have occurred the day before or a few days before the pathology session.  I'm not sure it is realistic to expect that in this short period of time, the students have mastered the normal tissue structure enough to understand the abnormal presented by the pathologists.  In fact, some of our students have commented on evaluations that they would appreciate seeing some images of normal tissue during the sessions presented by the pathologists.  This seems like a great opportunity for demonstrating to the students at least one example of how knowledge of normal histology is applied to a medical problem.  And it's a great opportunity to tie the two disciplines together - the histologist introduces the normal microanatomy, then in their presentation, pathologist briefly revisits the normal and explains how it is their touchstone or reference point for determining if and how a sample obtain from a clinical specimen is normal or abnormal.  Currently we are missing this opportunity in our curriculum.  I'm wondering if anyone else who is participating in an integrated curriculum has taken advantage of it?
    Thanks,
    Dave

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    David Bolender
    Associate Professor
    Medical College of Wisconsin
    Milwaukee WI
    414-955-8474
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  • 7.  RE: Is a lab a must in histology courses?

    Posted 07-03-2014 12:16
    Hi Dave and Doug,

    Thanks for your insights!

    I agree with the comparison of histology with anatomy - the fact that the lab component is crucial for both subjects.  I find myself frequently abandoning my powerpoints in class and just going straight into a virtual lab and walking students through the slides, talking about the structure-function relationships and integrating with gross anatomy and some pathology.  Thanks to my past pathology experience, I can talk about some common pathologies that are present in "normal" histology teaching slides - students find them incredibly interesting and want more.  Doug, you gave me an idea to perhaps compile the list of these things I see and work with a couple of pathologist colleagues to expand the list.  If anyone already has such list, please do share! 

    Manas Das, in his introduction, mentioned that histology is taught in an integrated curriculum by histologists and pathologists.  Hope he will join this discussion and elaborate on how this works.

    Happy 4th, everyone!

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    Lisa Lee
    Associate Professor
    University of Colorado School of Medicine
    Aurora CO
    303-724-7460
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  • 8.  RE: Is a lab a must in histology courses?

    Posted 06-27-2014 11:30
    Hello all,

    I learned my histology using both optical and virtual microcopy.  I have also taught with both modalities.  I cannot deny that there is much to be gained and appreciated from the mechanical interaction with optical microscopes and glass slades.  But I am in the camp that the accessibility, efficiency, convenience and many more advantages that Doug and others have brought up make virtual labs a superior educational tool. 

    There is another aspect of Bob's question though... and that is whether any type of lab (optical or virtual) is necessary for histology. 

    Here at CU, dental students have a seven-week histology course (2.5 credits).  The course consists of only lectures and no lab of any kind.  This is a team-taught course, so lectures are quite variable but most lecture slides contain bullet point notes and accompanying static images.  Some artistic instructors spend the entire lecture hour drawing a beautiful histology image on the white board.  I am the only instructor in that course who provides links to virtual slides but I don't always have the time to go over them in class - few students bother to clink on those links and even if they do, they have no clue as to what they are looking at.   Exams do contain some static images from lecture slides and students do fine on them - probably because they memorize the images.  Further, I know that at least for step 1 dental board exam, there is no image based histology questions (at least for now) - so it's a hard sell to push lab on these students.  What are your thoughts on this?  Do you know of any other histology courses (undergrad, grad, med, dent... etc) that have no lab component?  Can students truly learn histology without any kind of lab experience?

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    Lisa Lee
    Associate Professor
    University of Colorado School of Medicine
    Aurora CO
    303-724-7460
    -------------------------------------------




  • 9.  RE: Is a lab a must in histology courses?

    Posted 06-29-2014 21:38

    Lisa,

    As I indicated in my answer to Doug, it depends what you mean with "truly learn histology". At least in my definition, a lab session or independent work with virtual slides is necessary to "truly learn histology".  That makes teaching histology without a real lab session an additional challenge. It appears that we at the University of Michigan teach histology to dental students very similar to you at CU. A lecture to introduce the "facts" is followed with a lecture-style introduction to the virtual slides. However, no real lab session with faculty supervision is offered.  Dental students are expected to work with the virtual slides at their own time and I push the use of the Michigan dental histology website (http://histology.med.umich.edu/schedule/dental). As most dental students are less motivated to learn histology (at least when compared to medical students), this makes our teaching mission more demanding. A few days ago I mentioned our recent paper, which compares medical and dental students' learning strategies when learning histology (Johnson et al., Eur. J. Dent. Educ., online http://onlinelibrary.wiley.com/doi/10.1111/eje.12104/abstract).

    We had a now retired colleague, who also liked to draw elaborate pictures on a whiteboard. At one point he took photos of his drawings and we now offer them to our students as supplemental PowerPoint files. There are freely available and can be downloaded at http://open.umich.edu/education/med/resources/histology-laboratory-drawings. It is not the most popular supplementary learning tool, but a few students appreciate the drawings.

    I definitely do not use images that were used in lectures or in other material provided to the students for the exams. Yes, that makes the exams more difficult for our students. However, in my opinion pure image recognition has very little educational value. I believe students can be challenged, just as long as they feel fairly treated and as long as we provide them with the opportunities to succeed by hard work and as long as we provide them appropriate learning resources.

    All of you have a good workweek

    Michael


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    Michael Hortsch
    Associate Professor
    University of Michigan
    Ann Arbor MI
    734-647 2720
    -------------------------------------------




  • 10.  RE: Is a lab a must in histology courses?

    Posted 07-02-2014 10:25

    I followed this discussion with very much interest. From my experience and research, the laboratory provides great opportunities for active self-directed learning experiences, integration of histology with physiology and pathology, development of team skills (mainly communication/coordination), and also an opportunity to provide feedback for the development of professionalism. Thoughtful design of the lab activities will contribute to achieving the medical knowledge, interpersonal and communication, and professionalism as part of ACGME 6 core competencies domains.

    Our experience using the virtual microscopes is published in our Anatomical Sciences Education journal (http://onlinelibrary.wiley.com/doi/10.1002/ase.1350/abstract). Students indicated that the laboratory experience facilitated their learning by reinforcing and clarifying classroom sessions, improved their understanding, facilitated active and cooperative learning, and supported self-monitoring of their learning


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    Mohammed Khalil
    Associate Professor
    University of South Carolina, School of Medicine - Greenville
    864-455-9825
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  • 11.  RE: Is a lab a must in histology courses?

    Posted 07-03-2014 09:05
    I'm truly enjoying this discussion and the variety of perspectives and approaches that have been described. Like Dave Bolender, I would like to hear more about ways to combine histology and histopathology as a teaching tool. I have been especially interested in finding ways to introduce some basic histopathological concepts along with the presentation of normal histology without necessarily delving fully into more detailed histopathology, which might be more distracting than helpful to the students learning histo in the first year of medical school. I am not a pathologist, but a possible example of what I'm considering is lymphocyte infiltration of otherwise healthy tissues. We see this, for example, in many of our slides of tonsils where lymphocyte infiltration into the characteristic covering epithelia sometimes confounds the students. Comparisons of necrosis and apoptosis might be another example. It would be wonderful to have a list of such basic histopathologies broken out by histo lecture topic that we could begin incorporating into both lectures and labs. If anyone knows of such a simple listing, please let us know).

    The other idea I wanted to mention to the group that I've heard of others using, but which I haven't had the time to implement here, is including a histology scavenger hunt as an active learning component for each laboratory. In the example I heard about, a checklist of structures was provided to the students as groups, who found the structures on virtual slides and were checked off by faculty or teaching assistants. I can think of a number of ways that could be implemented both in the lab and online. I'd love to read descriptions of the use of that approach including what works and what doesn't and how to increase the fun factor. This would be a possible answer to the question about approaches to team or group learning in the histo lab.

    Happy 4th everyone :)
    -------------------------------------------
    Douglas Paulsen
    Professor, Associate Dean
    Morehouse School of Medicine
    Atlanta GA
    404-752-1559
    -------------------------------------------




  • 12.  RE: Is a lab a must in histology courses?

    Posted 07-04-2014 07:27
    Hello Doug,

    Our Microscopic Anatomy courses at Drexel University College of Medicine (DUCOM) are among those that use scavenger hunts in some lab sessions. We have two curricular tracks - one problem based (the Program for Integrated Learning or PIL) where Haviva Goldman serves as course director and one organized around symptom-based modules (Interdisciplinary Foundations of Medicine or IFM) where I am course director. The scavenger hunts work somewhat differently in each, so let me describe the elements common to both, and then point out some of the differences. We have six lab cubicles, each with seven tables, usually with five students at a table. For each hunt we generate seven different lists of structures for the students to find, so that each table in a cubicle is working on a different list.  Each list includes five structures, which allows every member of the group to lead the hunt for at least one structure. For every group, some structures are simply listed by name, while others are only described according to some characteristic structural or functional feature. For example one list might include "parietal cell", while for another hunt we might replace that with "cell that produces intrinsic factor". For each correct identification, every student in the group receives one point, so a scavenger hunt is essentially a five-point lab quiz.

    In IFM the students find the structures on glass slides from their own slide boxes. The hunts generally cover about four different lab sessions, so students are working with more than one tissue or organ system. When everyone in the group agrees with an identification, they show the structure to their instructor and then move on to the next item in their list. In both IFM and PIL, the instructor will generally ask one or two follow-up questions about their structure just to get them thinking more about it, but the answers to those off-the-cuff questions are not graded. After the hunt, the IFM students use the rest of the lab time to go on to study the next organ system.

    In PIL the students find their structures on virtual slides rather than glass slides, take screen shots of the structures, create a PowerPoint from those screenshots, have their presentation checked by their instructor, and then submit it electronically. Since there are fewer student groups per cubicle in PIL, there is time at the end of the lab session to project each PowerPoint and go over the structures for the students. Each PIL lab session includes, and in fact essentially consists of a scavenger hunt since the students are expected to do the preparatory lab work online outside of scheduled lab time. 

    I hope that gives you some idea of how we use  scavenger hunts. The students seem to enjoy them and always rate them highly on our course evaluations. They certainly stimulate discussion, and do clear up a large number of misconceptions.

    Please let me or Haviva know if you have any questions.

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    Janet Smith
    Professor
    Drexel University College of Medicine
    Philadelphia PA
    215-991-8474
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  • 13.  RE: Is a lab a must in histology courses?

    Posted 07-03-2014 12:22
    Hi Mohammed!
    Good to hear from you.  I remember our discussion at last year's AACA about how your lab and the educational tool are uniquely set up to promote collaboration.  Will you be at this year's AACA next week in Orlando?

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    Lisa Lee
    Associate Professor
    University of Colorado School of Medicine
    Aurora CO
    303-724-7460
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  • 14.  RE: Is a lab a must in histology courses?

    Posted 07-03-2014 11:58
    Hi Michael, thanks for your insight and for pointing me to your recent publication!  What a great study! 
    I definitely have seen similar trends you report on the paper with my dental students - we also have mandatory attendance policy with dental students but not with med students.  Our dental students don't have any lab activities though.  Kudos for testing your students using different set of images than the ones used in lectures... I would like to try this at some point, but expect some backlash. 

    Regarding dental students' motivation to learn histology, I struggle to get them excited about histology lectures and frankly, I refuse to use the "these are on boards, so learn it" argument, haha.  I talk about interprofessional approach to personalized health care and the fact that dentists might be the first and the only healthcare providers patients visit, etc... Still having a hard time getting a buy-in. 
    Any tips on this area from the group would be greatly appreciated.

    Happy 4th!!

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    Lisa Lee
    Associate Professor
    University of Colorado School of Medicine
    Aurora CO
    303-724-7460
    -------------------------------------------




  • 15.  RE: Is a lab a must in histology courses?

    Posted 07-17-2014 11:16
      |   view attached
    The discussion concerning whether a lab is necessary for a histology course has been most productive.  We have captured the essence of this discussion in a 3 page word document in which you will find a synopsis of the discussion.  You can retrieve here and also under documents.  I would like to add a thought at this point.

    " Learning histology without a lab could be compared to learning about a building without ever having visited and walked through it on site.  Years ago during a curriculum committee meeting of which I was a member,  the discussion was headed toward ganging up on me, the director of the medical histology course, to do away with histology lab.  The committee composition included a significant component of clinicians.  In a desperate (and I also thought strategic) move, I asked this question: "Do you really want train and educate a physician who would not be able to see in their mind's eye the microscopic architecture of the human body?"  After some discussion, they dropped the idea of removing a lab component from the histology course.  Seems the clinical faculty members of the committee needed a reminder that the body has both gross and microscopic architecture. While they would never think of doing away with gross anatomy, histology just did not mean much to them until I spoke up.  Before that meeting and for many years afterwards, I always began the course in histology by stating to the students that this course would lead them through the process of learning the 'microscopic architecture and function of the human body'.  Both to medical /dental students and to lay persons to whom I have attempted to explain what I do as a histologist, this phrase has always seemed to resonant and provide an understanding much more that either 'histology' or even 'microanatomy'.  Architecture has two components; the drawing or plan and the 'real thing'.  It seems to me that this discussion has gone along this line with many now using virtual microscopy to 'keep histology lab alive and well'.


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    Robert Ogilvie
    Professor Emeritus
    Medical University of South Carolina
    Mount Pleasant SC
    843-693-1065843-693-1065
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