Digital Histology Interest Group or DHIG

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  • 1.  Accommodated examinations for color blind students

    Posted 08-30-2016 08:30

    Hello histologists!

    Furthering the discussion that Brent Thompson initiated in the Open Forum about accommodated anatomy practical exams....

    What strategies have you used to accommodate color blind students when testing histological concepts using a virtual microscope or micrographs?  We have some color blind students seeking test accommodations because they have experienced difficulty completing histology laboratory activities. 

    In this paper, the authors describe adjusting hue in the images:  http://www.dentistry.bham.ac.uk/medicalimaging/page4.asp

    I also thought that a modified copy of the exam could be offered that has some descriptive labels on the images.  E.g. "this area is basophilic" or outlining shapes in a color that the student can see.

    I am interested in hearing about your experiences and ideas.

    Thank you,

    Stefanie

    ------------------------------
    Stefanie Attardi
    Assistant Professor
    Oakland University William Beaumont School of Medicine
    Rochester MI
    248 370 2830
    sattardi@oakland.edu
    ------------------------------


  • 2.  RE: Accommodated examinations for color blind students

    Posted 08-31-2016 07:25

    Stephanie

    Interesting question, since we typically have 1-2 students every year with this issue, and I just had a meeting with a new student this year about it.  In most cases, the fear of the student is worse than the actual problem, since most manage to navigate differences in color based on what they see.  Since many of our slides are H&E, and typical color blind students are red-green, the major problem they encounter is the difference between typical pink cytoplasm and the vibrant red found in eosinophils or other shades of red found in developing blood cells.  (We did have one student that had problems with blue shades, so could not see metachromasia in mast cells at all.)

    We ask these students to communicate with faculty during lab sessions about their situation, so that the faculty member can work with them, mostly to focus on other identifying factors not so dependent on color.  In addition, we have worked with color blind students in the past to help identify colors of arrows that work best with our slides. 

    Our standing policy in place for exams includes:

    1.  Student is able to ask a non-faculty proctor to point out an arrow or circle on an image.  This happens occasionally because they can't see the indicator, but typically once it's pointed out to them, they see it.

    2.  Student is able to ask a non-faculty proctor to state what color a region of an image is.

    We do this for any student, i.e. we don't require that students apply for special accommodations.  Note in both cases, they ask a non-faculty proctor, since we don't want the faculty member to add any other information other than basic facts about the slide.  In addition, neither accommodation addresses structures on glass slides, which are part of our practical exams.  However, as mentioned, we have never had an issue.

    Overall, this has worked.  We have never had to make any other formal accommodations, such as extended time, at least to this point.

    DJ

    ------------------------------
    Donald Lowrie
    Professor - Educator
    University of Cincinnati College of Medicine
    Cincinnati OH
    513-558-5032



  • 3.  RE: Accommodated examinations for color blind students

    Posted 08-31-2016 12:15

    This is an interesting question, Stefanie, that I have considered for several years.

    Actually, in our 2015 publication Selvig et al in Anat Sci Educ we looked at the examination results of color-blind students versus non-color-blind students. Although color-blind students score slightly lower than the rest of the class, statistically it was not significant. It should be noted that the number of color-blind students in our study was rather small and the questions might be worth revisiting.

    I talked to some of the color-blind students and they confirm that they are more challenged in histology, but they also say that they learned to compensate. As a conclusion, I don't think this is a very problematic issue, at least if we as teachers pay attention to it. My solution is to address the problem the first time I meet with a new class and ask students who are color-blind and concerned to send me an email. In addition, I tell them that if they ever think they have an unfair disadvantage in an examination, they should contact me. So far, I never have been contacted by a color-blind student that he (rarely she) felt disadvantaged. It is probably wise to consider the problem when creating examination questions and especially to avoid red-green labels.

    My advice is to address it early at the beginning of a histology course, keep it in mind when creating questions and learning material, and to be flexible when problems arise. I have not been asked for extra time by those students either. 

    I am looking forward to hearing/reading how other colleagues deal with this problem.

    All the best

    Michael

    ------------------------------
    Michael Hortsch
    Associate Professor of Cell and Dev. Biology and of Learning Health Sciences
    University of Michigan, Ann Arbor MI



  • 4.  RE: Accommodated examinations for color blind students

    Posted 09-01-2016 10:53

    Hello Stephanie,

    As you know I have been teaching an on line histology course for the University of South Carolina for a number years.  With now in my 18 semester since Spring 2011 and having over 1700 students complete the course, I have had less than 6 students express concern about color vision.  Several semesters ago I posted some help for this on my course web site.  I am sharing you here some of that including a few articles attached.

    First, I would remind us that the best term for inability to distinguish certain colors is "color deficiency", not "color blindness".  Color vision deficiency is the inability to distinguish certain shades of color or in more severe cases, see colors at all. The term "color blindness" is also used to describe this visual condition, but very few people are completely color blind and so that term is a misnomer.  People who cannot see color at all are truly "color blind".  The medical term for this is achromotopsia.  Persons with achromotopsia can only see things as black and white or in shades of gray.  Most people with color vision deficiency can see colors, but they have difficulty differentiating between particular shades of reds and greens (most common) or blues and yellows (less common).  Certainly, color is a factor in our every day lives, size, shape, position /location and density give important clues for distinguishing one object from another.  Consider the street and highway signs.  What is the shape for a stop sign, a speed limit sign,and a crosswalk sign?  The next time you walk or drive, take notice.   Then, there is the traffic light with red always on top, yellow in the middle and green below.  A search on the Internet using these phrases "color blindness and professions", "color deficiency and professions" will yield information on how color deficiency may be a factor in success in a profession.

    I ask my students to consider this:

    Question: If I cannot differentiate colors clearly, will this affect my learning histology?
    Answer:  Not as long as you recognize learning histology is not about color.
    Why:  Because, stains are used mostly to visualize histological specimens, not to distinguish and resolve structures.

    Then I share with them this:
    It is the size, shape, position/location, gradients of density, presence or absence of granules and much more that does not depend upon color that are the real enablers for recognizing and distinguishing between cells, tissues, structures, organs, parts of organs.  The American Flag as seen by different degrees of color blindness (really color deficiency) demonstrates how size, shape and location provide sufficient information to recognize the flag.  I provide the image of the Flag that illustrates 5 variants of color deficiency.  You can access it at a wikispaces science page where you will see the image of the flag in the history of color: 

    https://thescienceclassroom.wikispaces.com/Colors

    I then share with my students the atlas of histology by Reith and Ross that was entirely black and white. The First Edition of an "Atlas of Descriptive Histology" authored by Edward J. Reith and Micael H. Ross and published in the early 1970s, dealt with the possibility of students learning histology who had color deficiency. This text appeared in the preface of the atlas:

    "The interpretation of a histologic slide primarily involves the recognition of forms, general organization, and location of parts.  Identification by specific color reaction is less important.  This point is emphasized by the use of black and white in the Atlas.  The histologist can recognize cross striations regardless of whether they are stained red with eosin, dark blue with iron hematoxylin, or unstained and examined with phase contrast optics; he can recognize nuclei regardless of whether they are stained dark blue by hematoxylin of an H & E stained or red by Acid Fuchsin of a trichrome.  He does this by considering their form, arrangement and location.  The histology student should attempt to develop this skill, for he will quickly learn that a particular organ or tissue stained at different times, by different people may not have quite the same color characteristics.  This is not to say that the histologist does not make use of staining reactions; he does.  However, he depends more on differences rather than specific color reaction.  It should be noted that whereas the black and white reproductions do show the differences in staining reaction, they emphasize the more important criteria, namely, shape, location, and organization."

    I then invite my students to take a look at this 4 page PDF of several pages out of the 3rd edition of this atlas.  Look especially at the fourth page which is a page showing a specimen of hyaline cartilage at different magnifications.  I attached a PDF of the pages of the 3rd edition of the "Atlas of Descriptive Histology" by Edward J. Reith and Michael H. Ross.

    I also share with my students a peer-reviewed paper was published in the Journal of Anatomical Sciences Education, 2009 titled "Using Color and Grayscale Images to Teach Histology to Color-deficient Medical Students.  Take special note of the text that appears in the second paragraph, part of which is highlighted for emphasis.  Also, observe how you can still determine form, shape and densities in the gray scale specimens compared the same specimen stained with hematoxylin and eosin. (PDF of the article with highlighting is attached).

    I had an email exchange with a student recently who has a color deficiency and is concerned about performance in the course.  The email exchange is attached in PDF.

    Lastly, I share this with the students if they wish to learn more:

    If you would like to know more, follow these two links from the American Optometric Association:
    http://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/color-deficiency?sso=y
    and, a site called the Archimedes Laboratory Project that has much about color deficiency, including several tests:
    http://www.archimedes-lab.org/colorblindnesstest.html#visione

    I hope all of this is helpful and contributes to the discussion thread.

    Bob

    ------------------------------
    Robert W. Ogilvie, PhD
    Visiting Professor, University of South Carolina
    Professor Emeritus, Medical University of South Carolina
    Columbia & Charleston, South Carolina
    Cell Phone: (843) 693-1065
    Email: rogilvie31@yahoo.com



  • 5.  RE: Accommodated examinations for color blind students

    Posted 09-01-2016 11:41

    Stephanie:

    There actually are relatively few situations where tinctural information is needed in order to identify structures in histological specimens.  When I was a graduate student (many, many years ago) on of the best atlases then available was the Reith & Ross atlas, which (at that time) consisted entirely black-and-white images.  When you have a color-blind student, I think that you need to be aware that what he sees is different from what the rest of the class sees, and you (or your staff) should work closely with him to identify problematic specimens ... last time I had a student who identified himself as color-blind, one of our H&E kidney slides just did not work for him (the other H&E kidney slides were fine). However, you probably will spend more time accommodating the Dean of Students (or whoever is your ADA-officer) than accommodating the student with the color-blindness disability. 

    For image exams (or image-containing questions on other tests), if I was uncertain of whether a question would work for a color-blind student, I would have someone who wasn't familiar with the color images look at desaturated (B&W) versions of the images to make certain that color information wasn't essential for answering the question before using the (color) version of the question on the exam (I also would solicit feedback from the disabled student after the exam).

    On an H&E specimen, basophila is blue/purple and should not present a problem (so you don't need accommodate by labeling the specimen) unless the student is much more profoundly color-blind than the typical red-green color-blindness.

    Hope that this is helpful.

            - - Jim

    ------------------------------
    James Rhodes
    Associate Professor
    Pacific Northwest University of Health Sciences
    Yakima WA
    509-249-7738



  • 6.  RE: Accommodated examinations for color blind students

    Posted 09-12-2016 13:32

    Thank you all for sharing your thoughts.  It seems like you have all worked with color deficient students to develop compensatory strategies and as a result, examinations have not been an issue.

    Bob - I will try to change my vocabulary to color "deficient".  Thank you for sharing your conversations with a student.  I too resorted to showing students a black and white printed histology text (Ham and Cormack) that I still use from time to time!  I found Reith and Ross' excerpt to be a nice summary of how to explain to students how to read a slide without relying on color.  Thanks for sharing that too.

    I like Donald's rule that all students are able to ask questions during exams to non-faculty proctors regarding annotations and color.  I have started using only black annotations with a white glow so that every student should be able to see the contrast.   We have not made any examination accommodations as of yet because we have no students with university-approved accommodations.  

    Michael - thank you for highlighting your data from the Selvig et al. (2015) publication.  You mentioned that the number of color-blind students was small, but the number of histology questions involved in the analysis impressed me!  Did you have a lot of image-based questions in your test?

    Jim - One of our students has a type of color deficiency that I am unfamiliar with.  He has difficulty seeing blues and purples.  Needless to say, nuclei are a challenge to see when studying H&E slides.  Since we only use virtual slides, I will ask the student to set his monitor to greyscale to see if helps.  He does use special glasses in the histology lab now but it's my understanding that this helps him to better see pink/red but it does not fix the blue/purple issue.

    Thank you all.  If we come up with any new strategies that may be of interest to you, I'll share them here.

    Stefanie

    ------------------------------
    Stefanie Attardi
    Assistant Professor
    Oakland University William Beaumont School of Medicine
    Rochester MI
    248 370 2830
    sattardi@oakland.edu



  • 7.  RE: Accommodated examinations for color blind students

    Posted 09-13-2016 09:31

    Thank you Stefanie,

    I was pleasantly surprised that all colleagues who responded to your question had a similar attitude/opinion to the potential problem of color deficient students participating in histology courses.

    To answer your question, all of our histology tests and examinations at the University of Michigan are online and about 90% contain an image (mostly light microscopy or EM micrographs with a few questions containing a diagram). A smaller number of LM images are actually linked to virtual slides. We have a separate set of virtual slides that are dedicated for testing purposes only. Text-based histology questions usually rank low on Bloom's Taxonomy and including an image makes it easier to elevate questions to a higher Bloom's level.

    All the best

    Michael

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



  • 8.  RE: Accommodated examinations for color blind students

    Posted 10-02-2016 20:32
      |   view attached

    Hi Stephanie et al.,

    Our office of Student Disability Services recently published an article that may be of interest. I attach the pdf here.

    Meeks, L.M., Jain, N.R., Herzer, K. R. (2016). Universal Design: Supporting Students with Color Vision Deficiency (CVD) in Medical Education. Journal of Postsecondary Education and Disability. (29) 3.

    Best,
    Kim

    ------------------------------
    Kimberly Topp
    Professor and Chair
    Univ of California San Francisco
    San Francisco CA
    415-476-9449

    Attachment(s)

    pdf
    CVD-UDI.pdf   281 KB 1 version