Virtual Microscopy Research Articles

Virtual Versus Light Microscopy Usage among Students: A Systematic Review and Meta-Analytic Evidence in Medical Education.

The usage of whole-slide images has recently been gaining a foothold in medical education, training, and diagnosis. The first objective of the current study was to compare academic performance on virtual microscopy (VM) and light microscopy (LM) for learning pathology, anatomy, and histology in medical and dental students during the COVID-19 period. The second objective was to gather insight into various applications and usage of such technology for medical education. Using the keywords "virtual microscopy" or "light microscopy" or "digital microscopy" and "medical" and "dental" students, databases (PubMed, Embase, Scopus, Cochrane, CINAHL, and Google Scholar) were searched. Hand searching and snowballing were also employed for article searching. After extracting the relevant data based on inclusion and execution criteria, the qualitative data were used for the systematic review and quantitative data were used for meta-analysis. The Newcastle Ottawa Scale (NOS) scale was used to assess the quality of the included studies. Additionally, we registered our systematic review protocol in the prospective register of systematic reviews (PROSPERO) with registration number CRD42020205583. A total of 39 studies met the criteria to be included in the systematic review. Overall, results indicated a preference for this technology and better academic scores. Qualitative analyses reported improved academic scores, ease of use, and enhanced collaboration amongst students as the top advantages, whereas technical issues were a disadvantage. The performance comparison of virtual versus light microscopy meta-analysis included 19 studies. Most (10/39) studies were from medical universities in the USA. VM was mainly used for teaching pathology courses (25/39) at medical schools (30/39). Dental schools (10/39) have also reported using VM for teaching microscopy. The COVID-19 pandemic was responsible for the transition to VM use in 17/39 studies. The pooled effect size of 19 studies significantly demonstrated higher exam performance (SMD: 1.36 [95% CI: 0.75, 1.96], p < 0.001) among the students who used VM for their learning. Students in the VM group demonstrated significantly higher exam performance than LM in pathology (SMD: 0.85 [95% CI: 0.26, 1.44], p < 0.01) and histopathology (SMD: 1.25 [95% CI: 0.71, 1.78], p < 0.001). For histology (SMD: 1.67 [95% CI: -0.05, 3.40], p = 0.06), the result was insignificant. The overall analysis of 15 studies assessing exam performance showed significantly higher performance for both medical (SMD: 1.42 [95% CI: 0.59, 2.25], p < 0.001) and dental students (SMD: 0.58 [95% CI: 0.58, 0.79], p < 0.001). The results of qualitative and quantitative analyses show that VM technology and digitization of glass slides enhance the teaching and learning of microscopic aspects of disease. Additionally, the COVID-19 global health crisis has produced many challenges to overcome from a macroscopic to microscopic scale, for which modern virtual technology is the solution. Therefore, medical educators worldwide should incorporate newer teaching technologies in the curriculum for the success of the coming generation of health-care professionals.

Development and validation of digital medical laboratory educational platform

With the increased use of whole slide scanner technology, large numbers of tissue slides are being scanned and archived digitally. While digital pathology has substantial implications in telepathology, second opinions and education, there are huge research opportunities in this new type of digital data. Accessibility to large digital repositories of tissue slides is a huge educational resource for medical students and pathology residents. In addition to education of medical students, residents and clinical adoption, digital pathology has been transformative for computational imaging research. Many universities also do not have active pathology laboratories which are necessary in providing a steady flow of real life cases for medical training and research. Therefore, this project aimed at designing and validating a digital medical laboratory educational platform where learners could access the virtual slides from their individual student portals irrespective of their location when they logged in. With the use of a digital slide scanner, physical slides from the manual laboratory repository were scanned and stored in the cloud in a digital format. The two platforms of both institutions were integrated such that the students’ online learning portal was in sync with the Pathology Network’s digital repository. Once the integration was successful, the students were able to access and interact with the learning materials and virtual slides for Cytology and Cytological Stains which was the scheduled topic for teaching and learning. The study recruited thirty five students from Meru University of Science and Technology pursuing undergraduate studies in Medical Microbiology. Majority of the students (33 out of 35; 94.3%) indicated that digital pathology enhanced their understanding of the topic of study due to availability of virtual slides with ease and at any time of day. All students (35 out of 35; 100%) felt that digital pathology teaching was beneficial for Medical Microbiology students and expressed hope in continued learning using digital pathology to supplement face-to-face lectures. The study proved concept that digital pathology education is viable in medical training, particularly, for pathology and medical laboratory. There is need for additional work to include more areas in the field of laboratory medicine and development of virtual learning content. Such local digital slide repository can promote use of digital pathology in Kenya and the region for teaching and learning. Digital pathology together with virtual microscopy can progressively improve medical education and training of pathology and laboratory medicine.

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

BackgroundThe 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.MethodsMedical 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.ResultsFour 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.ConclusionsOur 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.

Light and focused ion beam microscopy workflow for resin-embedded tissues.

Although the automated image acquisition with the focused ion beam scanning electron microscope (FIB-SEM) provides volume reconstructions, volume analysis of large samples remains challenging. Here, we present a workflow that combines a modified sample protocol of the classical transmission electron microscope with FIB-SEM volume imaging. The proposed workflow enables efficient 3D structural surveys of rabbit ovaries collected at consecutive developmental stages. The precise trimming of the region of interest adds the time dimension to the volume, constructing a virtual 4D electron microscopy. We found filopodia-like processes emitted by oocyte cysts allowing contact between oocytes not previously observed.

Digital cytology: Current status and future prospects.

In this paper, we reviewed the basic principle and the currentstatus of digital cytopathology. We reviewed the published papers on digitalcytology and analysed its future prospects. Virtualcytology using digital platform is being increasingly used to render diagnosisrather than conventional glass slide microscopy. Whole slide imaging (WSI)offers the prospect of true virtual microscopy and in the near future, may evenreplace glass slides in routine practice. It may be pivotal in diagnosing andtraining pathology graduates faster and more accurately. The digital cytopathology is a promising field and may have great impact indiagnosis, research and teaching.

Virtual Microscopy Goes Global: The Images Are Virtual and the Problems Are Real.

For the last two centuries, the scholarly education of histology and pathology has been based on technology, initially on the availability of low-cost, high-quality light microscopes, and more recently on the introduction of computers and e-learning approaches to biomedical education. Consequently, virtual microscopy (VM) is replacing glass slides and the traditional light microscope as the main instruments of instruction in histology and pathology laboratories. However, as with most educational changes, there are advantages and disadvantages associated with a new technology. The use of VM for the teaching of histology and pathology requires an extensive infrastructure and the availability of computing devices to all learners, both posing a considerable financial strain on schools and students. Furthermore, there may be valid reasons for practicing healthcare professionals to maintain competency in using light microscopes. In addition, some educators may be reluctant to embrace new technologies. These are some of the reasons why the introduction of VM as an integral part of histology and pathology instruction has been globally uneven. This paper compares the teaching of histology and pathology using traditional or VM in five different countries and their adjacent regions, representing developed, as well as developing areas of the globe. We identify general and local roadblocks to the introduction of this still-emerging didactic technology and outline solutions for overcoming these barriers.

From amaurotic idiocy to biochemically defined lipid storage diseases: the first identification of GM1-Gangliosidosis.

On February 23rd 1936, a boy-child ("Kn") died in an asylum near Munich after years of severe congenital disease, which had profoundly impaired his development leading to inability to walk, talk and see as well as to severe epilepsy. While a diagnosis of "Little's disease" was made during life, his postmortem brain investigation at Munich neuropathology ("Deutsche Forschungsanstalt für Psychiatrie") revealed the diagnosis of "amaurotic idiocy" (AI). AI, as exemplified by Tay-Sachs-Disease (TSD), back then was not yet understood as a specific inborn error of metabolism encompassing several disease entities. Many neuropathological studies were performed on AI, but the underlying processes could only be revealed by new scientific techniques such as biochemical analysis of nervous tissue, deciphering AI as nervous system lipid storage diseases, e.g. GM2-gangliosidosis. In 1963, Sandhoff & Jatzkewitz published an article on a "biochemically special form of AI" reporting striking differences when comparing their biochemical observations of hallmark features of TSD to tissue composition in a single case: the boy Kn. This was the first description of "GM1-Gangliosidosis", later understood as resulting from genetically determined deficiency in beta-galactosidase. Here we present illustrative materials from this historic patient, including selected diagnostic slides from the case "Kn" in virtual microscopy, original records and other illustrative material available. Finally, we present results from genetic analysis performed on archived tissue proving beta-galactosidase-gene mutation, verifying the 1963 interpretation as correct. This synopsis shall give a first-hand impression of this milestone finding in neuropathology. Original paper: On a biochemically special form of infantile amaurotic idiocy. Jatzkewitz H., Sandhoff K., Biochim. Biophys. Acta 1963; 70; 354-356. See supplement 1.

Efficiency and Capability Improvements within the Firearms Section using 3D Virtual Comparison Microscopy (VCM)

Efficiency and Capability Improvements within the Firearms Section using 3D Virtual Comparison Microscopy (VCM)

A historical look using virtual microscopy: the first case report of adrenomyeloneuropathy (AMN).

The history of adrenoleukodystrophy (ALD), adrenomyeloneuropathy (AMN) and other peroxisomal diseases is exemplary for the stunning progress of scientific medicine within the past 50 years. Like many breakthroughs in medicine, the detailed analysis of patients' pathologically affected tissues was instrumental, resulting in stepwise systematic clarification of what had remained enigmatic until the 1970s. This flashback paper is a recollection of the first neuropathological description of a slowly evolving clinical phenotype, spastic paraparesis with adrenal insufficiency, in a young adult by Budka et al. 1976 [3], using virtual microscopy of the original histologic slides. The clinico-pathological presentation derives from the classical cerebral ALD phenotype in boys, where electron microscopy demonstrated the underlying pathological hallmark of characteristic lipid inclusions shared by both phenotypes. Our report allowed the delineation of a new disease type almost simultaneously described in more cases as AMN by Griffin et al. 1977 [4] and Schaumburg et al. 1977 [11]. Moreover, our report indicated clinical heterogeneity in the ALD disease group that, as shown later, extends further to females, to Addison-only, and even to asymptomatic subjects. The gene underlying ALD was discovered in 1993 as a defect in the ABCD1 gene. Yet, it has hitherto remained unclear how the gene defect causes the strikingly broad and unpredictable phenotypic spectrum of ALD/AMN.

Mitotic count is prognostic in IDH mutant astrocytoma without homozygous deletion of CDKN2A/B. Results of consensus panel review of EORTC trial 26053 (CATNON) and EORTC trial 22033-26033.

Gliomas with IDH1/2 mutations without 1p19q codeletion have been identified as the distinct diagnostic entity of IDH mutant astrocytoma (IDHmut astrocytoma). Homozygous deletion of Cyclin-dependent kinase 4 inhibitor A/B (CDKN2A/B) has recently been incorporated in the grading of these tumors. The question of whether histologic parameters still contribute to prognostic information on top of the molecular classification, remains unanswered. Here we evaluated consensus histologic parameters for providing additional prognostic value in IDHmut astrocytomas. An international panel of seven neuropathologists scored 13 well-defined histologic features in virtual microscopy images of 192 IDHmut astrocytomas from EORTC trial 22033-26033 (low-grade gliomas) and 263 from EORTC 26053 (CATNON) (1p19q non-codeleted anaplastic glioma). For 192 gliomas the CDKN2A/B status was known. Consensus (agreement ≥ 4/7 panelists) histologic features were tested together with homozygous deletion (HD) of CDKN2A/B for independent prognostic power. Among consensus histologic parameters, the mitotic count (cut-off of 2 mitoses per 10 high power fields standardized to a field diameter of 0.55 mm and an area of 0.24 mm2) significantly influences PFS (P = .0098) and marginally the OS (P = .07). Mitotic count also significantly affects the PFS of tumors with HD CDKN2A/B, but not the OS, possibly due to limited follow-up data. The mitotic index (cut-off 2 per 10 40× HPF) is of prognostic significance in IDHmut astrocytomas without HD CDKN2A/B. Therefore, the mitotic index may direct the therapeutic approach for patients with IDHmut astrocytomas with native CDKN2A/B status.

COVID-19 Adaptations with Virtual Microscopy.

This chapter aims to discuss and compare the different approaches used to teach histology to dental students before and during the COVID-19 pandemic and reflect on the best practices to be retained. Prior to the COVID-19 pandemic, the University of Glasgow School of Dentistry converted its large and unique collections of microscopy slides into digital files to curate this unique asset and protect it for prosperity. Initially, a virtual microscopy (VM) educational platform was purchased to allow digital teaching of histology, oral biology, and oral pathology. Prior to COVID-19, dental undergraduate students received VM teaching via a blended learning approach with theoretical content preceding a practical discussion session using VM. Some teachers in later years of the dental course experimented with flipped class strategies. At the beginning of 2020, with the lockdown restrictions imposed, the teaching content all had to move to remote online learning with virtual sessions, recorded video classes, online content, videotelephony, and online chat, allowing the students to undertake the content asynchronously and remotely. To overcome the interactive limitations of online delivery, a Microsoft Team was created in some sessions and used to support active small group learning and teaching of general histology allowing students to share histological annotations with their peers and tutors. The experience of teaching histology using only virtual and online content has had a positive academic outcome for the students as all first year students had passed their exams. However, we also recognise several limitations, such as the restrictive interpersonal interaction using videotelephony and online chat as well as the ad hoc feedback. The processes used and the challenges and benefits of VM will be discussed in this chapter.

Histological evaluation of PAXgene tissue fixation in Barrett’s esophagus and esophageal adenocarcinoma diagnostics

The dysplasia grading of Barrett’s esophagus (BE), based on the histomorphological assessment of formalin-fixed, paraffin-embedded (FFPE) tissue, suffers from high interobserver variability leading to an unsatisfactory prediction of cancer risk. Thus, pre-analytic preservation of biological molecules, which could improve risk prediction in BE enabling molecular and genetic analysis, is needed. We aimed to evaluate such a molecular pre-analytic fixation tool, PAXgene-fixed paraffin-embedded (PFPE) biopsies, and their suitability for histomorphological BE diagnostics in comparison to FFPE. In a ring trial, 9 GI pathologists evaluated 116 digital BE slides of non-dysplastic BE (NDBE), low-grade dysplasia (LGD), high-grade dysplasia (HGD), and esophageal adenocarcinomas (EAC) using virtual microscopy. Overall quality, cytological and histomorphological parameters, dysplasia criteria, and diagnosis were analyzed. PFPE showed better preservation of nuclear details as chromatin and nucleoli, whereas overall quality and histomorphologic parameters as visibility of basal lamina, goblet cells, and presence of artifacts were scored as equal to FFPE. The interobserver reproducibility with regard to the diagnosis was best for NDBE and EAC (κF = 0.72–0.75) and poor for LGD and HGD (κF = 0.13–0.3) in both. In conclusion, our data suggest that PFPE allows equally confident histomorphological diagnosis of BE and EAC, introducing a novel tool for molecular analysis and parallel histomorphological evaluation.

The challenges of histology education

Generations of students have struggled to learn histology. They have found the subject extremely dry and the nomenclature very challenging. Insidiously, histology is fading from the minds of stakeholders. Unless this is rectified, it is not inconceivable that the subject will be further diluted in the medical curriculum. What contributing factors could there be? Via a survey and focus group discussions, international faculty (n= 111) were asked what the challenges in teaching histology were. Both qualitative and quantitative data were collected and stratified by the number of teaching years. A collaborative teaching session with a pathologist was also delivered to the YLLSoMM1 students (n= 280), who gave opinions about it. Of the international faculty, 85 (±1)% responded. Among those, 60 (±1)% felt that the pedagogy should be reformed (e.g., by gamification). Interestingly, 30 (±1)% opined that organ system histology should be moved into the clinical years. Notably, 70 (±1)% of teachers preferred to teach face to face (FTF) using either microscopes or virtual microscopy. Among the students, 71 (±1)% reported self-teaching from online resources. Significantly, 88 (±1)% of M1 students agreed that having the pathologist co-teach histology was beneficial. Some teachers, and most students, struggle with histology. There is a generational divide in opinions concerning how histology should be taught. The traditionalists wish to maintain the status quo while the reformists want changes. Learners want to be engaged with hybrid approaches aided by the pathologist. They also welcome more clinical context during histology lessons.

HistoGuide mobile application (virtual microscopy and slides): A quantitative usability pilot study

HistoGuide application is a smartphone application system used by sixth-form students for virtual microscopy and slides to solve the problems of incorrect drawing and labelling, inability to apply magnification and scale, and inability to observe details in microscopic practical works. However, as a newly developed application, many still do not understand the usability of the HistoGuide application. In building a good application, one important part is good usability. Usability testing, especially in the HistoGuide application, can show users' ease and efficiency in using the system. The authors try using the USE questionnaire with 33 respondents as a pilot study before a real one. The analysis resulted in an average value of the usefulness construct of 92.8%. Then, the construct ease of use with 92.4%, ease of learning with 92.4%, and satisfaction with 93.8%. These results indicate that the HistoGuide application is good. The results of measuring the usability of the HistoGuide application with the classification "High" to use, with a usability value of 92.8%. The results of usability measurement are expected to help develop and improve the HistoGuide application in the future to complement the conventional microscopic practicals works.

Object-Based Learning Rocks! Integrating Digital Solutions into Geology Practicum

Over several years, the authors have pursued technology solutions to the difficult arena of moving geology practicum work into the online space (e.g., Tetley and Daczko, 2014). Through a partnership of teaching academics with professional staff trained in digitisation and software development, the authors have now solved the problem of verisimilitude and utility and opened a raft of future opportunities including a smooth and seamless transition to online teaching when presented with recent pandemic lockdowns. “Teaching geology with digital tools advances students’ learning experience by providing access to high-quality outcrops, enhancing visualization of 3D geological structures and improving data integration.” (Senger et al., 2021) Our solution required innovation on several fronts. Firstly, 3D digitisation and gigapixel imaging processes and methods were tried, evaluated, abandoned and refined until an ideal solution was developed that could actually replace the physical rock hand samples. Secondly, software platform development and integration was required. We utilised a custom developed 3D platform (Pedestal 3D) and also developed a bespoke platform for virtual petrographic microscopy (ImageMatrix). Finally, as “the organisation, logistics and relevance of an OBL session is critical to its efficacy” (Chatterjee and Hannan, 2016), all of this needed significant pedagogical underpinning and integration to ensure learning and outcomes were not impacted by the technology shift. We found that generally, digital resources allow for and encourage much more practice of the professional skills required for identification of minerals. “Most professional geoscientists spend much of their day in front of work-stations, interpreting or modelling digital data, in two or three dimensions.” (Bond and Wightman, 2012) so this mode of delivery is a naturally suited authentic task. On top of that, digital pre-lab work prepares students for being confronted with actual samples. Being able to digitally annotate the samples allowed for a virtual “guide on the side” pedagogy to allow for clarity of tasks and identification of specific object traits that are difficult in the traditional practical setting. The three main areas of impact were in Workshops, Field Trips and general Practicum. The specific mineral identification workshops were extended in a blended sense pre-COVID-19 and then seamlessly moved to online when required during the pandemic without any further development. Geological fieldwork traditionally has several core functions. “These include the determination of the geographical location of observation points, the description of outcrops, the macroscopic description of rocks, the detection of lithological boundaries, the spatial fixation of planar and linear objects (folds, joints, faults, linear position of minerals, etc.).” (Bubaniak et al., 2020) To respond to this digitally, a landmark yearly field trip in the program was developed into a fully online virtual field trip. The general practicum across the course was enabled to be taught in an online only mode which had never been possible before. We found that grade distribution did not suffer during the COVID-19 period which demonstrates that this mode of Digital Object-Based Learning is as good as traditional approaches to teaching. Although not originally intended, coursework could now also be offered fully online which opens a range of possibilities moving forward.

On the way to the virtual microscope: synchrotron-radiation-based three-dimensional imaging in pathology

On the way to the virtual microscope: synchrotron-radiation-based three-dimensional imaging in pathology

An international collaborative approach to learning histology using a virtual microscope.

Histology is often taught in higher education settings using online virtual microscopes (VM). This study aimed to develop and evaluate the use of VM in teaching on a BSc degree at the University of Nottingham by surveying students and staff. A key development was the use of an e-workbook so that students were actively engaged in creating their own bespoke revision material. Subsequently, this approach was used in a second study evaluating the use of VM in teaching the histology and pathology of the gastrointestinal (GI) tract via group work with students from two BSc courses at the University of Nottingham; one based at Derby (RDHC) and the other in Malaysia (UNMC). Students worked together in groups to complete an e-workbook, develop a presentation, and decide how to collaborate and communicate. An evaluation of these activities revealed advantages in developing transferrable skills, and good engagement with both the histology topic and group work. Analysis of assessment of the module at UNMC showed that student performance improved in the histology-based module after the intervention (p< 0.01) and that this improvement was not evident in other modules taken by the cohort. Furthermore, when interrogating the questions from the examination paper that asked students to identify features from histological images, fewer questions were seen as 'difficult' (p< 0.001) and more were seen as 'average' (p< 0.01). This study demonstrates that the use of VM in histology combined with active learning in creating a revision resource enhances engagement and depth of learning. When further combined with collaborative active group work, students developed a range of histology knowledge and transferrable skills, with notable improvement in examination performance relative to other contemporaneous modules.

Biannual Administration of a Slide Exam to Residents to Prepare them for Board Examinations: A Pilot Effort

Abstract Introduction/Objective To enhance surgical pathology education and allow residents to self-assess their progress, a pilot effort was made to twice a year administer a slide exam simulating the microscopic component of the American Board of Pathology anatomic pathology examination to a cohort of residents. Methods/Case Report The subjects were pathology residents in a mid-size academic program typically consisting of 12 residents. The quizzes were held twice a year from fall 2019 to fall 2021. In the fall of 2019, the exam consisted of 20 glass slides with accompanying history for which the residents were required to provide a free text diagnosis. After the onset of the coronavirus pandemic, the exam was transitioned to virtual microscopy using whole slide imaging similar to the board exam. The answers of the trainees were graded in comparison to the clinical diagnoses. The residents’ opinions of the exercise were anonymously assessed via a survey. Results (if a Case Study enter NA) Overall, resident performance roughly correlated with post-graduate year with a gradual improvement in performance every year. All residents agreed (with 84.1% of them “strongly” agreeing) that this exercise benefited their education. After two years of seasonal examination, there was an increasing trend showing more residents, including junior ones, becoming more confident in their preparation for the anatomic pathology board exam. Conclusion Though the sample size in this study is small, it demonstrates that regular administration of a slide exam to residents can be used to help residents assess their progress and help them feel more confident in their preparation and training for board exams.

Teaching Histology Using Self-Directed Learning Modules (SDLMs) in a Blended Approach.

New technologies like virtual microscopy have revolutionized histology education. However, first-year students often require additional assistance with virtual slides. Online self-directed learning modules (SDLMs) were developed to provide such support to learners by offering them short instructional videos that are uploaded to YouTube and the instructional website. The purpose of this study was to determine the effectiveness of SDLMs and to sample students' opinions about SDLMs. Over a 3-year time span, SDLMs were used to augment histology lessons, and their effectiveness (on learning outcomes) was measured by using traditional steeple-chase and/or virtual slide assessments. Average percentage scores for both methods of assessment were compared using paired or independent t-tests. Student opinions about SDLMs were collected using an anonymous survey. The survey results were analyzed by average scores and thematic analysis of the narrative responses. Using SDLMs in a blended approach showed significant improvement in students' academic performance - irrespective of the method of assessment. There was a strong positive correlation with the performance when students wereassessed using the virtual slide method. However, a standalone approach using SDLMs did not positively impact learning outcomes. Survey results indicated that most students perceived the videos as helpful for understanding the subject better and as quick review opportunities. The results support the use of SDLMs in a blended instructional approach and as an adjunct resource to conventional microscopy. This use of SDLMs was positively received by learners and significantly improved the learning outcome. The online version contains supplementary material available at 10.1007/s40670-022-01669-9.

Using HistoGuide Mobile Application (Virtual Microscopy): A Qualitative Pilot Study on Usability and Sixth Form Students’ Learning Experience

HistoGuide application is a smartphone application system used by sixth form students as virtual microscopy and slides to solve the problems of incorrect drawing and labelling, inability to apply magnification and scale, and inability to observe details in microscopic practical works. However, as a newly developed application, there are still many who do not understand the usability of the HistoGuide application. In building a good application, one important part is good usability. Usability testing, especially in the HistoGuide application, can show users' ease and efficiency in using the system. The authors try to use qualitative usability testing through observation, document analysis and interviews with four participants as a pilot study before a real study. The analysis revealed the preference of the students for utilizing virtual microscopy as an educational tool in terms of usability, in the construct of usefulness, ease of use, ease of learning, satisfaction, effectiveness and efficiency. These results indicate that the HistoGuide application is good. The results of usability measurement are expected to help the development and improvement of the HistoGuide application in the future, besides gauging the students’ learning experience. The study also revealed that students accepted virtual microscopic learning tool that was easy to use, available at a distance, encouraged collaboration and mastery, changed learning attitudes and emulated the same concepts of optical microscopy. Although there are some concerns and challenges, the overall learning experiences are highly positive towards complementing optical microscopy with virtual microscopy.