"Computer Based Learning: Integration into Pathology Teaching Programs for Medical and Dental Students."

John Wurzel, M.D.
Temple University Medical School
Department of Pathology and Laboratory Medicine
220 OMS
3400 North Broad Street
Philadelphia, PA 19140
Ph # : 215-707-3169
email: JWurzel@VM.Temple.edu
Platform: Macintosh
Presentation type: Demonstration
Focus: Program Implementation
Skill level: Beginning

Four years experience indicates that computer based learning is such a powerful tool for simulating pathology laboratories that it could partly or totally replace them in medical and dental student education. Using readily available technology, we have created a collection of almost 1800 high resolution images of various types (patient photographs, x-rays and other diagnostic imaging modalities, gross specimens, histologic sections, cytologic preparations, microbiology and clinical chemistry specimens and others). The images are linked to text and organized into lessons that correspond to all laboratories in required pathology courses for medical and dental students; there are also lessons based on pathology material that could not be presented in laboratory format, as well as in other disciplines. The computer based learning material is carefully integrated into the existing courses, used by almost all medical students, and extremely well received. Those attending the demonstration will have the opportunity to see the material and to discuss how to create similar materials and to successfully introduce them into courses.

Since 1990, members of the Department of Pathology and Laboratory Medicine of Temple University Medical School and collaborators have written 30 computer based learning (CBL) lessons based on the department's extensive collection of high resolution digital images. The department uses these lessons in two of the course it teaches: general and systemic pathology, a 200 hour course for second year medical students, and oral pathology, a 50 hour course for third year dental students. Students make extensive use of the CBL and value it highly. This discussion includes the following points: (1)the purposes of the teaching laboratories (and, therefore, of the corresponding CBL); (2)how CBL is created; (3)how the material fits into structure of the courses; (4)the advantages of CBL over traditional laboratory teaching using microscope slides and fixed specimens.

The laboratories use patient derived-material to illustrate the major educational points made in the lectures and textbook and to train the students to recognize the morphologic appearances of common disease processes and lesions. Each session centers on a specific theme (e.g., neoplasms of the lung) and uses histolopathology sections, gross specimens, and occasionally cytology samples. The CBL lessons have the same themes, but use high resolution digital images derived from photographic representations of the above mentioned specimens, as well as other materials (e.g., x-rays and forensic specimens), all in PICT format. The PICT images are linked to text as described below.

The technology for creating high resolution images is readily available. Images are scanned from projection slides (currently, using Kodak PhotoCD; originally, the Barneyscan ColorImaging System) and edited with Adobe Photoshop. The department has almost 1800 images, including gross specimens, histology and histopathology sections, cytology smears, special morphologic technique (ultrastructure, immunohistochemistry), patient photographs, x-rays and other radiology images, electrophoresis patterns, and microbiology specimens. Questions and answers pertaining to the images are created with standard word processing. A series of images and the corresponding questions and answers are compiled to create a lesson on a specific topic. The text and the images are integrated with a software package created by Dr. Steven Erde and his colleagues at Cornell University School of Medicine. Students use the same software to study the lessons. The hardware for student is a network located in the Temple University Health Sciences Center Library; the network consists of a file server and 16 workstations, each with a Mac II or Quadra and a 19" high resolution color monitor.

Implementation of the CBL so that it can be used by the students involves several factors: (1)The directors of the courses are intimately involved in the design of the material; the director of the medical pathology course supervises the project. (2)Most of the lessons closely parallel existing laboratories. In fact, many of the projections slides from which the images are scanned and some of the text are teaching materials used in the laboratories. Many of the CBL lessons for the medical students are designed to enable them to meet the educational objectives given for each of the laboratory sessions. Since examinations are, in part based on the laboratories, the close relationship between the laboratories and the CBL in their topics, objectives, and materials implies that study of the CBL helps the students to meet course requirements. (3)In the medical pathology course faculty-supervised sessions using the CBL replace 5 of 27 traditional laboratories. (4)Course surveys include questions about student use of and satisfaction with CBL.

Evidence from the course surveys indicate that student reaction to CBL has been favorable; in fact, in the case of the medical student course, much more favorable than originally anticipated. Data on medical student use of the CBL is as follows:

Course Year % Enrolled Students Answering Survey %Survey Respondents Using CBL %Survey Respondents Using CBL More Than 50 Hours

1991 90% 95% 23%
1992 96% 98% 25%
1993 91% 100% 19%

The medical students evaluate the quality and utility of CBL on a scale of 1 to 5, with 1 being the lowest (unacceptable) and five being the highest (excellent). Since the results are essentially the same each year, they are pooled, as follows: image quality, 4.51; tool for self-assessment, 4.19; for reinforcing concepts presented in textbook and lectures, 4.55; for teaching morphology, 4.55; ease of use, 4.82. Although not quite as enthusiastic as the medical students, the dental students also use the material. In two years in which the oral pathology CBL has been available, nearly 78% of the course survey respondents reported using it and 85% of the users found it to be helpful or very helpful.

In comparison to the traditional pathology laboratories using microscope slides and fixed organs, CBL has several advantages including: (1)permanent archiving of difficult to obtain or replace teaching specimens; (2)use of the same material for teaching different groups of students (in our case, medical and dental students and possibly residents); (3)creation of lessons in subjects for which there are no laboratories; (4)demonstration of material not often available in pathology laboratory format (e.g., forensic specimens); (5)display of many examples of same process or disease; (6) comparison of different types of images (e.g., gross specimen and x-ray) of the same process or diseaes; (7)use in both faculty-supervised and independent study; (8)ready direction of the student to the key points in the image; (9)access to the material for many hours (about 85 hours per week at Temple Health Sciences Center Library); (10)enthusiastic reception by students; (11) exchange of educational material with faculty at other institutions. Many of these advantages were not anticipated at the onset of the project.

In summary, existing technology allows for creation of lessons that integrate high resolution images with text. When appropriately integrated into course structure, CBL is well received and very extensively used by students. Integration requires that faculty design of the material so that it allows the students to meet educational objectives of the course. Computer based learning is such a powerful tool for simulating pathology teaching laboratories that it could partly or totally replace them in medical and dental student education.