The microscope and accompanying boxes of glass slides have been standard tools for learning both histology and pathology. But there is a new standard emerging; with the advent of digital whole slide imaging (WSI) over the past several years, there is an opportunity to revolutionize the way teaching and learning are done for students of pathology. In this blog post we’ll talk about three advantages that digital pathology brings to learning and teaching: precision learning, accessibility and cost.
Precision Learning
It’s broken. It’s missing. It’s faded. Yes, we are talking about glass slides. The downfall to using glass slides for teaching are many, a few we just mentioned.1 In addition, there are limitations to the type of glass slides that can be shared. Histology slides that are hard to prepare (e.g., calcified and decalcified sections of bone and teeth), one of a kind exotic cases (ever had the chance to look at signet ring carcinoma?) and surgical pathology cases that do not lend themselves well to recuts (e.g., needle core or small skin biopsies) rarely get incorporated into glass slide teaching sets. Students also have limited, if any, access to consult slides that must be returned and specific cytology cases (e.g., irreplaceable Pap tests where only one glass slide exists).2 This may affect the future quality of pathology services as students are missing out on key learning opportunities and potential cases they may come across once they are practicing pathologists.
There is also the issue of how learning is facilitated using glass slides. Group learning must be done at a multiheaded microscope (which many times has fewer heads than people present). Conventional microscope glass slides cannot be easily annotated with any precision, and rely on crude techniques like pen-marking/“dotting” and utilizing eyepiece with pointer for highlighting a certain area in the field. Multiple annotations (arrows, circles, texts, etc.) can be placed exactly where needed in the digital images.3 It’s this precision that is possible with digital pathology that brings great advantages to learning.
Accessibility
Teachers also benefit from teaching with digital pathology as well. In addition to precise annotations, they can prepare lessons at home on a personal computer without requiring access to a microscope. In addition, there will no longer be any time-consuming, hands-on microscope work during lessons which could create more time for reviewing specimens with the students. Time used for setting up the educational sessions and actual teaching process are much less compared to traditional multi-headed microscopy, hence giving teachers more time to teach and students more time to learn.4
Another highly desirable trait of digital pathology is that learning is not confined to the classroom or when faculty is available on campus. Glass slides and certainly microscopes cannot be removed from the department, which means learning is restricted to when department faculty are available. Digital pathology is less limited. Images loaded to the cloud can be accessed anywhere. Learning can take place where and when convenient for the student and on many devices with an internet connection. What’s more, not only can teaching sets include an array of those hard to find cases, but the platform exists to actually learn from those pathology experts that evaluate those rare cases.
Cost
There’s always cost associated with everything. Storage and maintenance of microscopes and glass slides sets are cumbersome and require significant expenses. A multi-viewer teaching microscope can cost upwards of $15,000 and that’s for only five heads, including the instructor; a microscope for ten heads runs in the range of $35,000. What if you have thirty or forty students? If a departmental whole slide scanner is not feasible due to limited resources, which can run over $100,000, there are emerging companies that offer service models which allow you to scan a set of slides at a cost per slide. The slides are then uploaded to a cloud where teachers can annotate their heart out while educating an entire class instead of playing round-robin with a multiheaded microscope. Digital images can be easily stored in server memory or thumb drives which provides smooth retrieval. Storage of whole slide images becomes a matter of having enough server memory. As server space is becoming increasingly inexpensive, the cost and effort of storing and maintaining both the microscopes and glass slide sets will become comparatively more burdensome.5
When learning via digital pathology it’s important to recognize that things are going to look a little different under the microscope than digitally on a computer monitor. It’s important for future pathologists to be led by champions of digital pathology so they can become more confident in their own skills and ability to diagnose using the advanced technology of digital pathology. It may be helpful to compare images from a microscope with digital images so students can get an idea of the differences they may come across when looking at cases. It’s important for educators to remember that teaching students how to diagnose via digital pathology is an investment in the future of pathologists. It helps with diversification of skills and could lead to career advancement once digital pathology becomes more common in the clinical setting.
While glass slides and microscopes in the educational setting bring with it many challenges, digital pathology could be just the solution needed to transform those challenges into opportunities for positive change in the learning and teaching environment. As adoption of digital pathology continues to build, it will only be a matter of “when” teaching via digital images becomes the norm.
Built on the vision of better patient outcomes, Instapath was founded in 2017 by engineers and scientists to enable patients to immediately know their cancer diagnosis. Our team made it our mission to develop fast and easy digital pathology technology so diagnosis can be made in minutes instead of days. To learn more about Instapath and our technology, visit https://instapathbio.com or contact us at info@instapathbio.com.
References
1 Foster K. Medical education in the digital age: Digital whole slide imaging as an e-learning tool. J Pathol Inform. 2010;1:14. Published 2010 Aug 10.
2 Pantanowitz L, Szymas J, Yagi Y, Wilbur D. Whole slide imaging for educational purposes. J Pathol Inform. 2012;3:46.
3-5 Sagun, Leonisa & Arias, Randell. (2018). Digital Pathology: An Innovative Approach to Medical Education. 3. 7-11.