Spotlight: Dr. Ritcha Saxena

The future colleagues you will meet and mentor are in medical school today. In a world filled with artificial intelligence and machine learning capabilities, it would be a disservice not to teach students digital pathology early on in their medical studies. Pathology technology advancements are moving fast. It may not be the norm now, but it’s the way of the future and we need to equip students so they are prepared to use these technologies as pathologists. So who is shaping the next generation of pathologists? One professor, Dr. Ritcha Saxena, is not only shaping the next generation of pathologists, but she’s doing it digitally.


Dr. Ritcha Saxena, MD is Professor in Pathology and Course Director at Medical University of the Americas, Nevis. Dr. Saxena has a broad background in Pathology, with specific training and expertise in Dermatopathology and Hematopathology. For her passion and dedication, she has received many teaching awards throughout her career. Most recently, she was awarded the Osmosis Raise the Line Faculty Award for excellence in teaching. The award recognizes educators who inspire students and colleagues, and help to “raise the line” by increasing the capacity of healthcare systems worldwide. Her scholarly activity primarily focuses on subjects centering on pathology education and digital pathology, including self-directed learning, integrated curriculum, molecular pathology, digital microscopy and virtual museum, and multi-omics. She frequently presents her work at international conferences such as College of American Pathologists, American Society of Clinical Pathology and American Association of Blood Banking.


What originally interested you about digital pathology?

Some years ago, when I was working as an educator at a different institute, our curriculum was undergoing a revamp. We were embracing new approaches, such as moving on from problem-based learning towards team-based learning. We had increasingly noted how using a microscope in teaching pathology was a cumbersome practice and posed several challenges. For instance, a single slide had to be explained multiple times by students individually which was a time-consuming process, not to mention required more faculty. In the setting of new active learning styles, I took note of digitization of pathology slides and saw that it was especially useful to use digital slides instead of the traditional glass slides in the pathology curriculum.


In this era where technology is undergoing rapid development, it is important for pathology educators to embrace and utilize it in the form of digital technology, and potentially implement it to advance our instructional strategies to consequently enhance student learning. It not only presents the opportunity to provide students with all the pertinent information electronically, but it is also cost-effective with its ease of access. With the abundant number of digital pathological atlases available online today, it has become easier than ever for the current students to access information directly at their fingertips and benefit from their use.


The advantages of using digital pathology in pathology education are numerous – the curriculum is easy to restructure using a digital library, the images are high-resolution (and do not require time-consuming processes like focusing on a microscope), the students have the power to explore the slides on their own, and zooming in and out to focus on particular areas of interest is a piece of cake, without losing picture quality. The list goes on. Furthermore, all students can get access to the same slide at the same time, and can follow the discussion together, which allows them to be more self-confident and independent, particularly in the setting of self-directed learning. Switching to digitization also meant that time spent operating microscopes is saved, and instead can be utilized for reviewing concepts with students.


How did you incorporate digital pathology into your curriculum?

Transitioning the curriculum from microscope-based to complete integration of digital pathology in the curriculum was a smooth but slow process. Initially, we began with incorporating digital pathology slides in only a few lectures, while also keeping the traditional lab microscopy sessions active. As the process became more familiar and the advantages got more apparent, we saw the benefit of a fully-digitized curriculum, and subsequently adopted the change completely.


We also introduced a new teaching activity at the time – team-based learning- in which we incorporated digitized pathology slides, a museum of virtual gross images, and radiology imaging, along with corresponding clinical case vignettes and questions to test the students’ understanding. Feedback showed that hi-tech amalgamation of radiology with virtual gross and microscopy slides made it far easier for students to correlate gross and microscopic specimens and the associated radiology. The correlation of radiological images with gross pathology, digital microscopic images along with clinical cases facilitated the students’ understanding of key histopathological aspects, for instance, identification of areas of diagnostic relevance and their application in clinical settings. Also, it created an opportunity for the students to interpret how a particular disease process might be viewed in a living patient. Solving complex clinical problems got a lot less complicated because utilizing digital pathology had the added benefit of enhancing retention capabilities.


What are the benefits to teaching using digital pathology?

Annotating traditional glass slides is not only a difficult job, but is also imprecise due to utilization of crude methods such as pen marking and indicating via pointers to highlight a particular section. In contrast, digital images can be accurately and distinctly labeled in multiple places, including indicating any specific structures of interest or areas of diagnostic relevance on the slide, which makes the understanding process much easier for the students and leads to better retention capabilities. Students can utilize these annotations to progress rapidly from one key point to next, and detailed information on a certain area can also be accessed using a legend. The use of the annotation feature offers the students the power to spot the essential aspects quickly, while at the same time being able to examine the slide in the usual fashion. This is one of the most important advantages of digital pathology.


Digital pathology also allows for labor and cost effectiveness. Traditional glass slide sets and microscopes require arduous and expensive maintenance, as opposed to virtual image libraries (many of which are open source), that can be easily stored on flash drives or online servers for simple retrieval. Digital pathology empowers the faculty to manipulate and tailor each slide to fit the needs of the curriculum, in order to choose the content that best promotes comprehension and application of concepts.

Incorporation of virtual slides into advanced learning settings such as clinical case scenarios also provides enormous opportunities to put together virtual instructional settings and simulate diagnostic procedures in pathology teaching.


Another benefit of digital pathology is the integration of gross and microscopic images into online block exams and self-assessment formative tests.


For faculty, it becomes much easier to prepare the course material. Adding virtual slides to pathophysiology cases and illustrating the association with radiological findings is made effortless with the use of digital pathology.


What are the limitations to teaching with digital pathology?

Feedback reveals that the utilization of a microscope and viewing glass slides in class is still important to some students, as they see the value in being capable of working using the conventional methods and cherish the feelings of gratification that comes with manually maneuvering a microscope. Understandably, this satisfaction cannot be achieved by the use of digital slides.


How do the students take to teaching using digital pathology? How do they take to not using the microscope?

Student feedback reveals that supplementing classroom learning with novel web-based tools utilizing digital pathology has improved their ability to learn pathology in several different ways, as it made the subject much more interactive and stimulating. Accessing the same microscopic images on their devices makes it much easier for them to follow the instructor, and leads to effective discussion of the content, along with constant group-thinking and sharing among the students, which is especially useful in strategies such as team-based learning. Aside from enhancing the learning process, utilization of digital slides in team-based learning advances the students’ leadership skills, critical thinking and the ability to form strong interdisciplinary teams.


Where did your passion for teaching pathology come from in a world where digital pathology isn’t the norm (yet)?

During undergraduate medical education, students sometimes find it hard to understand the role of pathologists in clinical settings. The process by which a pathologist comes to a diagnosis and makes crucial decisions that impact patient care is important for students to understand early-on in their training. Digital pathology is an exemplary means to provide the students insight into this process, including diagnostic analysis, which creates interest among students to pursue a career in the field of pathology.


A huge Thank You goes out to Dr. Saxena for her time in answering our questions. Would you like to share your experience with digital pathology, either in teaching or for research/clinical use? We want to hear from you! Just email Kristin at kmitchener@instapathbio.com and let’s talk!


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 www.instapathbio.com or contact us at info@instapathbio.com.