key: cord-0705983-fq1ffir4 authors: Saverino, Daniele; Zarcone, Daniela title: Keeping histology students under the microscope during Covid‐19 lockdown: Lessons learned from the University of Genoa date: 2021-11-10 journal: Anat Sci Educ DOI: 10.1002/ase.2153 sha: bfd5f38b13a4776afeff21d97da2df62f01b2766 doc_id: 705983 cord_uid: fq1ffir4 We have read, with great interest, articles published recently in Anatomical Sciences Education that describe histology education during the Covid‐19 pandemic (Evans et al., 2020; Caruso, 2021; Cheng et al., 2021a, b; Somera et al., 2021). As histology educators at the University of Genoa, we would like to add our perspective to these conversations. This article is protected by copyright. All rights reserved To the Editor, Anatomical Sciences Education: We have read, with great interest, articles published recently in Anatomical Sciences Education that describe histology education during the Covid-19 pandemic (Evans et al., 2020; Caruso, 2021; Cheng et al., 2021a, b; Somera et al., 2021) . As histology educators at the University of Genoa, we would like to add our perspective to these conversations. At the University of Genoa, the undergraduate human anatomy course is divided into three sections: musculoskeletal anatomy, systematic anatomy (including topographic and microscopic anatomy), and neuroanatomy. The first two sections are taught in the first year and neuroanatomy is taught in the second-year curriculum. In Italian universities, a histologist describes the structure and function of cells and tissues, and anatomists provide a hands-on look at organs through the use of traditional light microscopes. This strategy is believed to be effective as student learning is based on the structure of organs presented under the microscope. In this way "analytical observation" skills are built as students examine tissue preparations under a microscope and relate these observations to didactic knowledge that provides key characteristics and functions of the organ. For this reason, the microscopic anatomy course has a practical laboratory component that tests student visual recognition of specific cells, tissues, and organs. Prior to the Covid-19 pandemic, each student had access to sets of glass slides, binocular light microscopes, and faculty members who were on hand to address student questions. These laboratory sessions accounted for 32 hours of first-year medical curriculum. Unfortunately, the last two academic years courses could not be held face-to-face due to the pandemic (Government of Italy, 2020). Digitization has been embraced in the patient care arena as an avenue for reaching patients at a distance, but its development in the field of medical education has been lacking (de Carvalho Filho et al., 2021) . Fortunately, in recent years medical schools have increasingly combined traditional teaching methods with computerized learning particularly in anatomical sciences (Cheng et al., 2020; Cuschieri et al., 2020; Lee et al., 2020) . The Covid-19 pandemic accelerated digitization through the necessary development of engaging online teaching formats (Pather et al., 2020; Smith and Pawlina, 2021) . However, online lessons present specific challenges for histology courses that previously emphasized hands-on microscopy experience. This article is protected by copyright. All rights reserved Anatomists have embraced innovative, engaging, creative and multimodal means to stimulate proactive learning. The aim is not only to involve students (Longhurst et al., 2020; Donkin and Rasmussen, 2021) but to also align learning with goals of the profession (Durrani et al., 2021; Saverino, 2021) . Based on reports from the literature, distance-learning instructors are employing several strategies as they prepare for the virtual sessions. Especially in histology, many prepare Chase, MD), (Mione et al., 2013; Cheng et al., 2017; Alvarez, 2021) . Virtual laboratory simulations reach a large number of students simultaneously, enable laboratory experiences to be run with a limited number of teachers, eliminate biosafety concerns, and engage digital-age students more effectively (Alvarez, 2021; Pyatt and Sims, 2012; Darici et al., 2021; Somera et al., 2021) . However, these simulation platforms are unfortunately prohibitively expensive for some institutions. Thus, at the University of Genova we took a different path. We aimed to recreate the microscopy experience as much as possible with our online microscopic anatomy sessions. Our faculty in the laboratory used a microscope equipped with a camera. The images captured by the camera were Germany) provided acquisition, analysis and processing of high-quality digital images. This technology offered a high level of interactive functionality and collaborative potential (Hang et al., 2015) . Through this setup, students observed the histology slides as if they were using a microscope in person: "The teacher's eye has become the eye of all connected students". For each glass slide, an overview of the tissue and organ was provided first at low magnification, and then further details were This article is protected by copyright. All rights reserved presented at higher magnification. In addition, recordings of these sessions were available on Microsoft Teams to all the students. During Covid-19 pandemic this method was used to teach approximately 250 medical students per year. At the beginning of live transmissions, we experienced poor internet connections and slow communication between computer and microscope which created some difficulties. We resolved the internet connection speed by asking the students to turn off cameras and microphones during the lessons and by pausing at the end of each slide for any student questions or clarifications. Similarly, connection problems during the examinations were resolved by asking students to keep the cameras and microphones off when they were not personally taking the oral examination. (1) Virtual microscopy and annotations, (2) Availability of recorded lessons, etc." Most students (85%) appreciated the new methodology used in laboratory exercises. Interestingly, they considered both the live transmissions of images directly from the microscope, which allows them to interact with the teacher, and the asynchronous recordings (97%) the most useful. The This article is protected by copyright. All rights reserved appreciation of the course was greater for in online cohort when compared to the face-to-face cohort (84% vs. 81% respectively). However, many students described challenges resulting from the lack of interpersonal interactions. Prior work has highlighted that the socializing of in person learning and studying with other students is important and cannot be replaced by online lessons (Barry, 2016) . For both course formats, the final oral examination tested recognition of anatomical structures under the microscope and was administered online during the pandemic. The examining professors were the same for both course formats. The examination was divided into two parts. During the oral microscope portion, students identified structures seen under the microscope, and in the virtual format students directed the faculty to appropriate fields of view that allowed them to describe the relevant structures. Students who identified one of two structures correctly passed this part and then moved on to the second portion. Here, students were tested orally on their knowledge of topographical and systematic anatomy. Both examinations were oral, and the final grade took both portions into account. In the last two academic years, aapproximately 95% (470 out 495 students) of students in the online format successfully passed the examination on their first attempt. Importantly, a similar first pass percentage was obtained in prior years (before Covid-19 pandemic) when laboratory exercises were held face-to-face and each student personally used a microscope (92% of students scored positively in the first attempt, 449 out 488, P < 0.001 one-tailed t-test, unpaired with equal variance). These results indicate that online teaching formats are not only effective in histology/microscopic anatomy but can also provide benefits to student performance (Amer et al., 2021) . The Covid-19 pandemic forced teachers quickly reconfigure courses for the virtual setting, and the prolongation of the pandemic has allowed for the improvement and optimization of virtual courses (Evans et al., 2020) . The intent of this letter is not to suggest that all anatomy/histology courses for medical students should be delivered exclusively virtual, but rather to describe a fast, low-cost, inhouse method for converting to virtual teaching in microscopic anatomy courses that previously emphasized traditional hands-on student light microscopy experience. We hope that the digital innovation and didactic virtual delivery skills that have been gained through this pandemic can thus be employed in the future to achieve optimal integration between face-to-face and virtual activity under the microscope. Successful use of virtual microscopy in the assessment of practical histology during pandemic COVID-19: A descriptive study Anatomy education for the YouTube generation Virtual microscopy and other technologies for teaching histology during Covid-19 Histology and embryology education in China: The current situation and changes over the past 20 years Adaptions and perceptions on histology and embryology teaching practice in China during the Covid-19 pandemic Gross anatomy education in China during the Covid-19 pandemic: A national survey The "flipped classroom" approach: Stimulating positive learning attitudes and improving mastery of histology among medical students Accepted Article This article is protected by copyright. All rights reserved Spotlight on the shift to remote anatomical teaching during Covid-19 pandemic: Perspectives and experiences from the University of Malta Implementation of a fully digital histology course in the anatomical teaching curriculum during COVID-19 pandemic Anatomy 3.0: Rediscovering theatrum anatomicum in the wake of Covid-19 Student perception and the effectiveness of Kahoot!: A scoping review in histology, anatomy, and medical education Evaluation of innovative digital microscopy and interactive team-based learning approaches in histology teaching Going virtual to support anatomy education: A STOPGAP in the midst of the Covid-19 pandemic Recante Misure Urgenti in Materia di Contenimento e Gestione Dell'emergenza Epidemiologica da COVID-19 Integrating a web-based whole-slide imaging system and online questionnaires in a national cytopathology peer comparison educational program in Taiwan Accepted Article This article is protected by copyright. All rights reserved A web-based virtual microscopy platform for improving academic performance in histology and pathology laboratory courses: A pilot study Strength, weakness, opportunity, threat (SWOT) analysis of the adaptations to anatomical education in the United Kingdom and Republic of Ireland in response to the Covid-19 pandemic Evaluation of virtual microscopy in medical histology teaching Forced disruption of anatomy education in Australia and New Zealand: An acute response to the Covid-19 pandemic Virtual and physical experimentation in inquiry-based science labs: Attitudes, performance and access Teaching anatomy at the time of COVID-19 A journey like no other: Anatomy Virtual microscopy as a learning tool in Brazilian medical education Accepted Article