Comparison of conventional- versus technology-aided histology teaching for medical students – A meta-analysis

INTRODUCTION

Teaching anatomy disciplines especially histology is challenging and needs more interest and time for teaching and learning. Understanding the cellular architect is mandatory to master histopathology.^[1] Conventional learning encompasses routine didactic lectures followed by facilitator-assisted learning of histological images using an optical microscope in the laboratory. Conventional learning at the laboratory requires active involvement and interaction among students. Increasing students entry, disproportioned teacher-student ratio, and limited financing for infrastructure paved the upbringing of technology adopted of microanatomy lectures.^[2] Self-evaluation of learned images before assessment which was strenuous with conventional histology learning can be addressed by adopting computer-assisted teaching, as the millennials are also tech-savvy. The asynchronous technology assisted tools comfort learners to learn at their own pace.^[3] Digitalization of learning resources makes the student a better life long learner. Reduction in histology teaching hours, limited attention span of students provoked medical educators to adopt tools where teaching and learning outcomes are effective. Availability of such research work kindled the author to compare the effectiveness of learning outcomes of technology-aided microanatomy teaching with age-old conventional teaching.

MATERIAL AND METHODS

This study protocol was conducted with the requirements of the reporting rules in the “Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines”^[4] [Supplementary File 1-Figure 1] and strictly complied with its specifications. Since this work is a systematic review, the heterogeneity was present within the acceptable range, meta-analysis was performed.

RESULTS

Study selection and characteristics

The initial search yielded 34 records, of which 12 articles underwent full-text evaluation, which identified five articles. A meta-analysis of five eligible comparative studies assessed the learning outcome by employing different teaching methods to teach histology for medical students. Meta-analysis involved 837 subjects who had technology-aided teaching methods and 1047 subjects who received traditional method of teaching (Control group) showed an overall significant effect in favor of control group (mean differences = 0.08, 95% CI 0.05–0.12, P < 0.001), as shown in Figure 1. A significant Q statistic (P < 0.001) indicated the presence of considerable heterogeneity (I² = 100%) which could be due to varied demography and more recent studies.

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Figure 1:

Forest plot of comparison: Traditional teaching versus traditional teaching blended with computer-assisted learning. SD: Standard deviation.

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DISCUSSION

Conventionally, in many medical colleges, the primary component of histology courses has involved the presentation of printed photo micrographic images of structures utilizing slides under microscopes. Students need a long time to learn the individual structures in a printed image because it takes longer to identify a single structure in a tissue when it is surrounded by numerous other structures, they are unfamiliar with. Introducing computer-assisted instruction is one solution to the problems. Students’ learning experiences can be improved using computer technology to integrate written material, images, and animations.^[3]

Overall, in the five studies included in this meta-analysis, we observed that traditional teaching blended with computer-assisted learning can improve the students’ histology learning outcome. In terms of laboratory examination scores, our study findings did not appear to support the effectiveness of the method that used computer-assisted learning alone. This finding is parallel to Schmidt et al., who demonstrated that intelligent virtual microscopy facilitates self-directed learning and that blended learning can fulfill the individual needs of undergraduate medical students and support peer interactions without affecting practical skills.^[9] The creation and use of an interactive virtual histology atlas for chiropractic students enhanced their performance in lab tests. The characteristics and utility of this atlas also met with the pupils’ satisfaction. A comparison of the histology test results between the four lessons before and four lessons after the usage of the atlas enabled the evaluation of the atlas’ utility. To rule out any discernible disparities in academic competency between the groups being examined, an analysis of admissions data was first conducted. This analysis included overall grade point average (GPA), science and non-science GPA, and a number of course units.^[3]

Novel software program that uses annotated whole slide images in teaching normal histology can increase the test score of the students. Yohannan et al. showed virtual microscopic images as part of a blended instructional approach with traditional microscopy can give good results in the knowledge-based tests.^[10] The authors of the above study took care of confounding factors in the form of cross-over study design and analysis of covariance in the data analysis and a large sample size. The limitation of this study includes a small number of virtual slides, short duration of study, and 2 time-collection of students’ feedback. Regardless of the mode of evaluations, online self-directed learning modules in a mixed approach showed a considerable improvement in students’ academic performance. When students’ performance was evaluated using the virtual slide approach, there was a significant positive connection. However, adopting such module alone did not have a positive effect on learning outcomes. The authors declared the limitation of the study as the data presented for this study were gathered across several years at just one institution.^[11] In contrast to the results of the present study, Cheng et al., showed that the test results for the flipped classroom participants were found to be significantly greater when compared to non-participants in the control group, suggesting that students may benefit from the flipped classroom format.^[1] Subsequent questionnaires also revealed that the majority of the flipped classroom participants did relatively sincere preparations before class and engaged fully in classroom learning activities. This study has a few limitations which must be acknowledged. The study’s first drawback is that it only included a limited sample of students, and the findings were extrapolated from a group of students who had only studied a short section of a comprehensive histology curriculum. In this study, each of the flipped classroom students were volunteers. It is also probable that the volunteers behaved more independently, preferred self-guided learning, and had higher levels of motivation which must have created potential biases.^[1] Digitized microscopy images presented in dynamic format which considerably improved the practical histology scores as compared to static ones in remote histology learning.^[12]

CONCLUSION

Medical students must grasp fundamental histology to master more complex topics like histopathology. The introduction of computer-assisted learning in traditional teaching can be a great tool for better learning outcomes of the students in this era. This meta-analysis of published research studies demonstrates that traditional teaching gives promising results as compared to computer-assisted learning blended with traditional teaching. As a result, the authors states that though the students belong to the digital century they need traditional teaching for their academic performance. Further studies called for exploring the effect of teaching methods on the test score of the students in learning all portions of histology curriculum with a special focus on random sampling, adequate number of samples and confounding factors.