Digital learning programs - competition for the classical microscope?

The development of digital media has been impressive in recent years which is also among the reason for their increasing use in academic teaching. This is especially true for teaching Anatomy and Histology in the first two years in medical and dental curricula. Modern digital technologies allow for efficient, affordable and easily accessible distribution of histological images in high quality. Microscopy depends almost exclusively on such images. Since 20 years numerous digital teaching systems have been developed for this purpose. Respective developments have changed the ways students acquire knowledge and prepare for exams. Teaching staff should adapt lectures, seminars and labs accordingly. As a first step, a collection of high resolution digital microscopic slides was made available for students at the Friedrich-Schiller-University in Jena. The aim of the present study was to evaluate the importance of conventional light microscopy and related technologies in current and future medical and dental education aswell. A survey was done among 172 medical and dental students at the Friedrich-Schiller-University Jena. 51% of students use now frequently new digital media for learning histology in contrast to 5% in the year 2000 [1]. Digital media including Internet, CD- based learning combined with social networks successfully compete with classical light microscopy.

Introduction

Requests for the application of digital media for academic training purposes at universities are currently increasing, due to the increasing importance of those media in general. Since the middle of the 1990s the german Conference of University Rectors has been consistently pursuing this issue. The statement that “issues refering to the sustainable establishment of E-learning and the development of media literacy are essential for both students and lecturers.” [3] illustrates the importance of this issue. In the last few years the concept of academic knowledge transfer has been changing. Areas of study which are highly visually shaped such as microscopic anatomy and histopathology lessons are particularly enhanced by new digital media. Tutorial programs, available online or on disk, have become increasingly more important, as has been shown by a study at the University of Jena [8].

The role of cytological/ histological microscope training in medical education

Cytology is the study of cells and their structures whereas histology deals with the study of the microscopic anatomy of cells and tissues of plants and animals. Both cells and tissues are best visualised by microscopic techniques. These are comprise a „medium organisational level of the body and are particularly accessible to study by microscope“ [10]. Academic training transfers histological skills such as staining methods, preparation of tissue samples as well as their examination and diagnosis under a microscope. In combination with microscopic anatomy, histology imparts knowledge about the normal healthy microscopic structure of internal organs in order to recognize pathological changes and diseased tissues and understand their causes [10].

Educational concept at Jena University

The Institute of Anatomy offers lectures and courses in cytology, histology and microscopic anatomy at the University of Jena. In addition to microscope applications using the Institute’s considerable collection of cytological and histological preparations, importance is attached to staining techniques and correct handling of the light microscopes. However, due to changes of the regulations for the licensing of medical doctors (AÄpprO 2005) and corresponding changes to the University of Jena study guidelines, students no longer have the opportunity to create their histological preparations by themselves. This is mostly due to financial cutbacks, thus reducing the teaching resources for training and semester periods per week. Nevertheless, histology is taught within three semesters through lectures and a microscopic course diligently supported in a purpose-built room.

Uniquely in Germany, the University of Jena offers each student of medicine and dentistry their own microscopy units and a complete collection of cytological and histological preparations for their entire preclinical education. Leaving a deposit the students receive a key for their microscope workplace. Thus students receive the opportunity to practise with the microscope and are provided with preparations in addition to their regular cytological and histological practical courses.

The application of digital media for training was first realised by an e-learning program named "HistoInteraktiv". This e-learning programm was developed on the initiative of two former students from the University of Jena medical school [7]. The program represents training material for students developed by students themselves and has significantly enhanced practical histological training since its implementation, although it is not an official training resource. "HistoInteraktiv" is composed of a presentaion part and a tutorial part and comprises the histological lectures and courses up to the winter term 2011/12. These lectures and courses were not available online, but were shared by students via CD or USB stick. Nevertheless, by sharing the contents of lectures and courses this way, students gradually became aware of the e-learning program "HistoInteraktiv" (see figure 1 (Fig. 1)).

Figure 1

Ways of accessibility to the e-learning programm "HistoInteraktiv"

Starting with the winter term 2011/12, the schedule and contents of the histology course have been adapted and updated, which has also led to a new and official e-learning program taking the form of a virtual microscope. The new program comprises the preparations of the University of Jena Institute of Anatomy II and is accesable via any web-enabled device such as smartphones under http://www.anatomie2.uniklinikum-jena.de/Studium/Virtueller+Histokasten.html, using a login name and a password. Due to copyright issues, the access is restricted to a certain scope of persons. In order to comply with copyright issues, access codes for students were issued by the Institute.

The virtual "Jena Histokasten" may become available in the near future as a smartphone app.

Generally the above described initiative aims to continue restructuring the basic training concepts in microscopy and histology.

In this study we analyse how histological-microscopic education is delivered at specific German universities and to which extent new media is integrated. The study is based on a survey concerning the microscopic-histological training at the University of Jena.

Methods

Students' opinions were assessed by a voluntary questionnaire, either in paper form or digital. These questionnaires were dispersed among second- and third-year students at the end of a histology course. Furthermore the digital questionaires were distributed by the students council.

In addition to some statistical values at the beginning, the first part of the form comprises general questions about the use and approval of new media in training. Further questions related to the current teaching situation at the Institute of Anatomy II.

Two main foci of the survey were the presence study, meaning to be physically present in the lecture hall or trainings hall, and the e-learning program "HistoInteraktiv".

In all 172 students, 148 pre-clinics and 24 clinics, aged between 19 to 44 years (mean=22,2 years) completed this survey. Three students did not give their ages. Fifty percent of the participating students were male, 120 were female, two did not give their sex. Finally, 72% of those interviewed were medical students compared to 28% students of dentistry (see table 1 (Tab. 1) and 2 (Tab. 2)).

Table 1

Overview of the attendants at the student survey of the University of Jena

Table 2

Attendants distribution concerning of study year and unversity course

Hypotheses

Independent study is characterised by regular use of printed media, the microscope and of the e-learning-program "HistoInteraktiv". The internet, videos, movies and audio files are secondary.

Students of dentistry use the microscope more regularly and intensively than medical students do.

Results

Analysing the outcome of the survey interwieving students of medicine and dentistry at the University of Jena the following became evident: 31% use printed media such as books or journals for independent study, followed by 26% reverting to the internet, whereas the e-learning program is employed by 25%. Only about 5% of the students regularly use the microscope for independent study. Audio files, videos, movies as well as self-made drawings together represent a fraction of 13% (see figure 2 (Fig. 2)).

Figure 2

Regularly usage of media during the independent study

Looking in more detail at the use of the microscope for independent study, it turned out that 14% of the dentistry students do use it "regularly". Nineteen percent of them use the microscope either "frequently" or "never", whereas 48% use it "rarely" (see figure 3 (Fig. 3)).

Figure 3

Microscope using by students of dentistry

Nine percent of medical students, on the other hand, reach for the microscope in their independent study " regularly". The microscope is "frequently" used by 19% and "never" by 8%. A rate of 64% "rarely" make use of it (see figure 4 (Fig. 4)).

Figure 4

Microscope using by students of medicine

Analyses

The presented results partly support the above formulated hypotheses. Printed media and learning programs are widely used by students for independent study (in total by 56%). On the other hand, audio files, videos, movies and self-made drawings have only secondary importance for independent study (about 13%).

Surprising and interesting were the results concerning the use of microscopes and internet for independent study. Although microscopes are constantly available to students only 5% revert to them for independent study, whereas learning programs and internet are very popular for 51% of the interwieved students.

Compared to earlier studies a clear difference became evident, because e-learning programs were used in this studies only 5% [1] or 6% [6]. At that time “ only a small number of students knew about learning programs on disk or online. Furthermore, the use of these programs usually remained behind their contents (…).” [8].

Also for independent study new media such as the e-learning program "HistoInteraktiv" have gained increasingly more importance and have become an inherent part during intensive learning phases. That is reflected by 67 of 172 interviewed students who declared they revert frequently to this program, additionaly 65 students use it very often. That adds up to 78% of students working regularly with "HistoInteraktiv".

Only 38 Students declared using this program "sometimes", "rarely" or "never" (see figure 5 (Fig. 5)).

Figure 5

Usage of the e-learning program by the students of medicine and dentistry

Regarding the average time of program use our survey revealed that students work with the program normally for a longer time at a stretch, about 30 minutes (42%), some one hour (25%) and even longer (33%) (see figure 6 (Fig. 6)).

Figure 6

Usage period of the e-learning program by the students of medicine and dentistry

Analysing the use of the light microscope in more detail it turned out that medical students and dentistry students use it differently. Students of dentistry normally use it more regularly (14%) than medical students (9%). Most of the interviewees (48%) stated that they used light microscopes only rarely, mostly during the preparation of attestations and examinations. That reflects the above described minor significance of the light microscope compared to other learning media.

The more frequent use of the light microscope by students of dentistry might be based on the pecularities of their job profil, which requires from the beginning a precise coordination of hands and eyes as well as the literally enquiring eye [4]. Additionally, dentistry students have to complete a longer pre-clinical study of five semesters, which might leave them more time for more intensive work with the light microscope.

Discussion

During my work as a tutor in the histological course I have noticed a development in the learning process of students, which in my opinion could only have appeared on account of the new digital opportunities of the 21st century. Students are turning away from classical work with the light microscope, as shown the above presented survey. The students’ last remaining “hands-on” exercise, the work with the microscope, is increasingly replaced by digital-virtual zooming and cell phones, iPads, Netbooks and similar electronical devices.

I dare to ask, whether this method of involvement with histological preparations might still by termed "to microscope"?

The light microscop will apparently be replaced by the advantages of digital learning programs, to revert to independently in time and space [5]. This high level of flexibility and increasing individuality offers students the chance to fulfill and to organise themselve. Furthermore, the digital quality of the Jena preparation collection already outmatches the resolution quality of the light microscops due to continuous zooming and huge image files. However, does the digital competition also deliver the ability to adjust the lighting according to Köhler, to augment in a modulated way, and to consciously examine the preparation, as the microscope does? I am afraid these abilities will get lost as students are presented with everything ready. To microscope as a scientific tool and a diagnostic instrument is going to become outdated. The study of human medicine and dentistry is packed with subjects and working with a microscope takes a lot of time. However, to microscope correctly is one of the basics a student of medicine or dentistry should be able to perform. The correct use of the microscope is a prerequisite for the course of histopathology, what starts in the clinical education part of the student’s study. If these abilities are going to become clinically significant, one cannot adopt them only virtually, without any practical experience. That means if students don’t learn to use a light microscope properly in the pre-clinical part of their study, course time must be taken in their clinical phase. On the other hand, a study at Ulm University has demonstrated that interactive programs are useful to achieve the individual requirements of students. Learning programs represent a possibility to advance social interactions among learners, without neglecting practical skills [9].

Nevertheless, an essential aspect of medical practice is ignored by this new kind of learning – the interaction with a formerly living tissue. By exclusively using digital media there will be a loss of reality as well as the ability to recognise and detect the variability of it.

Conclusion

It has become evident that during the last decade the use of new media among students of medicine and dentistry has changed considerably at the University of Jena. Digital learning programs as well as the internet have achieved a high level of acceptence. In the same time a decrease in the use of the classical light microscope has been observed. The original intention to complement the light microscope with digital tissue slide boxes and e-learning programs should be discussed, because actually the microscope is under threat of complete obsoletion. The process of replacing the classical light microscope with other media for learning may be confirmed by additional studies in the future.

Note

Publication supported by: Fachschaftsrat Zahnmedizin FSU Jena Bachstraße 2 07743 Jena

Competing interests

The authors declare that they have no competing interests.