Undergraduate Histology Education: Fostering an Engaging and Interactive Environment is the Key

Medical Science Educator © IAMSE 2012 Volume 22(4) 244

MEDICAL SCIENCE EDUCATOR The Journal of the International Association of Medical Science Educators Med Sci Educ 2012; 22(4): 244-249

ORIGINAL RESEARCH

Undergraduate Histology Education: Fostering an Engaging and Interactive Environment is the Key Jeffrey Smirle1, Adam D. Parent1, Maryssa Canuel2 & Craig A. Mandato1 1McGill University, Montreal, Quebec, Canada 2Clinical Research Institute of Montreal, Montreal, Quebec, Canada Abstract Introduction to dynamic histology, an undergraduate course in McGill University’s department of Anatomy and Cell Biology, introduces students to microscopic anatomy and cellular functions. Maintaining student interest throughout the semester has been a major challenge, leading to poor student outcomes and negative course evaluations. In 2008, several changes to the pedagogical methodologies of the laboratory component of the course were implemented. Short pre-lab lectures, lab quizzes, student-directed team based learning, virtual microscopy, and an online discussion board were introduced in an attempt to improve the lab portion of the course. Following the 2008 class, 246 students were given a survey to assess the benefits of each individual change. Students rated four of the five changes as having a positive effect on their course experience, with the online discussion board receiving the only mixed rating. Furthermore, student performance on the lab exam was analyzed for the two years prior and the three years following the teaching changes. The post changes cohort achieved exam scores that were nearly 15% higher than the pre-changes cohort. These results indicate that combining lab talks, quizzes, team-based learning, and virtual microscopy is an effective way for educators to teach histology in an undergraduate setting.

Introduction Introduction to Dynamic Histology is an undergraduate science course with a large enrollment taught in the department of Anatomy and Cell Biology at McGill University in Montreal, Canada. It is an introductory survey of cellular structure, morphology and functions in different mammalian tissues. The course is compulsory for students registered in the Anatomy and Cell Biology undergraduate program, while students outside department may take the course as an elective. The course is separated into two components: a lecture session, and a laboratory session. In previous years, the laboratory session was taught by separating students into groups of six, and having an undergraduate teaching assistant present the material. Students received no microscope instruction, and the sessions often ended early. In 2007, a new course director (Dr. Craig Mandato) was appointed. At that time, it was noted that student laboratory examination grades were low

and that student evaluations indicated considerable dissatisfaction with the laboratory component of the course. Consequently, we decided to review the literature to see which teaching methods had been most effective in improving histology laboratory education. One reference in particular provided the basis for the changes that were made, albeit they were modified to fit our specific teaching goals.1 All changes made to the course were done with the aim to improve the learning environment within the laboratory. With the exception of the change in course director, no changes were made to the teaching methods of the lecture component of the course. However, we predicted that the laboratory changes would enhance students' understanding of the lecture material as well. Furthermore, for future class sessions, innovations such as the digital slide box could be used to provide high-quality histological images in class lectures.

Corresponding author: Craig A. Mandato, McGill University,Montreal, Quebec, Canada, Tel: +1-514-398-1259, Email:[email protected]


The following five major changes in teaching the laboratory were implemented and the impact on both the laboratory grades and student perceptions were assessed:

1) At the beginning of each lab, the head teaching assistant (graduate student who had successfully completed a graduate level histology course) gave a thirty minute lecture.1 This was an overview of all of the material that the students were required to learn during that particular lab. These lab talks contained detailed pictures of the structures that the students were required to identify on their slides, information as to how these structures tied into what the students were learning in the lecture portion of the course, and occasionally, clinical correlates to pique the students interest and highlight the importance of histology in the medical field.

2) A small group-based, self-directed hybrid learning component was introduced.2-4 Students were split up into groups of six for the semester. Every two or three groups were overseen by an undergraduate teaching assistant (TA) who had previously achieved a high grade in the course. Indeed, these students were specifically selected based on their performance on the final lab exam. Thus, instead of actually lecturing to the students, as was done previously, the undergraduate TAs were only required to answer questions when their groups were having difficulty. This was a significant reduction in responsibility for the undergraduate TAs, while still providing them with some minor teaching experience. In this format, more responsibility was given to the graduate student TAs, as they had received a higher level of instruction in histology (see change 1 above). Each student in the group of six was required to lead the other members through two labs during the course of the semester. This involved operating the microscope, guiding their classmates through the lab material, and answering questions. Lab leaders would be graded by their undergraduate TAs based on preparedness, ability to get through the material in a timely fashion, and overall knowledge. If a lab leader could not answer a question or ran into problems with the microscope, they could then turn to their TA for assistance. This mark accounted for 5% of their total grade in the course.

3) At the end of each laboratory session, a five-question quiz was given to assess what the students had learned during the lab, as well as what they had remembered from previous labs. These quizzes were in the same format as the final lab exam: Each question was on the screen for one minute, and the students were required to either identify a structure on the screen, or identify the function of a given structure.5-7 The average of the quiz grades was assigned to represent 5% of the total student grade. 4) Access to an electronic slide box (Aperio™) was provided, which enabled students to view histological sections through remote access. The Aperio™ (Vista, California) digital slide box is an online resource where high-quality histological slides have been scanned onto a website. Students are able to zoom in and out on each unlabelled section, very similar to visualizing a slide under a light microscope. The students were given access to the digital slide box both in the lab, as well as at home to help prepare for the labs and final lab exam.1,8-12

5) An online discussion board was established as a venue where students could post questions, discuss lab materials, and discuss upcoming lab quizzes and exams. It was designed as an open forum allowing students to learn together.13

At the end of the 2008 course, prior to the lab exam, the students were surveyed on their perception of the changes and the extent to which they thought these changes contributed to the quality of the laboratory portion of the course. Lab exam grades were analyzed for the two years prior (2006, 2007), and the three years after (2008-2010) the changes were made. Methods Laboratory examination raw scores for the pre-changes cohort (n=593) and post-changes cohort (n=1067) were tested for significance with an unpaired, two-tailed student t-test. In addition to this, the means for each individual year were tested for significance with a Bonferroni multiple comparison test and sign test for corroboration. An intersectional analysis was conducted to determine the relationship between the trend of laboratory grades and lecture grades in the pre-


changes and post-changes cohorts. An unpaired, two-tailed student t-test was used to test for significance. We evaluated student perceptions of each of the changes in the course using a modified six-level Likert scale survey given to students near the end of the 2008 class (0=Not Helpful; 5=Extremely Helpful). Students were asked to evaluate the lab talks, the usefulness of being a lab leader, the quizzes, the electronic slide box, and the online discussion board. At the end of the survey, students were given the opportunity to make comments. The survey was pilot tested on former students (n=25). Results Following a review of the Likert scale survey of student perceptions, the mean and standard deviation of each of the individual components was tabulated. Lab talks received a mean score of 4.66 with a standard deviation of 0.59. The usefulness of being a lab leader received a mean score of 4.09 with a standard deviation of 0.96. The lab quizzes received a mean score of 4.45 with a standard deviation of 0.91. The electronic slide box (Aperio™) received a mean score of 4.24 with a standard deviation of 0.99. The online discussion board received a mean score of 2.57 with a standard deviation of 1.52. Lab exam grades from the past five years were collected and analyzed. These data included grades from two years from the pre-changes cohort (2006 and 2007- Table 1) as well as three years from the post-changes cohort (2008, 2009, and 2010- Table 2). When comparing the two groups of scores (Group 1 from 2006-2007 collectively, and Group 2 from 2008-2010), the mean lab grade before and after the changes was 63.3% and 77.8%, respectively (Figure 1). The unpaired, two-tailed student t-test yielded a p-value <0.001. The content and difficulty of the exams for the pre and post-change cohorts were the same. When a similar analysis was performed for the lecture exam grades for the pre- and post-change cohorts, again a significant improvement was seen (p<0.01); however, this increase was not as dramatic as what was seen for the lab exam scores (Figure 1). Bonferonni’s Multiple Comparison Test: Significant results (p<0.01) were found for eight of the ten yearly comparisons. Non-significant results were found between 2006/2007, as well as between 2008/2010. Significance between 2008/2009, and 2009/2010 was modest relative to other years. The

sign test was positive and corroborated the results of the Bonferonni test.

Course Year

Student Enrollment

Lab Exam Average

2006 279 65.4%

2007 324 61.5%

Table 1: Introduction to Dynamic Histology course data prior to laboratory teaching changes. Enrollment is based on the number of students who wrote the final lab exam. Lab exam average is the mean student mark on the 20 question lab exam expressed as a percentage.

Course Year

Student Enrollment

Lab Exam Average

2008 338 76.4%

2009 362 80.8%

2010 367 76.1%

Table 2: Introduction to Dynamic Histology course data following the changes to laboratory teaching techniques. Enrollment is based on the number of students who wrote the final lab exam. Lab exam average is the mean student mark on the 20 question lab exam expressed as a percentage. Discussion This study was developed in order to improve student perceptions and outcomes in the laboratory component of a histology course in the undergraduate sciences program at McGill University. After consultation of the literature and a review of previous student evaluations, we decided to implement five main changes: lab talks, a small group learning approach, individual lab quizzes, virtual microscopy, and an online discussion board. Short lectures at the beginning of a laboratory session have been used as a means to disseminate a baseline of knowledge to all students in the lab, and we believed that this could be specifically effective when paired with a self-directed learning component.1 The small group learning approach has been well-established in the medical education field as an effective teaching method both for student outcomes and perceptions, and quizzes have long been used as a method to enhance student retention.2-7 More recently, virtual microscopy has been implemented in several histology laboratories as a means of either replacing or enhancing the traditional light microscope.1,8-12 Finally, while little literature exists on the benefits of an online discussion board for student outcomes and perception, the previous student course evaluations indicated a potential need for one in this course.13


While there have been several studies done on each of the individual changes, very few have combined the different teaching methods and evaluated student performance and perceptions on the course as a whole. The Goldberg and Dintzis 2007 study was unique in its assessment of student outcomes after implementation of a combination of established teaching methods in a first-year medical school class. Our study both confirms the benefits of combining these teaching methods on student outcomes, and furthers the previous study by quantitatively assessing the student’s perceptions of

each individual change (through the student survey). Furthermore, our study shows that these methods can be effective in teaching a basic undergraduate science course with a very high enrollment (see Table 1 and Table 2 for enrollment in each year of the study). Lastly, this teaching structure incorporates both the use of virtual microscopy and the use of the basic light microscope, as students should still be required to learn the basic microscopy skills in a histology course (a drawback that was highlighted in the Goldberg and Dintzis 2007 study).

Figure 1: Intersectional analysis of lecture and lab grades. From the pre-changes and post-changes cohorts, we compared the written exam marks to their laboratory exam marks. We found a significant difference in both exam grades; however, the increase in written exam is modest when compared to the laboratory grades. Significance [*] was tested by an unpaired, two-tailed student t-test (p<0.01). The plotted mean and standard error values [bars] are shown. The results of this study indicate that combining several techniques, such as a small group learning approach, virtual microscopy, and repetitive assessment (using quizzes) is an effective way to not only improve student outcomes on exams, but also to pique student interests in the course material. In the comments section of the survey, large numbers of students indicated that they found the new teaching structure to be engaging and informative. We were not able to assess the specific impact on numerical outcomes of each individual change in this study; however, the student perception survey indicated that the lab talks, quizzes, virtual slide box, and independent learning components were the most well-received changes. According to the survey, the online discussion board was not as useful as the other changes; however, as educators, we found the online discussion board to be an effective way of communicating with the student base outside of class time. Furthermore, many

students indicated that they did not use the discussion board very often. This may have led to the mixed evaluation scores of the discussion board, and the students who did use the board on a regular basis likely found it quite useful. The intersectional analysis showed that not only did the students lab grades increase significantly, but the students lecture exam grades increased (albeit more modestly) as well. We hypothesize that this increase in the lecture exam grades is due to the students having a better grasp of the laboratory material, as the two components of the course are quite complimentary. Furthermore the content, teaching style, and difficulty of the lecture component did not change from the pre and post-change cohorts. However, further studies need to be done to address this.


Conclusions This study provides a basis for future analyses of student learning in undergraduate basic sciences courses that combine lecture and laboratory components. With the exception of the virtual slide box, these changes are all relatively easy to implement in a wide variety of courses. Future investigations could focus on specific student populations within the class (i.e.: year of study and student major). This would determine whether specific populations of students selectively benefit from the innovations and might help tailor specific changes to courses of various levels. There are many teaching methods that have been presented in the medical education literature, and combining these different methods in undergraduate and graduate courses will help improve student performance and aid in fostering an interactive and engaging atmosphere in the laboratory sessions. Acknowledgements We would like to thank Dr. James Brawer for his endless and enthusiastic advice and guidance. We would also like to thank Dr. Carlos Morales for his work in the development of the electronic slide box in collaboration with Aperio™. Dr. Meredith Young for her help with the statistical analyses. Finally, we would like to thank Dr. Hershey Warshawsky for his direction in implementing the teaching changes. Keywords Histology, Interactive environment Notes on Contributors JEFFREY SMIRLE is a senior graduate student in the Department of Anatomy and Cell Biology, McGill University, Montreal, Quebec, Canada. ADAM D. PARENT is a second year medical student in the Department of Medicine, McGill University, Montreal, Quebec, Canada. MARYSSA CANUEL is a post-doctoral fellow at the Laboratory of Biochemical Neuroendocrinology, Clinical Research Institute of Montreal, Montreal, Quebec, Canada. CRAIG A. MANDATO is a professor and the chair of the Department of Anatomy and Cell Biology, McGill University, Montreal, Quebec, Canada. Jeffrey Smirle and Adam D. Parent were both the driving force behind the study and should be considered as co-primary authors of this article.

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Undergraduate Histology Education: Fostering an Engaging and Interactive Environment is the Key